med 610 clinical respiratory diseases & critcare med

Mechanical Ventilation

Case 1

A 55 year-old man with a history of COPD presents to the emergency room with a two day history of worsening shortness of breath which came on following a recent viral infection. In the emergency room, his oxygen saturation is 88% on room air. He is working hard to breathe and is only speaking in short sentences. On exam, he has diffuse wheezes and a prolonged expiratory phase. His chest x-ray reveals changes consistent with COPD but no new focal infiltrates. An arterial blood gas (ABG) is done and shows pH 7.17, PCO2 55, PO2 62, HCO3- 25.

What are the indications for starting a patient on mechanical ventilation?


What do you think about the possibility of using non-invasive positive pressure ventilation (bi-level positive airway pressure) in this patient?


What is the difference between bi-level positive airway pressure (BiPAP) and continuous positive airway pressure (CPAP)? What are the indications for using these different modes of non-invasive mechanical ventilation?


Return to Case Index | Go to Case 1 answers

Top of Page