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COPD exacerbation with hypercapnic respiratory failure — SCE Geriatric Medicine MCQ

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HardRespiratory medicineCOPD exacerbation with hypercapnic respiratory failureSCE Geriatric Medicine

An 87-year-old man with COPD and frailty is brought in with drowsiness after two days of increasing breathlessness. ABG on air shows pH 7.29, PaCO₂ 8.6 kPa, PaO₂ 6.9 kPa and bicarbonate 31 mmol/L; CXR shows hyperinflation without consolidation. He has a ReSPECT form supporting ward-based active treatment but not intubation. What is the most appropriate management?

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Correct answer: D — Controlled oxygen, bronchodilators, steroids, antibiotics if indicated and ward-based NIV if consistent with goals

The ABG shows acute-on-chronic hypercapnic respiratory failure from COPD exacerbation. Controlled oxygen and standard COPD treatment are required, and NIV is appropriate for persistent respiratory acidosis if it fits the agreed ceiling of treatment. High-flow oxygen can worsen CO₂ retention. Frailty and ReSPECT guide proportionality, but they do not preclude active ward-based treatment.

Reference: BTS oxygen guideline; NICE COPD guidance; ReSPECT