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Acute hypercapnic COPD exacerbation — SCE Respiratory MCQ

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HardCOPDAcute hypercapnic COPD exacerbationSCE Respiratory

A 72-year-old woman with severe COPD is admitted with increasing sputum and confusion. On controlled oxygen 28%, SpO2 is 88%, respiratory rate 30/min and she is using accessory muscles. ABG after nebulisers and antibiotics shows pH 7.28, PaCO2 9.1 kPa, PaO2 7.6 kPa and HCO3− 34 mmol/L. She is alert enough to cooperate and has no facial trauma or vomiting. What is the most appropriate ventilation strategy?

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Correct answer: C — Bilevel NIV with target SpO2 88–92%

This is acute-on-chronic hypercapnic respiratory failure with respiratory acidosis, and bilevel NIV is indicated after initial medical therapy. High oxygen targets can worsen hypercapnia in COPD and are a common error. NIV should be delivered with controlled oxygen aiming for 88–92% unless blood gases show a different safe target.

Reference: BTS/ICS Guideline for acute hypercapnic respiratory failure; NICE NG115