The first arterial blood gas for an asthma patient in the emergency department reveals: pH 7.49;partial pressure of carbon dioxide (PCO₂)30;partial pressure of oxygen (PO₂)82;oxygen saturation (SO₂)95%;bicarbonate (HCO₃-)24 on a nasal cannula 3 L/min.The patient's peak expiratory flow rate was 165 L/min,respiratory rate was 16,and pulse 106.After continuous aerosolized albuterol over the last hour patient'scurrent arterial blood gas results are as follows: pH 7.34;PCO₂ 45;PO₂ 49;SO₂ 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,pulse 128,and the patient is diaphoretic.The respiratory therapist should suggest which of the following at this time?

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This patient's airway obstruction is worsening as evidenced by the deterioration in the patient's acid-base status,oxygenation status,and peak expiratory flow rate.The patient has also developed tachycardia,tachypnea and sweating.The critical values are partial pressure of oxygen in the arteries (PaO₂),peak expiratory flow rate (PEFR),respiratory rate (RR),and pulse.This patient is now in impending ventilatory failure and meets the standard criteria for instituting mechanical ventilation.(see Box 4-5)Changing oxygen delivery devices to a nonrebreather mask will not increase the fractional inspired oxygen (FIO₂)delivered.Continuous positive airway pressure may address the patient's oxygenation problem;however,it will not help to improve the patient's increased work of breathing.

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