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Severe hypoxaemic respiratory failure — SCE Acute Medicine MCQ

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HardCritical care medicineSevere hypoxaemic respiratory failureSCE Acute Medicine

A 62-year-old woman admitted with pneumonia becomes progressively hypoxic despite oxygen. RR is 34/min, SpO2 88% on 15 L/min via non-rebreathe mask and BP is 92/58 mmHg. Chest radiograph shows bilateral infiltrates, and ABG shows pH 7.31, PaO2 7.6 kPa, PaCO2 4.2 kPa and lactate 3.1 mmol/L. What is the most appropriate next step in management?

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Correct answer: E — Escalate urgently to critical care for invasive ventilation assessment

This is severe hypoxaemic respiratory failure with bilateral infiltrates and shock physiology, consistent with evolving ARDS or severe pneumonia. NIV is often inappropriate as definitive management when oxygenation is failing on maximal oxygen and there is haemodynamic compromise. Urgent critical care involvement is needed for invasive ventilation and organ support planning.

Reference: Faculty of Intensive Care Medicine GPICS; NICE NG253