A 63-Year-Old,5'11",185 Lb Male Patient with a History of Chronic

A 63-year-old,5'11",185 lb male patient with a history of chronic obstructive pulmonary disease (COPD) is admitted to the hospital due to liver failure.Over the course of the 48 hours he has developed respiratory distress.The respiratory therapist performs a physical assessment and finds the following: heart rate 135 beats/min,respiratory rate 28 with accessory muscle use.Breath sounds are decreased bilaterally with coarse crackles in the right base.A chest X-ray from 24 hours ago shows bilateral lower lobe infiltrates.The patient has a nonproductive cough.The respiratory therapist draws an arterial blood gas that reveals: pH 7.31; partial pressure of carbon dioxide (PₐCO₂) 57 mm Hg; partial pressure of oxygen (PₐO₂) 58 mm Hg; arterial oxygen saturation (SₐO₂) 87%; bicarbonate (HCO₃-) 27 mEq/L while receiving oxygen via nasal cannula 3 L/min.The respiratory therapist should recommend which of the following for this patient?

A) Continue with current therapy and monitor the patient closely.
B) Place the patient on a nonrebreather mask with 15 L/min oxygen.
C) Intubate and place on pressure-controlled continuous mandatory ventilation (PC-CMV) , peak inspiratory pressure (PIP) 40 cm H₂O, positive end-expiratory pressure (PEEP) 8 cm water (H₂O) , fractional inspired oxygen (FɪO₂) 1.0.
D) Use BiPAP with IPAP 10 cm H₂O, EPAP 5 cm H₂O, and bleed in 4 L/min oxygen.

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