Question

A 60-year-old with obesity and OSA presents with COPD exacerbation and hypercapnia. After initial bronchodilators and steroids, pH 7.30, PaCO₂ 68, somnolent but arousable. Best next step?

Accepted Answer

Trial of noninvasive ventilation

Answer

Immediate intubation

Answer

High-flow nasal cannula only

Answer

Heliox only

Answer

No ventilatory support

Practice question

A 60-year-old with obesity and OSA presents with COPD exacerbation and hypercapnia. After initial bronchodilators and steroids, pH 7.30, PaCO₂ 68, somnolent but arousable. Best next step?