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A 61-year-old woman with a 60-pack-year history of smoking who was diagnosed with COPD 7 years ago. She is currently being treated on the general floor for community-acquired pneumonia. She has been intubated twice because of COPD exacerbations. She is currently complaining of dyspnea. Vital signs are: heart rate 96/bpm, blood pressure 138/86 mmHg, respiratory rate 22 breaths/min, and SpO2 90% on 6 L/min nasal cannula. ABG's reveal pH 7.25, PaCO2 66, PaO2 59. She is very anxious and tripoding.
1. What treatment would you recommend at this time?
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