Respiratory Therapists Stingy with o2?
- 0Jan 19, '13 by hajiThis has happened to me twice recently. I have had some very sick patients on bipap (DNR) who were near death. When the patients desaturated, and I suggested to the respiratory therapist (both times already at the bedside with me) to turn the fio2 up to 100%, they balk and only go up to 50%. So I have to go over myself and push the buttons. Both patients died pretty soon after this despite some improvement in sat. I don't think the patients died because of hypoxemia.
Anyway, it just seems crazy to me, if somebody is hypotensive, desaturating, and barely alive, why be stingy with the o2? Has anybody else had this issue?
- 6Jan 19, '13 by XB9S GuideWere they do not resuscitate but for active treatment.
If DNR and death imminent in my opinion, increasing oxygen to improve saturations is just prolonging the inevitable, if they weren't distressed I'd have let them be.
- 3Jan 19, '13 by samaschOxygen is a drug and with any drug if you give too much there could be adverse reactions. If the patient was near death anyway, why would you want to give them more of a drug just too make your numbers look good? Giving oxygen to a dying patient doesn't help at all. Instead of thinking that the RT was "stingy", you should trust the RT in their assessment.
- 0Jan 20, '13 by prep8611It's kinda like adding a fifth pressor on someone who is 60/30 post code who they just made dnr. I understand your thought but your paddling against a white water with a dingy. Your delaying the inevitable and the patient doesn't want to live on a vent for the rest of their life.
- 1Jan 21, '13 by hajiOne patient was DNR but we were trying to keep him going until his family got there. The next was a meds only code. So in both cases I had an intensivist in the room and we were giving pressors and code drugs. I don't like it when really sick DNR patients are brought into the icu and we try to resuscitate them. I don't see the point in it either, but its relatively common at my unit. So I try and keep them alive, short of CPR and intubation.
My point was that if someone is dying and you are trying to keep them alive, they need oxygen and there is no reason to resuscitate them on 40%.
- 1Jan 21, '13 by prep8611My hospital doesn't do "med codes" or at least i haven't witnessed it thank god. If ur hearts not squeezing what's the point exactly for asystole or vfib patient to receive pressors? Beating a dead horse is all it is.... Kinda like increasing the 02 on bipap for a dying patient that needs to be intubated. Unless you were stalling for the family to get there i still see no point.
- 1Jan 21, '13 by Altra GuideQuote from hajiWhy?Anyway, it just seems crazy to me, if somebody is hypotensive, desaturating, and barely alive, why be stingy with the o2? Has anybody else had this issue?
Because the patient is actively dying, and has expressed a desire to have heroic efforts limited.
One more thought: it may very well be acceptable at your hospital for you to change BIPAP and/or vent settings ... but I would be very careful about making sure there is an order for those settings.