A patient is experiencing an exacerbation of COPD. He is 65 years old, slim, and in notable dis-tress with tachypnea, tachycardia, and an arterial blood pH of 7.29. Which of the following therapies would be most indicated?
a. Intrapulmonary percussive ventilation
b. Intubation and mechanical ventilation
c. Nasal CPAP
d. Noninvasive ventilation
ANS: D
Criteria defining candidacy for noninvasive ventilation include acute respiratory acidosis (with-out frank respiratory arrest), hemodynamic stability, ability to tolerate the interface needed for noninvasive ventilation, ability to protect the airway, and lack of craniofacial trauma or burns, copious secretions, or massive obesity.
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