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Opioid-induced ventilatory impairment — SCE Geriatric Medicine MCQ

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HardAcute medical careOpioid-induced ventilatory impairmentSCE Geriatric Medicine

An 88-year-old woman is admitted after a fall and fractured pubic ramus. She has severe COPD and becomes acutely breathless after oxycodone dose escalation; RR is 8/min, oxygen saturation is 89% on air and pupils are small. ABG shows pH 7.25 and PaCO₂ 9.2 kPa. What is the most important next step?

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Correct answer: A — Treat opioid-induced ventilatory impairment with naloxone titration and urgent respiratory support

Bradypnoea, miosis and hypercapnic acidosis after opioid escalation indicate opioid-induced ventilatory impairment. Naloxone should be titrated to restore ventilation while maintaining analgesia, with urgent monitoring and respiratory support. Oxygen alone does not correct hypoventilation and can mask deterioration. The pearl is that opioid safety in frail COPD requires dose caution, bowel regimen and close sedation monitoring.

Reference: BNF; BTS oxygen guideline; NICE CG103