In a patient with chronic obstructive pulmonary disease (COPD) and acute respiratory failure, which setting adjustment would aid in relieving their hypoxemia?

• A. Increase FIO2
• B. Increase PEEP
• C. Increase tidal volume
• D. Increase respiratory rate

Answer: (A)

Increasing the fraction of inspired oxygen (FIO2) is an effective adjustment for alleviating hypoxemia in patients, particularly those suffering from chronic obstructive pulmonary disease (COPD) combined with acute respiratory failure. By raising the FIO2, you directly enhance the amount of oxygen available for exchange in the lungs. This is crucial for COPD patients, as their obstructive lung disease often compromises gas exchange efficiency.

In cases of acute respiratory failure, especially when hypoxemia is evident, ensuring that a higher concentration of oxygen reaches the alveoli can significantly improve oxygen saturation levels in the bloodstream. This adjustment is typically one of the first-line interventions in acute settings as it immediately addresses the low oxygen levels that are characteristic of hypoxemia.

Other options, such as increasing positive end-expiratory pressure (PEEP), tidal volume, or respiratory rate, may have different effects on ventilation and oxygenation but can also lead to complications or not be as effective in rapidly correcting hypoxemia in these patients. Increasing PEEP might help in maintaining alveolar recruitment but could also reduce cardiac output or cause barotrauma if not managed carefully. Increasing tidal volume can improve overall ventilation but also risks hyperventilation or barotrauma. Lastly, increasing the