A 70-year-old male with chronic obstructive pulmonary disease (COPD) presents with worsening dyspnea, increased sputum volume, and purulence. Arterial blood gas shows pH 7.31, PaCO2 58 mmHg, and PaO2 54 mmHg. After controlled oxygen therapy and bronchodilators, what is the most appropriate next respiratory intervention?

Answer and explanation

Correct answer: B. Non-Invasive Positive Pressure Ventilation (NIPPV / BiPAP)

  1. Step 1: The patient presents with an acute severe COPD exacerbation with acute respiratory acidosis (pH < 7.35, PaCO2 > 45 mmHg).
  2. Step 2: GOLD guidelines establish NIPPV (BiPAP) as the first-line ventilatory support, significantly reducing intubation rates, hospital stay, and in-hospital mortality.
  3. Step 3: Intubation is reserved for NIPPV failure or hemodynamic instability.
Answer
Non-Invasive Positive Pressure Ventilation (NIPPV / BiPAP).
Why not the others: 'Immediate invasive intubation' is premature before an NIPPV trial; 'High-flow 100% oxygen mask' abolishes hypoxic respiratory drive in chronic retainers and worsens hypercapnia; 'Intravenous doxapram' is obsolete and unsafe.

Practise more Internal Medicine and Emergency Therapeutics.

Free questions with an explanation for every one, and full timed Qatar Healthcare Practitioner Licensing Exam (QCHP / DHP) mock tests.

All Internal Medicine and Emergency Therapeutics questionsTake a mock test

More Internal Medicine and Emergency Therapeutics questions