Doxapram in hypercapnic chronic obstructive pulmonary disease with respiratory failure

An 81-yr-old man with severe chronic obstructive pulmonary disease and hypercapnia presented to the emergency department (ED) obtunded and in acute respiratory distress. He had instructed his family to refuse intubation but agreed to all other measures to sustain his life. Treatment measures included the administration of intravenous doxapram, which was followed promptly by a marked improvement in his respiratory function and mentation. Respiratory stimulants may be useful as a temporizing measure in this difficult ED therapeutic problem.