nonrebreather-how long, and what should be next

O2 sat alone is not enough to decide if the pt is okay. What were his ABGs? If the pt was groggy its very possible it could have been from elevated CO2 or hypoxia or both. If CO2 is a problem, the NRB only makes it worse, and the worsening decline in LOC/resp drive makes the hypoxemia worse.

I would have went from the NRB to a Venti Mask, titrated down the venti mask until I could put on a NC.
If I was unable to titrate down from the NRB to a Venti, I would have put the patient on Bipap.

If the problem was elevated CO2, I would have went straight to bipap. Then, if the ABG didn't improve after Bipap, we would intubate in my unit.

I need your help about the nonbreather.

This is the Pt's history: an eldrely pt admitted for pneumonia. He was doing fine, A&Ox2, no fever, bed resting, on PEG feeding and 3-4 IV antibiotics. He went for sacral pressure ulce debridement at noon, and around 4 pm he became totally disoriented, eye open for pain, SOB, O2 sat down to 87%. They doc. and day nurse put him on nonrebreather with O2 95-98% and I got him at 7 pm. PEG eeding was D/Ced, dressing was changed which with no bleeding. The only thing was the nonrebreather and slightly labored breathing I thought was problem. I talked to the doc. and called the RN from RRT. They all said O2 sat was fine leave him alone, "call me if he needs to be intubated," the doc said. I did chest pts and suctions, and he was on that nonrebeather with O2 about 95-97%, whenever it was removed O2 will go down to low 80. I knew non rebreather was for short time use, but don't know how short is short.

A Different nurse came for my district for day shift. When he heard the pt was on nonrebreather for about 15 hours, and next step would intubation, he was very angry.

My questions are: how long usually nonbreather used for pts; what else I, as nurse, can do to void nonrebreather or intubation for pt like this; what I can suggest doc to do.

Thank you in advence for your help and sharing you knowledge.

One can suffer both neurological and pulmonary effects from oxygen toxicity, but no clear threshold of duration for this exists, to the best of my knowledge.

For reference, the astronauts aboard Gemini and Apollo were kept in an 100% oxygen environment for up to a week and a half without any problems, however, it was at a pressure much lower than atmospheric.

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The bigger problem is the NRB is just there to stabilize a patient until definitive treatment is established. It's a stop-gap measure at best. What did this guy's gasses look like?