Viva 5

You are the intensivist on duty. A 50 year old woman has just been transferred from the surgical ward with worsening shortness of breath day 5 post-oesophagectomy and a presumed anastomotic leak. On arrival in ICU she is tachypneic and extremely agitated.

Arterial blood gas analysis on 80% Oxygen via Venturi mask shows:

pH                   7.12 
PaO2              50 mm Hg 
PaCO2           50 mm Hg 
HCO3             16 mmol/L

A CXR shows bilateral pulmonary opacification.

What are the possible causes for her respiratory failure and outline your initial approach to her respiratory management?

Disclaimer: the viva stem above may be an original CICM stem, acquired from their publicly available past papers. Or, perhaps it is a slightly altered version of the original CICM stem. Or, it is a completely original viva stem, concocted by the monstrously amoral author of Deranged Physiology for nothing more than his own personal amusement. In either case, because the college do not make the main viva text or marking criteria available, almost everything here has been confabulated. It might sound like a plausible viva and it could be used for the purpose of practice, but all should be aware that it does not represent the "true" canonical CICM viva station.