How many liters of O2 is really safe with COPD?

  1. 0
    Hi this is my first time posting I tried to search my question but the search was not working. I'm a newly licensed RN and I'm not working yet so I'm a little unsure of my knowledge. Ok so some background before my question. My husbands great grandma was recently hospitalized for SOB. When we went so see her I noticed she was on 15 liters of O2 I thought wow that's a lot later I found out that she has COPD. Imediatly I thought that's too much oxygen for someone with COPD. I questioned the nurse and RT together they both said that's what she needs. So the next day they move her to hospice for the reason that she cannot get rid of the CO2 and I'm thinking no wonder with the O2 so high. Now in hospice she is still on 15 liters and going down hill quickly. Just 6 months ago I was taught with COPD 2-3 liters max. So my question is am I way off base are the hospitals doing something different now?

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  2. 27 Comments...

  3. 6
    COPD patients are usually given 1-2 liters of Oxygen on nasal cannula. I think you may not have all the pieces of the story, people are not moved to hospice just because their CO2 isn't coming down.
    GrnTea, nursenotamaid, chevyv, and 3 others like this.
  4. 0
    The doctors told the family that she is retaining carbon dioxide her fingers and toes are turning blue and black and eventually she would go into a coma and not wake up.
  5. 0
    I think hospice was more of the daughters decision because the doctor told her that he did not think her mom would make it and they could keep her comfortable.
  6. 13
    We can't give you any advice on your personal situation--it's against our Terms of Service. But we can explain some of the principles at work with COPD patients.

    Many COPDers do well with 2-3 liters. But the rule is to give them what they need to stay alive. If 2-3 L isn't enough to keep their O2 sats at a reasonable level (normal could be 85% with COPD), then they get more O2. Raising the O2 level could very well knock out their respiratory drive, but staff then needs to be ready to bag the patient or otherwise provide respiratory support.

    If someone with COPD is coming to the end of their life, they may well need a higher level of O2. They aren't denied this just because they have COPD.

    I'm sorry your family is going through this.
  7. 0
    Thanks I was just really confused because that was just going against everything we were taught and since I'm not working yet I don't have any personal experience to draw from.
  8. 8
    Quote from Mardisb
    Thanks I was just really confused because that was just going against everything we were taught and since I'm not working yet I don't have any personal experience to draw from.
    In my tagline I have a quote that applies here:

    Education teaches the rules. Experience teaches the exceptions.

    It's sad when you watch someone you care about going downhill. If you want to understand their rationale, ask them to explain it to you. As long as you aren't confrontational or acting like you want them to justify their decision to you, they should be able to help you.

    As a previous poster mentioned, patients aren't placed in hospice unless there is more going on than just retaining CO2. That can be fixed by dialing down the O2. If they aren't decreasing the level, it would appear that they are taking into account other things that are going on and treating the retention of CO2 as an unwelcome but unavoidable side effect.

    Please, ask someone involved in her care for more information--not because you disagree, but because you want to understand.
  9. 0
    I have noticed that not everyone is on the same page in regards to COPD and O2.
    I have had 2 different rapid responses with COPDer's. First one I put a non rebreather on him. Sats came up. At the time I did not put two and two togerther (new grad). The MD got mad.
    Speed up two years later and the same thing happened. This time I did not put a nonrebreather on him and RT therapist questioned why then proceeded to do so.
    IMO, not one action is recommended for everyone.
  10. 6
    i am sorry your family is going through this. . i agree with rnwriter.....oxygen must be delivered(not denied) to these patients carefully due to the complications that arise in their care. in many stages o2 will be administered to counter hypoxemia and to give comfort in late stages of the dsease.

    there are techincally two types of "typilcal copd. the "blue bloaters" and the "pink puffers". not all copd patients are sensitive co2 retainers. o2 will be given to counter act hypoxemia as the hypoxemia becomes life threatening. the problem is that many people trat the numbers and not the patient....a copd patient may happily live with an o2 sat of 83% that you and i would be cyanotic and gasping.

    a "pink puffer" is a person in which emphysema is the primary underlying respiratory problem. emphysema is caused by the destruction of the airways distal to the bronchiole. it involves the gradual destruction of the pulmonary capillary bed the decreased inability to oxygenate the blood. the body then has to compensate with a lower cardiac output and hyperventilation. eventually, because of the low cardiac output, people afflicted with this disease develop muscle wasting and weight loss. they develop a reddish complexion and a "puffing" appearance when breathing hence "pink puffer".

    out of the two types "pink puffer" or "blue bloater", a "pink puffer" has a better overall prognosis if treatment is sought early. thesesa re the big co2 retainers and o2 administration needs to be watched closely as the breathe on a co2 drive not an o2 drive. so if the o2 levels rise the respiratory drive shuts down.

    a "blue bloater" is a person that actually suffers from chronic bronchitis. utilmately called cor pulmonale due to the heart failure caused by the chroic obstruction of the lungs preventing the circulation of blood on it's way to getting o2 from the lungs. chronic bronchitis is caused by excessive mucus production with airway obstruction and notable hyperplasia of mucus-producing glands. unlike emphysema, the pulmonary capillary bed is undamaged. instead, the body responds to the increased obstruction by decreasing ventilation and increasing cardiac output. this is a horrible mismatch within the body that results in a rapid circulation in a poorly ventilated lung leading to hypoxemia and polycythemia. with this occurring, as well as increased carbon dioxide retention, these people have signs of heart failure and are labeled as "blue bloaters". the prognosis for a "blue bloater" is very poor.

  11. 5
    keep in mind, hospice pts will require o2 according to their comfort levels.
    and that is how we guide our care...not according to med'l indications, but comfort ones.
    they're (hospice) is doing what they need to do, for your grandma's sake.

    wishing you peace and comfort.

    chevyv, jelly221,RN, Psychtrish39, and 2 others like this.

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