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Severe hypoxaemic respiratory failure from COVID-19 — SCE Acute Medicine MCQ

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HardCritical care medicineSevere hypoxaemic respiratory failure from COVID-19SCE Acute Medicine

A 55-year-old man is admitted with severe COVID-19 pneumonitis and escalating oxygen requirement. He is on high-flow nasal oxygen at FiO2 0.8 with RR 36/min and increasing exhaustion. ABG shows pH 7.33, PaO2 7.4 kPa and PaCO2 5.2 kPa. He is for full escalation. What is the most appropriate next step in management?

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Correct answer: C — Call critical care urgently to assess for CPAP, intubation and organ support

Persistent severe hypoxaemia and exhaustion despite high-flow oxygen indicate impending respiratory failure. A patient for full escalation needs urgent critical care assessment for non-invasive support, intubation and organ support as appropriate. A normal PaCO2 in severe hypoxaemia can be falsely reassuring because fatigue may lead to rapid decompensation.

Reference: NICE COVID-19 Rapid Guideline; FICM GPICS