The First Arterial Blood Gas for an Asthma Patient in the Emergency

The first arterial blood gas for an asthma patient in the emergency department reveals: pH 7.49; PₐCO₂ 30; PₐO₂ 82; SₐO₂ 95%; HCO₃⁻ 24 on a nasal cannula 3 L/min.The patient's peak expiratory flow rate was 165 L/min,respiratory rate was 16 breaths/min,and pulse 106 beats/min.After continuous aerosolized albuterol over the past hour,the patient's current ABG results are as follows: pH 7.34; PₐCO₂ 45; PₐO₂ 49; SₐO₂ 79%; HCO₃⁻ 25 on a high flow nasal cannula 15 L/min.The patient's peak expiratory flow rate is 95 L/min,respiratory rate 35 breaths/min,pulse 128 beats/min,and the patient is diaphoretic.The respiratory therapist should suggest which of the following at this time?

A) Change to a nonrebreather mask.
B) Begin continuous positive airway pressure.
C) Intubate and initiate mechanical ventilation.
D) Initiate noninvasive positive pressure ventilation.