ICU Cases · Advanced respiratory support
COPD exacerbation — NIV success to liberation
A long case on a COPD exacerbation managed with NIV (the first-line for the acidotic COPD), the settings titration, the monitoring for the failure, and the eventual liberation.
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Prompt
A 68-year-old smoker with COPD presents with an infective exacerbation and a respiratory acidosis. Outline the management from the NIV to the liberation.
Presentation
A 68-year-old chronic smoker with the known COPD (the FEV1 of 40 per cent predicted) is admitted with a 3-day history of a purulent cough, the worsening dyspnoea and the confusion. The blood gas on arrival shows a pH of 7.27, a PaCO2 of 82, a PaO2 of 52 on room air — a decompensated respiratory acidosis. The respiratory rate is 32, he is using his accessory muscles, and the saturation is 82 per cent.
References2ShowHide
- [1]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.
- [2]Burns KEA, Stevenson J, Laird M, et al. Non-invasive ventilation versus invasive weaning in critically ill adults. Thorax, 2022.PMID 34716282