Pulmonary Disorders II

Patient Cases

A 79-year-old woman (weight 70 kg) is admitted to the ICU for the management of hypercapnic respiratory

failure related to an ECOPD. She has had several admissions for ECOPD. The patient presents with fever,

profound dyspnea, increased sputum production (thick and purulent), and confusion. She has a history of

anaphylaxis to penicillin. Her blood pressure is 190/100 mm Hg, heart rate is 110 beats/minute, and respira-

tory rate is 22 breaths/minute. Her chest is hyperinflated and has poor air entry bilaterally. Her ABG values

are as follows: pH 7.20, Pco2 85 mm Hg, and Pao2 44 mm Hg on 6 L of nasal cannula. She is intubated and

placed on MV. Which would be the most appropriate group of medications to treat this patient’s severe

ECOPD?

nebulization, ampicillin/sulbactam 3 g intravenously every 6 hours for 7 days, and azithromycin 500

mg intravenously daily for 5 days.

nebulization, ampicillin/sulbactam 3 g intravenously every 6 hours for 10 days, and azithromycin 500

mg daily intravenously for 5 days.

ipratropium by nebulization, and levofloxacin 750 mg by NGT daily for 7 days.

levofloxacin 750 mg intravenously daily for 5 days.

8. A 75-year-old woman presents to the ED with a productive cough and altered mental status (oriented only

to person). Her medical history is significant for type 2 diabetes and severe COPD. On physical examina-

tion, she has a productive cough and is alert and oriented × 4. Her vital signs are temperature 101.8°F, heart

rate 95 beats/minute, respiratory rate 33 breaths/minute, systolic blood pressure 105 mm Hg, and Spo2 86%

on her home oxygen of 2 L/minute by nasal cannula. The patient is placed on noninvasive ventilation by

Venturi mask at an Fio2 of 40%, and her Spo2 is now 91%. A basic metabolic panel returns with SCr 1.3 mg/

dL and serum urea nitrogen 55 mg/dL, and an ABG reports pH 7.37, Paco2 55 mm Hg, and Pao2 59 mm Hg.

Radiography reveals multilobar infiltrates. Which best describes the severity of the patient’s ECOPD and

her level of respiratory failure according to the 2024 GOLD guidelines?