Question About COPD Patients

Nurseboy1 · Mar 11, 2005

Giving someone with COPD more than 3 liters of oxygen can decrease their carbon dioxide in their blood. For someone, esp. with hypercapnia, the increased CO2 in their blood is the primary drive to breath. If you increase the oxygen and decrease the CO2, then the patient has a decreased drive to breath and may become hypoxic or develop resp. failure.

oswonghk · Mar 11, 2005

Giving someone with COPD more than 3 liters of oxygen can decrease their carbon dioxide in their blood. For someone, esp. with hypercapnia, the increased CO2 in their blood is the primary drive to breath. If you increase the oxygen and decrease the CO2, then the patient has a decreased drive to breath and may become hypoxic or develop resp. failure.

Dear All,

Well, actually, low flow O2 that means less than 3L , usually not more 2L/min is to prevent CO2 narcosis to occur in patient with COPD/COAD.

Rationale: In a healthy person, an increase in CO2 will stimulate breathing centre to increase breathing so as to blow off CO2 .

However, in a COPD patient, who has an on-going increased CO2 level in blood, the stimulation of breath centre by CO2 does no longer work. Then the body will work on the "hypoxic drive," which is to get stimulated by low O2 in blood. Therefore, patient with COPD if given high O2, the breathing centre will be mistaken that the patient has enough O2 in blood, that ends up to cease breathing...and you end up with a patient needs CPR, that is not a good thing! So, patient teaching is very very very important, especailly to those will use home oxygen!

PS: Nicolel1182, Remember, there is no such thing called "stupid question." I am glad you have a right attitude to ask!

leslie :-D · Mar 11, 2005

Dear All,
Well, actually, low flow O2 that means less than 3L , usually not more 2L/min is to prevent CO2 narcosis to occur in patient with COPD/COAD.
Rationale: In a healthy person, an increase in CO2 will stimulate breathing centre to increase breathing so as to blow off CO2 .
However, in a COPD patient, who has an on-going increased CO2 level in blood, the stimulation of breath centre by CO2 does no longer work. Then the body will work on the "hypoxic drive," which is to get stimulated by low O2 in blood. Therefore, patient with COPD if given high O2, the breathing centre will be mistaken that the patient has enough O2 in blood, that ends up to cease breathing...and you end up with a patient needs CPR, that is not a good thing! So, patient teaching is very very very important, especailly to those will use home oxygen!
PS: Nicolel1182, Remember, there is no such thing called "stupid question." I am glad you have a right attitude to ask!

now here's a scenario that i never learned.

i was sending a pt w/copd (advanced) to the hospital. he was on 2-3L/min via nasal cannula. when the paramedics came, the automatically put him on 10-15 L/min via non rebreather mask. i told them that he wasn't supposed to get that much o2 to which they responded that we'll know if it's too much if he starts becoming lethargic (which he was already!!)

what's the rationale behind such a high amt of o2?

NurseFirst · Mar 11, 2005

now here's a scenario that i never learned.
i was sending a pt w/copd (advanced) to the hospital. he was on 2-3L/min via nasal cannula. when the paramedics came, the automatically put him on 10-15 L/min via non rebreather mask. i told them that he wasn't supposed to get that much o2 to which they responded that we'll know if it's too much if he starts becoming lethargic (which he was already!!)
what's the rationale behind such a high amt of o2?

I believe EMT (and EMT-P, I guess--don't know, just EMT-B now) protocols are to give lots of oxygen. I should point out that what needs to happen if the patient stops breathing is that the patient gets rescue breathing, NOT CPR. I'm not sure, but I think the rationale is that it is better to make sure the person has enough oxygen, and have to breathe for them, than for the patient to not have sufficient oxygen at all.

NurseFirst

oswonghk · Mar 11, 2005

I believe EMT (and EMT-P, I guess--don't know, just EMT-B now) protocols are to give lots of oxygen. I should point out that what needs to happen if the patient stops breathing is that the patient gets rescue breathing, NOT CPR. I'm not sure, but I think the rationale is that it is better to make sure the person has enough oxygen, and have to breathe for them, than for the patient to not have sufficient oxygen at all.
NurseFirst

Hi NurseFirst,

Thanks for your pointing out, yes you are right.

However, earle58, do you know paramedics have blood analysis machine equipped?

In case of emergency, I believe high O2 will be given to patient with COPD too with the reason depicted by NurseFirst. However, what is the definition of emergency situation? I think paramedics should have protocol of their own.

