A 68-year-old male with severe COPD is hospitalized for an exacerbation, presenting with worsening dyspnea, increased sputum production, and a pCO2 of 60 mmHg. Despite maximal bronchodilator therapy, systemic corticosteroids, and supplemental oxygen, his respiratory status continues to decline, and he becomes lethargic. What is the most appropriate next step in management?
✓ Correct Answer: Option B
NIPPV is indicated for COPD exacerbations with acute respiratory acidosis (pCO2 > 45 mmHg with pH < 7.35) or severe dyspnea and signs of increased work of breathing, especially if the patient is still responsive. It can prevent the need for invasive ventilation.