USMLE Step 2 Quiz
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CRITICAL CARE
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A 68-year-old man with a history of severe COPD is brought to the emergency department with a 3-day history of worsening shortness of breath and productive cough. He is using his accessory muscles to breathe. Initial vital signs are temperature 37.8°C (100.0°F), heart rate 125/min, respiratory rate 34/min, and blood pressure 140/90 mmHg. Oxygen saturation is 86% on 6 L/min nasal cannula. He is started on noninvasive positive pressure ventilation (NPPV). After 2 hours, he becomes increasingly somnolent and difficult to arouse. Repeat arterial blood gas analysis shows pH 7.18, PaCO2 88 mmHg, and PaO2 65 mmHg.
Which of the following is the most appropriate next step in management?
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