A Chronic Obstructive Pulmonary Disease (COPD)patient with an Ideal Body

Multiple Choice

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 administered.The arterial blood gas reveals the following: pH 7.31,partial pressure of carbon dioxide (P_aCO₂) 72 mm Hg,partial pressure of oxygen (PaO₂) 88 mm Hg,oxygen saturation (S_aO₂) 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 bpm,tidal volume (V_T) 650 mL,fractional inspired oxygen (F_IO₂) 50%,positive-end-expiratory pressure (PEEP) 6 cm H₂O
B) Noninvasive positive pressure ventilation (NPPV) with bilevel positive airway pressure (Bilevel PAP) rate 8 bpm,inspiratory positive airway pressure (IPAP) 10 cm H₂O,expiratory positive airway pressure (EPAP) 2 cm H₂O
C) Intubate,pressure-controlled synchronized intermittent mandatory ventilation (PC-SIMV) rate 10 bpm,peak inspiratory pressure (PIP) 30 cm H₂O,F_IO₂ 60%,PEEP 3cm H₂O
D) Administer 30% oxygen via air entrainment mask and continuous bronchodilator therapy