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Acute exacerbation of COPD with ventilatory failure — RACP Adult Medicine MCQ

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HardRespiratoryAcute exacerbation of COPD with ventilatory failureRACP Adult Medicine

A 71-year-old man with severe COPD presents with increasing dyspnoea and purulent sputum. After bronchodilators, controlled oxygen and antibiotics, ABG on 28% oxygen shows pH 7.27, PaCO2 74 mmHg and PaO2 66 mmHg. He is drowsy but rousable. What is the most appropriate management?

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Correct answer: E — Commence non-invasive ventilation with close monitoring

Acute hypercapnic respiratory failure with acidosis in COPD is an indication for non-invasive ventilation if there is no immediate need for intubation. High-flow uncontrolled oxygen can worsen hypercapnia. Bicarbonate, discharge and bronchoscopy do not treat the ventilatory failure.

Reference: COPD-X Australian and New Zealand Guidelines; TSANZ; eTG