A 75-year-old man with a long history of COPD is brought to the emergency department with shortness of breath.He has a persistent,productive cough with green purulent sputum,cyanosis of the lips and extremities,and is uncooperative.His arterial blood gas values on 2 L/min by nasal cannula are: pH = 7.25; PₐCO₂ = 90 mm Hg; PₐO₂ = 38 mm Hg; SₐO₂ = 59%; HCO₃⁻ = 38 mEq/L.The most appropriate action at this time is which of the following?

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Quizplus · Accepted Answer

This patient meets the blood gas criteria for moderate to severe respiratory failure and therefore needs ventilatory support,as evidenced by the pH <7.35 and the PₐCO₂ >45 mm Hg; the PₐO₂/FɪO₂ is estimated at 38/0.28 = 136.This patient is at risk for failure of NIV because he is uncooperative (probably due to hypoxia)and has excessive secretions,as evidenced by his persistent productive cough.

A 75-Year-Old Man with a Long History of COPD Is