Which of the following therapeutic modalities would be useful for a COPD patient who has failed numerous spontaneous breathing trials because of respiratory muscle weakness, and is still intubated and receiving invasive positive-pressure ventilation?
A. negative pressure ventilation
B. noninvasive positive-pressure ventilation
C. sedation and controlled mechanical ventilation
D. pressure support ventilation
ANS: B
A. Incorrect response: See explanation B.
B. Correct response: When patients with COPD exacerbations are intubated because they are not candidates for NPPV initially, or fail a trial of NPPV, clinical research demonstrates that NPPV can be used to permit earlier extubations even with patients who have failed multiple T-piece trials, and early extubation to NPPV increases eventual weaning rates. The strength of evidence for COPD exacerbation justifies use of NPPV.
C. Incorrect response: See explanation B.
D. Incorrect response: See explanation B.
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