COPD pt's and 2L o2

texas2007, BSN, RN · Dec 8, 2006

You are correct! In normal people, the brain cues us to breathe based on having increased CO2. However, in patients with COPD, their brain becomes less sensitive to this increase so it will cue them to breathe when they have low O2 instead. If you have them any more than 2L/min, the brain won't cue them to breathe normally.

subee, MSN, CRNA · Dec 8, 2006

You are correct! In normal people, the brain cues us to breathe based on having increased CO2. However, in patients with COPD, their brain becomes less sensitive to this increase so it will cue them to breathe when they have low O2 instead. If you have them any more than 2L/min, the brain won't cue them to breathe normally.

You give people the oxygen they need to keep the hypoxia at bay. If we gave every copd'er only two liters of oxygen for surgery with a local or regional anesthetic, most of them would desaturate with only two liters. If you are so chronically hypercarbic from COPD that you can't tolerate another oxygen at higher flows, you are just waiting to go to heaven in a very short time. Just give the patient what makes them comfortable.

SuesquatchRN, BSN, RN · Dec 8, 2006

I was taught the same thing and found, unless someone was what my supervisor called a "CO2 retainer," that they might be on O2 up to 6L in my ex-facility. Yeah, shocked me, too.

banditrn · Dec 8, 2006

There are many things you can do for a COPD'er - and sometimes an anti-anxiety can help. Positioning can help - prop pillows under their arms to help expand the lungs - morphine and lasix, if it's a fluid problem.

Sometimes turning up the O2 a little will help for a short time - but watch it carefully. The best thing to know is what sats the patient runs at most of the time.

One thing I was taught in the ICU is to NEVER deny a patient oxygen just because they are a COPD'ER - but, then, that was in ICU, where we could ambu them if needed.

berry · Dec 8, 2006

You dont let people stay hypoxic. If it means cranking up the O2 then so be it you dont have to get a sat of 100% but 90-92% is a better place. If it means putting you patient on a 100% O2 thats what you do although this is a short term fix,

ZASHAGALKA, RN · Dec 8, 2006

A very interesting article on point.

The use of oxygen in patients with hypercapnia

"Physicians have observed for many years that the administration of oxygen to patients with chronic obstructive pulmonary disease (COPD) may be followed by hypercapnia. Traditional teaching emphasizes that hypercapnia results from suppression of hypoxic ventilatory drive and warns that "patients will stop breathing" if given oxygen. However, this interpretation does not account for the many factors that contribute to the control of breathing in these patients, and has resulted in oxygen being withheld inappropriately from some patients with acute respiratory failure."

"RECOMMENDATIONS-It is important to understand the goals of oxygen therapy and the multiple factors that can contribute to hypercapnia when considering the use of supplemental oxygen in the treatment of patients with ARF. An elevation in FiO2 may cause PaCO2 to rise, but it is unlikely to result in severe CNS depression unless the PaCO2 exceeds 85 to 90 mmHg. Many patients with acute on chronic respiratory failure have a chronic compensated respiratory acidosis (in which the arterial pH is only modestly reduced) and are at greater risk from hypoxemia than hypercapnia. The primary goal of therapy should be the maintenance of an SaO2 of 88 to 93 percent or a PaO2 of 60 to 70 mmHg [14,27]. Further increases in the FiO2 above the level needed to achieve the latter goals do not add significantly to the oxygen content of blood but do increase the potential for more severe secondary hypercapnia."

~faith,

Timothy.

mced · Dec 8, 2006

This past weekend, as I was beginning my shift, a pt was c/o SOB.... The tx nurse had found her in bed red to the face (note: not cyanotic) and saying she couldn't breathe. All licensed nurses rushed in the room (4 LVN's & 2 RN's). Her vital signs were stable, she was COPD and her o2 sat was 82% on 2L/via N/C. The began to increase her o2, I kept repeating (She's COPD! ), both RN's said it was okay and increased her o2 to 8L/face mask to get her o2 sat up....I'm a new nurse...but someone correct me if I'm wrong...COPD pt's are NOT to have more than 2L o2...right?? This causes more damage.
Is it common for nurses to do that?
They took the pt via 911, of course she came back 3hrs later. The pt was having an axiety attack...something a lil Ativan could've relieved. :icon_roll

I'd be willing to bet you patient was hypoxic as hell and you perceived it as anxiety. With an Spo2 stat of 82 percent what would be worse than withholding oxygen besides applying a pillow directly to the face. Co2 does not regulate respirations, it is hydrogen ion concentration. If these gomers need oxygen you have to give it to them to atleast crank the Sp02 some where into the A minus percentile.

Altra, BSN, RN · Dec 8, 2006

With an Spo2 stat of 82 percent what would be worse than withholding oxygen besides applying a pillow directly to the face.

Exactly. I hate to see knowledge of the COPD disease process get in the way of nursing care. Hate it when that happens.

Let's hypothetically play out this scenario to its logical conclusion: could you defend your actions? Could you explain to a jury that you withheld oxygen from an SOB patient because of his/her disease process? Pt. wasn't actually turning blue in my presence, so I stuck with 2L O2 via NC because of that darned COPD???

God willing, I will never develop COPD (I've always been a non-smoker & I have no asthma or other respiratory hx). But if by chance I do and I am in your care, and some day for whatever reason (anxiety, fever, any one of 100 other co-morbidities) I desaturate ... please, please crank up the O2. Thanks. I'd do the same for you.

morte, LPN, LVN · Dec 8, 2006

you need to know where the patient routinely "lives" have seen persons who appeared to be fine at this level and others that obviously werent...do they have perepheral vascular disease which decreases the validity of the PcO2? and indeed, does she have the comorbid dx of anxiety?

Altra, BSN, RN · Dec 8, 2006

Her vital signs were stable, she was COPD and her o2 sat was 82% on 2L/via N/C.
...
They took the pt via 911, of course she came back 3hrs later. The pt was having an axiety attack...something a lil Ativan could've relieved. :icon_roll

Two more questions:

1) Does a pt. with an SpO2 of 82% have stable vital signs?

2) If you suddenly feel SOB, would you feel anxious?

JaneyW · Dec 8, 2006

There is a great article addressing this in Medsurg Nursing from April 2004 Vol 13/No 2. It is called Informed Nursing Practice: The Administration of Oxygen to Patients with COPD. Only a small percentage of COPDers will have problems with higher O2 flows. As other posters have said, you cannot deprive the pt of O2 when the science really isn't as clear as you may have been taught. Here is a portion-

"Despite the fact that ample research has rendered [The hypoxic drive theory] defunct, perpetuation of this medical myth and a nurturing of the ensuing clinical mindset persist. The result is a danger that misinformed clinicians may deliver doses of oxygen that are inadequate for the patient's metabolic needs."

Check it out!