Respiratory failure — type 2

Classification: The type 2 (hypercapnic) respiratory failure, acutely decompensated — the PaCO2 raised (9.5 kPa), the pH low (7.27), and the bicarbonate only mildly raised (28, not the fully-compensated chronic) — the acute-on-chronic decompensation of the COPD.^[3]

Management:

1. The ABCDE, the controlled oxygen targeting the 88 to 92 per cent (the AVOIDANCE of the high-flow oxygen and the CO2 narcosis — the Haldane effect, the reduced hypoxic drive, the V/Q mismatch).
2. The nebulised bronchodilators — the salbutamol and the ipratropium (the air or the controlled oxygen driven).
3. The systemic corticosteroids — the prednisolone 30 to 40 milligrams.
4. The antibiotics if the infective trigger (the Anthonisen criteria).
5. The non-invasive ventilation (the BiPAP) — the first-line for the decompensated acidosis (the pH 7.27). The continuous, the monitoring of the arterial blood gas for the improvement (the rising pH and the falling carbon dioxide).^[4]
6. The intubation if the NIV fails, the contraindicated, or the unconscious.
7. The investigation and the treatment of the trigger.

Disposition: The high-dependency or the intensive care, the continuous monitoring, the gradual wean of the NIV.^[4]