How many liters of O2 can a patient with COPD be on?

Specialties Pulmonary

Published

I recall being told by an instructor during my nursing clinicals that a patient can be on up to 4L of O2 but no more due to the retention of CO2 and loss of respiratory drive if they have COPD. A colleague of mine today told me that she was told that it shouldn't go over 2 Liters however. What is the correct answer, or is it one of those things that is more individualized to meet the needs of the specific patient? Also if anybody has any good sources or links to studies for this info it would be a bonus.

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Specializes in CRNA.
I recall being told by an instructor during my nursing clinicals that a patient can be on up to 4L of O2 but no more due to the retention of CO2 and loss of respiratory drive if they have COPD. A colleague of mine today told me that she was told that it shouldn't go over 2 Liters however. What is the correct answer, or is it one of those things that is more individualized to meet the needs of the specific patient? Also if anybody has any good sources or links to studies for this info it would be a bonus.

Try that 2 LPM gimmick when that COPD dude has SpO2 sats in the 60's is as blue as Casper and hypoxic as hell. They will be showing you the Q sign and going to meet Jesus in no time. Seriously, that old school nursing instruction is way behind the eight ball on modern day practice. The truth is, you give those guys what they require to maintain homeokinesis. Whether that is 2 LPM, a nonrebreather, or a new extension of their trachea attached to a blower....give them what they require. For references try looking in any physiology textbook copyright 2000 and beyond.

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Specializes in CRNA.

Actually, try reading Respiratory Physiology The Essentals 7th ed. by John West. That guy literally wrote the book on understanding this stuff. It is a quick read so if you bring it with you while in the can you will be done in no time.

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Specializes in OB/GYN, Med/Surg, Family Practice.

If I'm remembering correctly, I believe I was taught in school that a COPDer can not be on anything greater than 6L because anything greater than that will only adversely effect their respiratory effort.

However, I'm sure there are exceptions to the rule as nothing in medicine is set in stone.

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Actually, try reading Respiratory Physiology The Essentals 7th ed. by John West. That guy literally wrote the book on understanding this stuff. It is a quick read so if you bring it with you while in the can you will be done in no time.

LOL...good info. I actually looked in my medical surgical nursing book beforehand (smeltzer and bare, copyright 2004) and read the pertinent information, but the info was rather generic and it didn't say anything as far as what is too much O2 and what is too little, just the basics about "if you give too much it will suppress their repspiratory drive etc. etc." but nothing about where that threshold actually lies. As I said, i suspect that it's entirely individualized. I would think that the worse their degree of pulmonary obstruction is, the more CO2 they will retain, therefore the less O2 you can give them without suppressing their respiratory drive. I would think that the only way you could determine this on an individual basis would be by aggessively check their O2 sats with each change. But I don't know if there is a specific level that your general person with COPD absolutely cannot go above.

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Not every COPD'er is chronically hypercapnic. And not every retainer has burnt out thier central chemo recepters either. There is no magic number. If the Pt. is severly hypoxic, they need O's period, paragraph. God I love CRNA's. (And SRNA's too!) Also, to paraphrase Egans Fundamentals of Respiratory Care: "That oxygen therapy can cause some patients to hypoventilate should NEVER stop the RT (or other practitioner) from giving oxygen to a patient in need. Preventing hypoxia is the first priority".

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NOBODY should EVER be on more than 6L by NC.

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Specializes in Med/surg,Tele,PACU,ER,ICU,LTAC,HH,Neuro.

I don't know what your clinical instructor was saying when she said," UP to 4 L/m." The standare is 2 L/M per n/c and I would not go over that without ABGs and a doctors order. If the clinical picture makes you want to go over, I would consult with co-workers because it would shock me to see a COPD on more than 2 L/M, unless you were testing and monitoring them closely and the doctor was being made aware.

Don't take my word for this alone. Though I have 22 years of clinical experience, I have been out for 4 years.

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While I agree with closley monoriting and consulting co-workers, I gotta ask; if your Pt is 70% by pulsox, tachypenic (not neccessarily hyperventilating mind you), and cyanotic on 2L, you're not going to turn them up right away?!?!?!? So the MD writes an order to "maintain sats 88% - 92%, what if it takes an NRB to acheive? Would you still only give them 2L? Just asking.

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While I agree with closley monoriting and consulting co-workers, I gotta ask; if your Pt is 70% by pulsox, tachypenic (not neccessarily hyperventilating mind you), and cyanotic on 2L, you're not going to turn them up right away?!?!?!? So the MD writes an order to "maintain sats 88% - 92%, what if it takes an NRB to acheive? Would you still only give them 2L? Just asking.

Good point. And in my case, I work in a nursing home. There aren't doctor's around every corner in long-term care, and they can be difficult to reach in general. You also aren't going to be getting ABGs on a patient who's in such a facility, the best you have to go on is your pulse oximeter.

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Not every COPD'er is chronically hypercapnic. And not every retainer has burnt out thier central chemo recepters either. There is no magic number. If the Pt. is severly hypoxic, they need O's period, paragraph. God I love CRNA's. (And SRNA's too!) Also, to paraphrase Egans Fundamentals of Respiratory Care: "That oxygen therapy can cause some patients to hypoventilate should NEVER stop the RT (or other practitioner) from giving oxygen to a patient in need. Preventing hypoxia is the first priority".
Exactly. I've seen them placed on a NRB over a cannula...'course by that point, it's pretty much an exercise in futility.

On an assignment last year, walked in to find my patient fast on his way to arrest. RR ~ 2-4. The new RT had just given him a treatment, and thinking he "looked a little short of breath", cranked his O2 up to 6L. (she responded with the RRT and admitted she'd not done sat before turning him up)

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Specializes in IM/Critical Care/Cardiology.

I just loved it when an RT would wisp by me and tell me my patient she just did a treatment on is in the 40"s for HR. and then leave the floor...........I know I'll get flamed, but the guy coded just as she got the words out and split. Grrrrrrrrr.

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