A patient with COPD exacerbation has an ABG showing severe hypoxemia. What is the next anticipated treatment?

In the context of a COPD exacerbation with severe hypoxemia, non-invasive positive pressure ventilation (NIPPV) is considered an appropriate next step in treatment. NIPPV helps improve ventilation, reduce the work of breathing, and enhance oxygenation without the need for invasive procedures, such as intubation. It is particularly beneficial in patients with COPD as it can assist in the removal of carbon dioxide and improve gas exchange, leading to better overall respiratory function.

High-flow oxygen therapy is also a supportive treatment, but it may not adequately address the ventilation-perfusion mismatch that often accompanies COPD exacerbations. NIPPV directly assists in both oxygen delivery and CO2 removal, which is crucial in this acute setting.

While nasal cannula is useful for mild hypoxemia, it is insufficient for the severe levels of hypoxemia associated with a COPD exacerbation. Intubation is typically reserved for cases where non-invasive methods fail or in patients who exhibit severe respiratory distress or inability to protect the airway, making it a more drastic intervention when NIPPV is effective.

Thus, NIPPV is the most appropriate intervention at this stage, prioritizing both oxygenation and ventilation in a less invasive manner.