A patient who enters the emergency department has an exacerbation of COPD complicated by pneumonia. The patient is hemodynamically stable, demonstrates a strong cough, and has ABG data consistent with respiratory failure. Which of the following therapeutic interventions would be appropriate at this time?
A. endotracheal intubation and a T-piece
B. endotracheal intubation and invasive positive-pressure ventilation
C. negative pressure ventilation
D. noninvasive positive-pressure ventilation
ANS: D (page 367)
Cognitive Level: Application
A. Incorrect response: See explanation D.
B. Incorrect response: See explanation D.
C. Incorrect response: See explanation D.
D. Correct response: In the setting of an exacerbation of COPD, NPPV consisting of pressure support and positive end-expiratory pressure, or bilevel positive airway pressure (BiPAP), is well-suited to avert respiratory failure, endotracheal intubation, and invasive positive-pressure ventilation. Clinical evidence justifies the use of NPPV for COPD exacerbations when complicated by pneumonia, do-not-resuscitate situations, or postoperative or postextubation respiratory failure.
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