A chronic obstructive pulmonary disease (COPD) patient with an ideal body weight of 65 kg is brought to the emergency department
The patient is short of breath and using accessory muscles. Aerosolized bronchodilators are ad-ministered. The arterial blood gas reveals the following: pH 7.31, partial pressure of carbon diox-ide (PaCO2) 72 mm Hg, partial pressure of oxygen (PaO2) 88 mm Hg, oxygen saturation (SaO2) 90%, bicarbonate (HCO3?) 32 mEq/L on nasal cannula 2 L/min. The respiratory therapist should recommend which of the following at this time?
a. Intubate, volume-controlled continuous mandatory ventilation (VC-CMV) rate 15 breaths/min, tidal volume (VT) 650 mL, fractional inspired oxygen (FIO2) 0.50, positive end-expiratory pressure (PEEP) 6 cm H2O.
b. Noninvasive positive pressure ventilation (NPPV) with bilevel positive airway pres-sure (bilevel PAP) rate 8 breaths/min, in-spiratory positive airway pressure (IPAP) 10 cm H2O, expiratory positive airway pressure (EPAP) 4 cm H2O.
c. Intubate, pressure-controlled intermittent mandatory ventilation (PC-IMV) rate 10 breaths/min, peak inspiratory pressure (PIP) 30 cm H2O, FIO2 0.60, PEEP 3 cm H2O.
d. Administer 30% oxygen via air entrain-ment mask and continuous bronchodilator therapy.
ANS: B
Unless critical emergency, an initial attempt with noninvasive ventilation should be tried using inspiratory positive airway pressure (IPAP) 10-12 cm H2O and expiratory positive airway pres-sure (EPAP) 3-5 cm H2O.
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