Low-flow O2 is a general principle to take care of COPD patient, which does not count the emergency situation.

Any other thoughts to share?!

LilRedRN1973 · Mar 11, 2005

I asked this same question at work. I am an Apprentice Nurse in an ICU and we had a patient with COPD the other night. They had her on BiPap the night before, but she wasn't tolerating that well at all for several reasons. When we came on shift, she was on a Venti Mask at 6L (50%, I think?). She couldn't get above the mid 70's on her O2 sats. So we tried a nonrebreather at 15L and she quickly went up to the 90's.

After a while, we tried the Venti mask again, tried suctioning her, tried a face mask.....nothing worked and we had to put her back on the nonrebreather. When I asked about the complications of putting a COPD'er on such a high level of 02, I never really got an explanation other than it was the lesser of the two evils. That was last Friday and apparently, this Monday, she was still on that nonrebreather. Her Co2 levels on Friday were around 50-60, I believe (it's hard for me to remember that far back....LOL).

I know they didn't want to re-intubate this woman, but wasn't this doing damage as well? Her lungs sounded like absolute crap....the worst lung sounds I've ever heard. She was extremely tachy with respirations (around 40-50) until they put her on the nonrebreather and then she decreased to the 20's.

So what's the rationale for this? Was it to the point where you had to chose between the lesser of two evils?

Melanie

NurseFirst · Mar 11, 2005

I asked this same question at work. I am an Apprentice Nurse in an ICU and we had a patient with COPD the other night. They had her on BiPap the night before, but she wasn't tolerating that well at all for several reasons. When we came on shift, she was on a Venti Mask at 6L (50%, I think?). She couldn't get above the mid 70's on her O2 sats. So we tried a nonrebreather at 15L and she quickly went up to the 90's.
After a while, we tried the Venti mask again, tried suctioning her, tried a face mask.....nothing worked and we had to put her back on the nonrebreather. When I asked about the complications of putting a COPD'er on such a high level of 02, I never really got an explanation other than it was the lesser of the two evils. That was last Friday and apparently, this Monday, she was still on that nonrebreather. Her Co2 levels on Friday were around 50-60, I believe (it's hard for me to remember that far back....LOL).
I know they didn't want to re-intubate this woman, but wasn't this doing damage as well? Her lungs sounded like absolute crap....the worst lung sounds I've ever heard. She was extremely tachy with respirations (around 40-50) until they put her on the nonrebreather and then she decreased to the 20's.
So what's the rationale for this? Was it to the point where you had to chose between the lesser of two evils?
Melanie

There's a lot of "lesser of two evils" in medicine. For instance: do we give gentamycin and possibly cause the person to lose their hearing--or ARF, or do we risk not treating an infection appropriately early enough? Do we amputate feet, or let the patient die of gangrene? Do we do cardiac cath, generally requiring that that person may need to be put on anticoagulants, and definitely pre-procedure antibiotics, for the rest of their lives--or not discover a possible 80% coronary artery occlusion?

Even though I'd been a paramedic previously, I was still amazed at the number of interactions and complications of medications. (I think the knowledge of drug interactions had not gotten to the sophistication that it is at now, it was 27 years ago...)

NurseFirst

BittyBabyGrower, MSN, RN · Mar 11, 2005

My dad had a similar scenario with the bipap, o2 mask..they don't want to intubate because it is very hard to get some of these people off the vent and they will end up with a trach or long term ventilation. They can also get barotrauma to the already pretty badly damaged lung tissue, so then you have even less than what you started with. The risk of pneumonia goes up with intubation also (usually some noscomial thing). It may have also been the patient's wishes to not be intubated. They get tachy from the meds they are on and all the aerosols they get. So, yeah, sometimes you have to go with the lesser of two evils. My dad always did best with the non-rebreather...he couldn't stand the bi-pap..he felt like he was suffocating with it on. It is such a tough call sometimes.

furrie, BSN · Oct 13, 2009

If they're low O2 you have to get it up someway. I was taught to give the higher O2 but watch LOC and reduce O2 if LOC diminishes...this in case of low PaO2, high PaCO2.

ssnodg1 · Feb 6, 2010

I am studying for NCLEX and wanted to know why 'hypoxemia is a greater threat in somebody with COPD than oxygen toxicity'? This was a rationale to a practice quesiton I had..... I thought it would be the opposite. :banghead:

Any carification would be great.

Thank you