QuestionSBA
QuestionChoice
This choice would not solve this patient's respiratory acidosis, which is an immediate concern that needs to be corrected with non-invasive ventilation. Furthermore, this patient is alert and unlikely to tolerate an OP airway.

BiPAP is used in patients with type II respiratory failure and pH <7.35.
10003519
d
Oesopharngeal airway (OP)
QuestionChoice
Invasive ventilation is not indicated in this patient who is alert and has a raised respiratory rate. His respiratory acidosis should instead be managed less aggressively with non-invasive ventilation.

BiPAP is used in patients with type II respiratory failure and pH <7.35.
10003517
b
Invasive ventilation
QuestionChoice
CPAP is commonly used in patients with type I respiratory failure.
This patient has type II respiratory failure with respiratory acidosis secondary to his COPD exacerbation and requires BiPAP.
10003520
e
Continuous positive airway pressure (CPAP)
QuestionChoice
The patient is already on 15L NRB, therefore this choice represents a step down in this patient's management, which is not appropriate given his signs and symptoms.
10003518
c
Nasal high-flow oxygen
QuestionChoice
Respiratory acidosis is an immediate concern that needs to be corrected with non-invasive ventilation (NIV). This patient is alert with a pH of less than 7.35 and is in type II respiratory failure, making NIV the optimal initial management.

BiPAP is used in patients with type II respiratory failure, with two different levels of positive pressure on inspiration and expiration.
10003516
a
Bilevel-positive airway pressure (BiPAP)
Concept
Chapter
2693
3902
COPD
Topic
132
Respiratory
13250
A 71-year-old man with known COPD presents to A&E with increasing shortness of breath. He is alert.


His observations are: Temp 38.0°C, pulse 101, BP 98/77mmHg, RR 31 and saturations 88% SpO2 on a 15 L non-rebreather mask (NRB).


The results from the patient's arterial blood gas are shown below:


||||
|--------------|:-------:|------------------|
|pH|7.30|7.35 - 7.45|
|PaO₂|6.9 kPa|11 - 15|
|PaCO₂|9.3 kPa|4.6 - 6.4|
|Bicarbonate|32 mmol/L|22 - 30|


What is the most important initial management?
a