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?

Question

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 PaO_2/F_IO₂ is estimated at 38/0.28 = 136.This patient is at risk for failure of NPPV 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