MSRA-2789

A 65-year-old male with COPD presents to the hospital with worsening cough, difficulty breathing, and heavy green sputum production. He is placed on a 35% venturi mask with target oxygen saturations of 88-92% due to his known hypoxic drive. Despite receiving nebulised salbutamol, nebulised ipratropium, intravenous hydrocortisone, and intravenous theophylline, there is minimal improvement. The patient is becoming fatigued and his oxygen saturations remain at 87%. An arterial blood gas is ordered and empirical intravenous antibiotics are started. What is the most appropriate next step in management?