Chapter 1: Chapter 1

A¥5-year-old man is admitted to the ICU with increased respiratory distress. He is a current smoker (75-pack-year history). Most recent outpatient spirometry revealed a forced respiratory volume in 1 second (FEV1 ) of 50% of predicted and presence of an obstructive ventilatory defect. At home, he is on inhaled tiotropium and an albuterol inhaler as needed. Treatment was initiated with supplemental oxygen, 4 L/min via nasal cannula, IV steroids, inhaled bronchodilators, and broad-spectrum antibiotics. He notes progressive dyspnea. On evaluation, he appears fatigued but follows all commands. He is currently afebrile, his heart rate is 96 beats per minute, his blood pressure is 104/62 mim Hg, and his respiratory rate is 32 breaths per minute with use of accessory muscles. Oxygen saturation Is 92%. Auscultation of lungs reveals bilateral expiratory wheezes. ABG reveals pH 7.29, Poo? 60 mm Hg, and PO? 66 mm Hg. What would be the best next treatment?