A 36-Year-Old Female Patient with a History of Asthma Is

Multiple Choice

A 36-year-old female patient with a history of asthma is admitted to the ICU from the emergency department.Her respirations are 30,very labored,with accessory muscle use and bilateral inspiratory and expiratory wheezing.There is bilateral hyperresonance during chest percussion.A blood gas taken in the ICU after 1 hour of continuous aerosolized albuterol (15 mg) reveals: pH 7.38,partial pressure of carbon dioxide (PₐCO₂) 42 mm Hg,partial pressure of oxygen (PₐO₂) 53 mm Hg,oxygen saturation (SₐO₂) 88%,bicarbonate (HCO₃⁻) 25 mEq/L with nasal cannula 6 L/min.The patient is 5'5" and weighs 135 lb.The most appropriate action at this time is which of the following?

A) Continue current therapy with 20 mg albuterol and reassess in 1 hour.
B) Noninvasive positive pressure ventilation (NPPV) with bilevel positive airway pressure (bilevel PAP) , f = 12, inspiratory positive airway pressure (IPAP) 28 cm H₂O, expiratory positive airway pressure (EPAP) 3 cm H₂O, fractional inspired oxygen (FɪO₂) 0.30
C) Intubate, use pressure-controlled continuous mandatory ventilation (PC-CMV) , f = 8, peak inspiratory pressure (PIP) 28 cm H₂O, TI 0.75 seconds, positive end-expiratory pressure (PEEP) 3 cm H₂O, FɪO₂ 1.0
D) Intubate, use volume-controlled continuous mandatory ventilation (VC-CMV) , f = 12, tidal volume (Vᴛ) 600 mL, PF 40 L/min, PEEP 5 cm H₂O, FɪO₂ 0.60