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COPD exacerbation with hypercapnic respiratory failure — SCE Acute Medicine MCQ

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HardRespiratory medicineCOPD exacerbation with hypercapnic respiratory failureSCE Acute Medicine

A man with an infective COPD exacerbation has received controlled oxygen, bronchodilators, antibiotics and one hour of well-tolerated NIV. He is now more confused, respiratory rate is 36/min and ABG has worsened from pH 7.24 to 7.16 with PaCO2 11.8 kPa. What is the most appropriate next step?

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Correct answer: A — Obtain critical-care assessment for invasive ventilation

Worsening acidosis, consciousness and respiratory distress despite an adequate NIV trial indicate NIV failure. Obtain immediate critical-care and anaesthetic assessment for invasive ventilation if consistent with the escalation plan. Persisting with ineffective NIV delays definitive support; oxygen remains titrated to 88–92% because excessive oxygen can worsen hypercapnia.

Reference: https://www.brit-thoracic.org.uk/clinical-resources/guidelines/niv/