Respiratory Therapists Stingy with o2?

  1. 0 This 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?
  2. Visit  haji profile page

    About haji

    Joined Nov '05; Posts: 51; Likes: 16.

    19 Comments so far...

  3. Visit  XB9S profile page
    6
    Were 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.
    RT_Skyler, opossum, RW23RN, and 3 others like this.
  4. Visit  samasch profile page
    3
    Oxygen 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.
    RT_Skyler, opossum, and canoehead like this.
  5. Visit  machaix profile page
    0
    And the patients were on bipap. They probably did not tolerate it, even with an increase of fio2. Intubation should have been done. But since they are on DNR, I don't think that was necessary...
  6. Visit  prep8611 profile page
    1
    Given the fact that the patient was hypotensive i severely doubt more fi02 would have fixed them
    RT_Skyler likes this.
  7. Visit  prep8611 profile page
    0
    It'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.
  8. Visit  haji profile page
    1
    One 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%.
    Mully likes this.
  9. Visit  prep8611 profile page
    1
    My 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.
    turnforthenurseRN likes this.
  10. Visit  Altra profile page
    1
    Quote from haji
    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?
    Why?

    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.
    RT_Skyler likes this.
  11. Visit  K+MgSO4 profile page
    0
    they are dying............the O2 is not going to fix it if they are activly dying. Just prolong the time by a very short ammount.
  12. Visit  Mully profile page
    0
    If they are a DNR with advanced interventions like acls meds and such, then yes I agree the BIPAP should get turned up. Otherwise, the previous posters are right that there is no point.

    I actually like the concept of DNR with meds and such, but not for any reason other than this - it helps the family start heading down the slope of letting the person die. It's a lot harder to go from a full code to a DNR comfort care only than it is to go from a full code to, pretty much full code except we're not going to break their ribs or put a tube down their throats. Obviously we as health care providers know that it's pretty close to pointless to push ACLS drugs if the heart's not beating, but I think it helps the family feel that they did everything for the person that they would want.
  13. Visit  Esme12 profile page
    0
    I my opinion...if death is imminent...100%FIO2 won't prevent them from dying....so if they are struggling there is NO REASON not to try to make them as comfortable as possible. Sometimes it is important to comfort the living by comforting the family. The patient is going to die.... we ALL know that...but if turning up the O2 will comfort the family then I see no problem with it...it' not like you are adding any expense to the bill.
  14. Visit  hodgieRN profile page
    0
    The only time I would ask to have the fio2 turned up is if the pt looked like he was gasping for air. I agree with everyone else that it would have done anything, but if they are actively dying with no morphine gtt or palliative care on the case, I would try to make the pt as comfortable as possible. If the pt was comfortable, but hypoxic, then there's nothing to do with the fio2 as long as the pt is at peace.


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