A 48-year-old man with COPD is admitted to ICU with type 2 respiratory failure. He has failed a trial of NIV on the ward. ABG on NIV (IPAP 20/EPAP 6, ...

Question

A 48-year-old man with COPD is admitted to ICU with type 2 respiratory failure. He has failed a trial of NIV on the ward. ABG on NIV (IPAP 20/EPAP 6, FiO2 0.28): pH 7.22, PaO2 7.8 kPa, PaCO2 10.2 kPa, HCO3 32 mmol/L, BE +5. He is drowsy (GCS 10) with a respiratory rate of 8/min. What is the most appropriate next step?

Accepted Answer

Intubate and commence invasive mechanical ventilation

Answer

Increase IPAP to 24 cmH2O and reassess in 1 hour

Answer

Switch to high-flow nasal oxygen at 60 L/min

Answer

Administer intravenous doxapram

Answer

Commence nasal high-flow with CPAP at 10 cmH2O

uk-fficm MCQ (SBA): Acute Hypercapnic Respiratory Failure