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COPD exacerbation with hypercapnic respiratory failure — SCE Respiratory MCQ

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ModerateCOPDCOPD exacerbation with hypercapnic respiratory failureSCE Respiratory

A 69-year-old woman with COPD is admitted with drowsiness and increasing sputum purulence. She is receiving controlled oxygen at 28%; ABG shows pH 7.28, PaCO2 9.1 kPa, PaO2 8.0 kPa, HCO3- 31 mmol/L. She has had nebulised bronchodilators, antibiotics and prednisolone. What is the most appropriate ventilation strategy?

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Correct answer: B — Start acute non-invasive ventilation

Acute hypercapnic respiratory failure with persistent acidosis after initial COPD treatment is an indication for NIV if there is no immediate contraindication. Increasing oxygen to high saturations risks worsening CO2 retention. Intubation may be needed if NIV fails, but an immediate pre-emptive intubation is not the best next step in a suitable patient.

Reference: BTS/ICS Guideline for Acute Hypercapnic Respiratory Failure; NICE NG115