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Chest wall disease with hypercapnic respiratory failure — SCE Respiratory MCQ

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HardVentilationChest wall disease with hypercapnic respiratory failureSCE Respiratory

A 70-year-old man with kyphoscoliosis presents with somnolence and worsening ankle oedema. ABG on 24% oxygen shows pH 7.29, PaCO2 9.8 kPa, PaO2 8.5 kPa and HCO3- 36 mmol/L. CXR shows no consolidation. What is the most appropriate ventilation strategy?

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Correct answer: BStart NIV with controlled oxygen and assess for long-term domiciliary ventilation

Kyphoscoliosis can cause acute-on-chronic hypercapnic respiratory failure, and acidaemia with high CO2 requires NIV with controlled oxygen. High-flow oxygen alone can worsen CO2 retention and fails to ventilate. CPAP, antibiotics alone and nocturnal oxygen do not address ventilatory pump failure.

Reference: BTS/ICS AHRF Guideline; BTS Oxygen Guideline