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A 72-year-old man with a history of COPD is admitted with increasing breathlessness over 3 days. His arterial blood gas on room air shows: pH 7.32, PaO2 7.1 kPa, PaCO2 8.2 kPa, HCO3- 32 mmol/L. He has bilateral wheeze and is using accessory muscles of respiration.
What is the most appropriate initial oxygen therapy?
What is the most appropriate initial oxygen therapy?
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The ABG shows type 2 respiratory failure (hypoxaemia + hypercapnia) with partially compensated respiratory acidosis (elevated bicarbonate). BTS guidelines recommend controlled oxygen therapy in COPD exacerbations, targeting SpO2 88-92%. A Venturi mask allows precise FiO2 delivery. Non-invasive ventilation (NIV) should be considered if acidosis persists despite optimal medical therapy.
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