Recently, a patient with COPD has successfully completed spontaneous breathing trials for weaning from mechanical ventilation and has been extubated. The patient is now experiencing respiratory distress. What should the therapist do at this time?

A. Reintubate the patient.
B. Administer 40% oxygen via an aerosol mask.
C. Institute NPPV.
D. Continue monitoring the patient.

ANS: C
A. Incorrect response: See explanation C.
B. Incorrect response: See explanation C.
C. Correct response: Studies have shown that noninvasive positive-pressure ventilation (NPPV) can avert reintubation in recently extubated COPD patients who are failing. This practice may also apply to COPD patients who have failed SBT trials, but are judged capable of protecting their airways. In these patients, the artificial airway is removed, and ventilatory support is supplied with NPPV. The use of NPPV for these purposes appears limited to only patients with COPD because larger studies have demonstrated that non-COPD patients do not benefit from NPPV.
D. Incorrect response: See explanation C