Pulmonary Disorders II

A 66-year-old man presents to the ICU with acute

respiratory failure from a chronic obstructive pul-

monary disease exacerbation (ECOPD). He has

had no exacerbations in the past 2 years. His home

medications include albuterol hydrofluoroalkane 2

puffs four times daily as needed and tiotropium 1

puff once daily. The patient denies any recent sick

contacts or changes in sputum production. He has

no known drug allergies. He is placed on 3 L of

nasal cannula (Sao2 97%) and inhaled albuterol and

ipratropium by nebulization. Which other therapy

would be most appropriate for this patient?

every 6 hours.

A 65-year-old Black man (height 177.8 cm, weight

90 kg, SCr 1.5 mg/dL) presents with a medical his-

tory of end-stage renal disease on dialysis, COPD,

hypertension, and hyperlipidemia. He is admitted

from home to the ICU with respiratory failure. His

symptoms before admission included shortness

of breath, cough, increased sputum production,

purulence, and fever. His respiratory viral panel is

positive for rhinovirus. His Sao2 is 85% on room air;

he is placed on high-flow nasal cannula (HFNC) 40

L/minute, fraction of inspired oxygen (Fio2) 60%.

The patient’s work of breathing decreases, and after

15 minutes, his Sao2 is 97%. He is continued on the

same HFNC settings. He has been administered

methylprednisolone 60 mg intravenously once and

azithromycin 500 mg intravenously once. Which

best depicts the current intervention for this patient

that has demonstrated an increase in mortality?

mg oral equivalent.