What is the escalation treatment for an acute COPD exacerbation with an SpO₂ of 88% on 4 L NC?

In the context of an acute exacerbation of chronic obstructive pulmonary disease (COPD), the primary goal is to improve oxygenation and relieve respiratory distress. An SpO₂ of 88% indicates that the patient is experiencing significant hypoxemia, and while various treatment options exist, they must be chosen carefully to avoid further complications.

Continuous Positive Airway Pressure (CPAP) is an effective non-invasive ventilation strategy for managing acute respiratory failure, particularly in COPD patients who may not be able to increase their respiratory effort adequately. By using CPAP at 5-10 cmH₂O, it helps to recruit collapsed alveoli, improve ventilation/perfusion ratios, and decrease the work of breathing. This can significantly enhance gas exchange and improve SpO₂ levels without the need for intubation.

Using high-flow oxygen via a non-rebreather mask may seem like an obvious choice for treating hypoxemia, but for COPD patients, there is a risk of suppressing their respiratory drive due to the potential for hypercapnia. Intubation is typically reserved for cases where non-invasive methods fail or when the patient is unable to maintain their own airway, making it a more aggressive approach that would be avoided if possible during an initial management attempt