19th February 2025

You are called to review a 60-year-old gentleman on the ward due to an escalating oxygen requirement.

You are called to review a 60-year-old gentleman on the ward due to an escalating oxygen requirement. He was admitted a few days ago with a decompensation of his heart failure and is currently on IV furosemide 120 mg twice a day. You review the notes and see that his oxygen requirement has been slowly increasing over the last few days and note that his weight, when measured daily, has been much the same since admission.

His observations currently show a heart rate of 103, blood pressure of 109/61, respiratory rate of 26 and saturations of 94% on 15 L/min. Examination reveals bibasal crepitations up to the midzone bilaterally with increased work of breathing and he is GCS 15/15. You perform an ABG which shows:

pH 7.367, pO2 7.9, pCO2 5.2, HCO3 26, BE +1.2, lactate 1.2

What would be your next step in the management of this patient?

Select the SINGLE most appropriate option from the list below. Select ONE option only.