A 55-year-old man is hospitalized in the ICU with acute onset of respiratory distress. He has...

A 55-year-old man is hospitalized in the ICU with acute onset of respiratory distress. He has a long history of chronic obstructive pulmonary disease (COPD) with frequent exacerbations leading to multiple hospitalizations. He has never been intubated before for any of these exacerbations. On physical examination, he is afebrile, blood pressure is 170/100 mm Hg, and heart rate is 123 beats/min. There is jugular venous distention. Although the patient is in apparent respiratory distress, he is still able to answer questions and follow directions. Decreased breath sounds are heard in both lungs. There is 1+ lower extremity edema. A chest radiograph shows hyperinflation without infiltrates or pneumothorax. The remainder of the physical examination is normal. Laboratory results are below:

Arterial Blood Gas Studies	Result h(Normal Reference Range)
pH	7.48 (7.35-7.45)
Paco2	30 mm Hg (36-45 mm Hg)
PaO2	60 mm Hg (>80 mm Hg)
FiO2	100% with PEEP 5
PaO2/Fio2 ratio	60 (>350)
HCO3	26 mEq/L (22-26 mEq/L)
Hemoglobin	18.0 g/dL (13.8-17.2 g/dL)

What is the next best step in managing this patient’s respiratory status?
What other treatment options should be considered concurrently?
What are the primary goals of NIPPV?
What are the main complications and interventions for NIPPV?

Solutions

Expert Solution

(1) The next best step in managing the patient's respiratory status is, Nasal Intermittent Positive Pressure Ventilation (NiPPV) via nasal or facial mask or helmet. It is indicated in such acute respiratory distress with exacerbation of COPD.

(2) Other treatment options includes

Bronchodilators like selective beta 2 adrenergic agonists,
Anticholinergics
Theophilline
Combination of these drugs
Continuos positive airway pressure
Invasive mechanical ventilation
Treatment for other symptoms

(3) The chief goals of NiPPV are:

Improve oxygenation
Improve oxygen saturation in blood
Relax or unload respiratory muscles
Releive breathlessness or dyspnea
Adequate patient tolerance and comfort
Minimize the damage to lungs.

(4) complications of NIPPV are:

Pneumothorax
Subcutaneous emphysema
Pneumoperitoneum
Pulmonary barotrauma
Dry mouth
Facial injury
Retained secretion

Indications(interventions) of NIPPV:

COPD
Post-extubation
Asthma
Bronchiectasis
ARDS
Pneumonia
Pulmonary edema
ILD-1

Nightingale answered 1 year ago

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