A 70-year-old male is having difficulty breathing. What factor should most influence your decision to assist his ventilation with a BVM?

In this scenario, the most critical factor influencing the decision to assist ventilation with a bag-valve mask (BVM) is a decrease in the patient's mental status. When a patient has a compromised mental status, they are less likely to protect their airway effectively and may be unable to maintain adequate ventilation on their own. A decline in consciousness can indicate hypoxemia or hypercapnia, which necessitates immediate intervention to ensure the patient's airway remains patent and oxygenation is preserved. Assisting ventilation in such cases helps to overcome the patient's impaired ability to breathe adequately due to altered consciousness.

While an increase in respiratory rate may suggest respiratory distress, it does not necessarily indicate inadequate breathing if the effort remains effective. Similarly, an SpO2 below 90% is a concerning sign; however, if the patient is still alert and able to breathe, supplemental oxygen or another intervention might suffice without the need for BVM. Lastly, a history of COPD suggests a chronic lung condition, but it does not automatically necessitate BVM use unless it has led to acute respiratory failure or severe ventilation issues. Therefore, the decrease in mental status stands out as the key determinant for immediate ventilation support.