A 50 years old lady, who has a known diagnosis of bronchial asthma, presented to the AIIMS emergency with complaints of severe breathlessness, diaphoresis and wheezing. On examination, you find that the patient is conscious with a respiratory rate of 30 per minute, blood pressure of 96/64 mm Hg and a pulse rate of 144 per minute. An aerial blood gas analysis showed a pH of 7.2, p02 of 50 mm Hg and pCO, of 70 mm Hg. How will you manage the patient?
(A) Ventilation with continuous positive airway pressure (B) Oxygen supplementation by nasal mask (C) Mechanical ventilation with controlled ventilation (D) Intubation
(A) Ans: A. Ventilation with continuous positive airway pressure(Ref: Harrison 19/e p1731, 18/e p2200)The patient here has decreased and increased paO2 as well as paCO2.Hence the patient is type 2 respiratory failure, which can be seen in bronchial asthma patients.Best management strategy - Assisted ventilation with CPAP (Non-invasive ventilation) rather than controlled mandator), ventilation.Type II respiratory failure - Mains stay of therapy:Directed at reversing underlying cause(s) of ventilatory failure.Noninvasive positive-pressure ventilation with a tight-lining facial or nasal mask, with avoidance of endotracheal intuhation, often stabilizes these patients.Mainly in exacerbations of chronic obstructive pulmonary disease.Check for hemodynamic instability, inability to protect the airway, respiratory arrest.