COPD

[Grasshopper11]

A family member came out of the room and stated that pt was having trouble breathing. So we went in and I originally bumped up the o2 to 6L but while doing so I found out that she had copd so I dipped it down to 3L. Checking pulse ox she was 93%. We then found out that she went to the bathroom without the oxygen on.

The other nurse in the room told me that if a pt is having trouble breathing the oxygen gets bumped all the way up. I was always told that if the pt is copd that that does more harm than good, which is why I just increased it from 2L to 3L? Am I correct?

[AngelRN27]

Too much O2 on a pt with COPD will eventually suppress their drive to breathe. You are correct.

[EricJRN, MSN, RN]

In reality, the issue with hypoxic drive issue is usually overblown. Even placing a patient on a nonrebreather at 15 LPM for a short while in an emergency is unlikely to knock out the respiratory drive in a COPD patient. If it does, that patient needed to be bagged/tubed anyway. We have similar discussions here at least every few months on this topic, so there are some good threads that will come up in a search.

Here are a couple of web links to get you started.

http://www.respiratoryupdate.com/members/Hypoxic_Drive_Theory.cfm

http://www.mstherapycentrenotts.co.uk/Downloads/COPD/COPD-Schmidt---Hall.aspx

[RRT_charlie]

In respiratory school, instead of harping on this theory of knocking out a COPDers hypoxic drive, we are told time and time again to NEVER withold oxygen from a patient of any kind at any time if they are in need of it. I feel like nurses have this hypoxic drive fear drilled into their heads that a lot of times can have a negative impact on patient care. I don't ever blame the nurses because I understand that they are treating the patient to the best of their ability with the knowledge they have available to them, but as far as RT's go, the hypoxic drive is a non-issue. I will not hesitate to slap a COPder on 100% oxygen if I feel they need it.

With that said, there can be a huge misconception about exactly when a patient needs additional oxygen. Seeing as your COPD patient walked to the bathroom without her cannula (or whatever she was wearing) on, but that her sat's were 93% when you checked them and they were complaining of SOB, in my professional opinion, the patient's oxygen flow didn't need to be bumped up at all (though you did not hard the patient by doing that).

A lot of healthcare workers do not understand the complexities involved with the entire "SOB" syndrome. It is NOT always due to low O2 levels in the blood (as estimated by the SpO2 readings). It can simply be a patient needing more airflow (as would be the case in someone with already restricted lungs walking to the bathroom and back). Another reason that is typically not widely understood at my hospital is that sometimes patients are SOB because their RBC's are unable to properly transport the O2 (think anemia or CO poisoning). Finally, of course there is SOB caused by a lack of O2 in the air (like being high in the mountains). Because there are lots of different reasons for SOB, it's important to understand that it can be a complex issue, and that just upping the O2 isn't always the answer. Additional liter FLOW may help the COPD patient in the short term after walking to the bathroom, but it's the extra FLOW, not the O2 that is helping them out! :)

[MunoRN, RN]

More O2 will rarely help a CPOD'r with SOB. Their SOB is due to airway constriction, which will eventually lead to low O2 levels but adding additional O2 initially will do absolutely nothing. What they need to less airway constriction (bronchodilation). If you're just giving more O2 then your treating an effect and not the cause, and even then it's a late effect; usually hypercapnea comes first.

[classicdame, MSN, EdD]

During new nurse orientation I have the Respiratory Therapy supervisor talk to nurses about this and other topics. He brings samples of masks and I provide (with his assistance) a reference telling which masks does which task and how much O2 to administer. You can kill patients by automatically giving more O2 and without MD order this could be a risk you should not take. I highly recommend you ask RT for assistance. Perhaps your education department can get an in-service scheduled for the benefit of all.

[Medic/RN2B]

A patient with COPD will do fine on high flow O2..even a non rebreather at 15lpm as long as they are not on it very long....a short period of time is not long enough to knock out their hypoxic drive. However you arent going to see great O2 sats with a COPD'er anyways and if they were already on 2lpm and then went to the bathroom with their NC off and their O2 sats were 93%. You probably wouldve been ok bumping them up to 4lpm and having them take some slow deep breaths in through their nose and out through their mouth. Works wonders with COPD'ers. Get them all the time like this on the ambulance. Just remember not to leave high flow O2 on very long if you put it on because it WILL knock out the hypoxic drive :)