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Bet 2: Doxapram resurrected? Weak evidence of efficacy suggests a potential use in patients ineligible for non-invasive ventilation

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Report by: John J MacDonald

Search checked by: Richard Body

Institution: Stockport NHS Foundation Trust, Stockport, UK

Clinical scenario

A 73-year-old male with known chronic obstructive pulmonary disease (COPD) presents to the emergency department with dyspnoea. He is diagnosed with an acute exacerbation of COPD. Despite optimal medical management he fails to improve, his arterial blood gases demonstrate type II respiratory failure with worsening respiratory acidosis. He is offered a trial of non-invasive ventilation but refuses as. A decision is taken that invasive ventilation is not in the best interests of the patient. You wonder if the respiratory stimulant doxapram may improve the patient's respiratory failure.

Three-part question

In (patients with an acute exacerbation of COPD who are unwilling or unable to have ventilatory …

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