[Annebug]

Should baseline ABGs be measured when patients are admitted with chronic lung disease?

I guess it wouldn't really reflect their normal baseline if they're being admitted in respiratory distress anyway.

I ask because I've cared for several folks w/COPD who are being maintained on 5 or more LPM of O2 with sats at 99-100%, and I've heard how dangerous this can be.

Docs in my hosp. tend to write orders like "O2 PRN to maintain sats greater than 90%." Many nurses crank it up to get "normal" sats.

What do you think?

[GilaRN]

Baseline ABG's in the ER are quite common and I support having a baseline ABG on admitted patients with chronic resp. disease.

I am not a big fan of open O2 protocols such as the one you defined. It is easy to become complacent and simply turn up the O2 if the SPO2 drops. In some cases, you may actually miss a profound change in your patients condition. Pulse oximetry can be quite misleading in COPD patients and should be used in context to your patient assessment, ABG values, and knowledge of the patints baseline status.

I understand your concern relating to the whole hypoxic drive concept. It typically takes several hours on high Fio2 oxygen to wipe out the hypoxic drive. I would be more concerned about simply titrating up the Fio2 in response to low SPO2's and missing a change in my patients condition.

[earle58]

i've read data that supports and discourages the use of hi-flo o2 for pts w/copd.
what 'seems' to be more consistent, however, is the use of o2 during flare-ups and exacerbations.
it seems those pts on ltot (long term o2 therapy) are the targets where the disputes focus on.
most data suggests that hi-flo does suppress hypoxic drive.
yet, there is evidence out there that clearly negates these findings.
so, who knows?
but again, if one is going to use hi-flo during an acute flare-up, it seems the risk of long term damage would be greatly diminished.

leslie