19th February 2025

You are called to review a 73-year-old gentleman on the ward due to an increasing oxygen requirement.

You are called to review a 73-year-old gentleman on the ward due to an increasing oxygen requirement. He was admitted a few days ago with a decompensation of his heart failure and is currently on an IV furosemide infusion of 240 mg over 24 hours. 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 only decreased by 0.5 kg.

His observations currently show a heart rate of 111, blood pressure of 103/59, respiratory rate of 28 and saturations of 92% on 15 L/min. Examination reveals bibasal crepitations up to the midzone bilaterally with no wheeze, he has an increased work of breathing and he is GCS 15/15. You perform an ABG which shows:

pH 7.287, pO2 7.9, pCO2 7.3, HCO3 25, BE +1.8, lactate 1.4

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.