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 bpm,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 which reveals: pH 7.31;partial pressure of carbon dioxide (PaCO₂)57 mm Hg;partial pressure of oxygen (PaO₂)58 mm Hg;arterial oxygen saturation (S_aO₂)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 nonrebreathing 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