A 72-Year-Old Male Patient (Height 6'2",weight 95 Kg)with a History

A 72-year-old male patient (height 6'2",weight 95 kg) with a history of congestive heart failure (CHF) presents to the emergency department complaining of shortness of breath and inability to lie down to sleep.Physical assessment reveals a very anxious patient with a pulse of 140,respirations 32,and labored with diaphoresis.Breath sounds are decreased with bibasilar coarse crackles.The patient has a productive cough of pink frothy secretions.The patient is placed on a nonrebreather mask and the resulting arterial blood gases (ABG) show: pH 7.25,partial pressure of carbon dioxide (PₐCO₂) 55 mm Hg,partial pressure of oxygen (PₐO₂) 54 mm Hg,oxygen saturation (SₐO₂) 86%,bicarbonate (HCO₃⁻) 24 mEq/L.The most appropriate immediate action to take includes which of the following?

A) Face mask continuous positive airway pressure (CPAP) 10 cm H₂O
B) Intubate, volume-controlled continuous mandatory ventilation (VC-CMV) , respiratory frequency (f) 20, tidal volume (Vᴛ) 810 mL, positive end-expiratory pressure (PEEP) 8 cm H₂O, fractional inspired oxygen (FɪO₂) 1.0
C) Intubate, volume-controlled intermittent mandatory ventilation (VC-IMV) , f 6, Vᴛ 425 mL, PEEP 10 cm H₂O, FɪO₂ 0.80
D) Noninvasive positive pressure ventilation (NPPV) with bilevel positive airway pressure (bilevel PAP) , inspiratory positive airway pressure (IPAP) 15 cm H₂O, expiratory positive airway pressure (EPAP) 5 cm H₂O, FɪO₂ 0.60

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