A 63-year-old,5'11",185 lb male patient with a history of chronic obstructive pulmonary disease (COPD)is admitted to the hospital due to liver failure.Over the course of the 48 hours he has developed respiratory distress.The respiratory therapist performs a physical assessment and finds the following: heart rate 135 beats/min,respiratory rate 28 with accessory muscle use.Breath sounds are decreased bilaterally with coarse crackles in the right base.A chest X-ray from 24 hours ago shows bilateral lower lobe infiltrates.The patient has a nonproductive cough.The respiratory therapist draws an arterial blood gas that reveals: pH 7.31; partial pressure of carbon dioxide (PₐCO₂)57 mm Hg; partial pressure of oxygen (PₐO₂)58 mm Hg; arterial oxygen saturation (SₐO₂)87%; bicarbonate (HCO₃-)27 mEq/L while receiving oxygen via nasal cannula 3 L/min.The respiratory therapist should recommend which of the following for this patient?

Question

Quizplus · Accepted Answer

This patient is showing signs of ventilatory failure as evidenced by his acute-on-chronic respiratory acidosis with uncorrected hypoxemia.This patient should be tried on noninvasive positive pressure ventilation (NPPV)prior to intubation to try to avoid it if possible.Using a nonrebreather mask would not address the patient's ventilatory problem and may cause oxygen-induced hypoventilation.Continuing with current therapy would not address the problem of impending ventilatory failure.If intubated and mechanically ventilated with pressure-controlled continuous mandatory ventilation (PC-CMV),starting off at 40 cm H₂O is too high.When the peak inspiratory pressure (PIP)or plateau pressure (P_plateau)from volume ventilation are not available,an initial pressure of 10-15 cm H₂O should be set followed by volume measurements and pressure adjustments when appropriate.

A 63-Year-Old,5'11",185 Lb Male Patient with a History of Chronic