Question

A 68-year-old man with known COPD presents with a 3-day history of increasing dyspnoea and purulent sputum. He is drowsy, with respiratory rate 28 breaths/min, oxygen saturation 88% on 2 L/min oxygen and use of accessory muscles. Arterial blood gas on 2 L/min oxygen shows pH 7.29, PaCO2 8.5 kPa, PaO2 7.1 kPa. Which is the most appropriate next step in management?

Accepted Answer

Commence non-invasive ventilation in addition to optimal medical therapy

Answer

Increase oxygen to achieve saturation 100% and continue nebulised bronchodilators

Answer

Intubate and provide invasive ventilation immediately without a trial of non-invasive ventilation

Answer

Stop oxygen therapy to avoid further CO2 retention

Answer

Switch to high-dose intravenous corticosteroids alone

Practice question