Question about COPD and Oxygen

[RN and Mommy]

How much oxygen is too much for a COPD patient? We had a patient who was on 3 1/2 liters NC who insisted she be brought up to 5L with activity. I though that a COPDer should only be on 1-2 L because too much oxygen can knock out their drive to breathe? Am I way off here? Thanks!

[RN and Mommy]

thoughts anyone????

[sadsaddy29]

I am just a lowly nursing student, but we actually just tested on this exact thing. In fact, our instructor told us a story about when she first got out of school (40ish years ago), they didn't know back then about the back-up mechanism and that COPD pts' breathing relied on O2 levels instead of CO2 levels and they actually had a few people stop breathing because they were given WAY too much O2...she also said that pts and their families often don't understand this and think, if a little's good then a lot must be better...which can cause a lot of trouble. Anyway, after all this babbling :imbar I'm pretty sure you're right about the 1-2 L

[EricJRN, MSN, RN]

Does your pt have primarily emphysema (a pink puffer) or primarily chronic bronchitis (a blue bloater)? A blue bloater is a little more likely to develop respiratory depression from O2 than a pink puffer, but we now know that there's not as much to the whole hypoxic drive thing as people used to think.

If your pt is so unstable that a brief 1.5 L increase in oxygen would do the trick, they probably ought to be intubated and in the ICU.

Check out this link:

http://www.emedicine.com/emerg/topic99.htm

[RN and Mommy]

She was a chronic bronchitis (blue bloater) patient. She wasn't unstable. It was just a question becuase it went against what I was taught in school regarding COPD and oxygen use. I was taught 1-2 L for chronic bronchitis.

[Daytonite, BSN, RN]

You are correct about too much oxygen not being good for COPDers. The reason lies in the pathophysiology of what is going on in their lungs and respiration processes. Increasing oxygen in someone results in the the patient's arterial blood becoming highly oxygenated. The cells of the body will take up those oxygen molecules very willingly and rapidly. Just as fast and even more quickly, the cells will give up CO2 to the blood. In the normal person this CO2 goes to the lungs where it is blown off. However, remember that COPDers have damaged alveoli. They can't handle all that increase in CO2 so it builds up in the blood. Now the patient becomes hypercapneic and acidotic, the symptoms of which result in the patient eventually becoming apneic. This is why you normally wouldn't give a COPDer 5L of oxygen.

If a person with chronic bronchitis does not have the alveolar changes in their lung tissue they will be better equipped to handle a higher oxygen flow rate since they will be able to blow off the increased CO2 through their respiratory track.

[RunnerRN, BSN, RN]

It was just a question becuase it went against what I was taught in school

I'm not making fun or anything, but if you knew how many times I have thought that exact thing in the last year......

[RN and Mommy]

I'm not making fun or anything, but if you knew how many times I have thought that exact thing in the last year......

Right, I understand that the way the teach nursing and real world nursing can be very different sometimes, but I was just looking for some explaination. I was only working as the CNA that day with that patient while I am waiting to take NCLEX, so I didn't have all the information about her, and I asked the RN I was working with and she agreed that it seemed like a lot of oxygen, but didn't offer any explaination as to why. That's ok. I was just looking for somewhat of an explaination. I still have sooooo much to learn!

[RN and Mommy]

You are correct about too much oxygen not being good for COPDers. The reason lies in the pathophysiology of what is going on in their lungs and respiration processes. Increasing oxygen in someone results in the the patient's arterial blood becoming highly oxygenated. The cells of the body will take up those oxygen molecules very willingly and rapidly. Just as fast and even more quickly, the cells will give up CO2 to the blood. In the normal person this CO2 goes to the lungs where it is blown off. However, remember that COPDers have damaged alveoli. They can't handle all that increase in CO2 so it builds up in the blood. Now the patient becomes hypercapneic and acidotic, the symptoms of which result in the patient eventually becoming apneic. This is why you normally wouldn't give a COPDer 5L of oxygen.

If a person with chronic bronchitis does not have the alveolar changes in their lung tissue they will be better equipped to handle a higher oxygen flow rate since they will be able to blow off the increased CO2 through their respiratory track.

Thanks for the explaination!!!!:flowersfo

[EricJRN, MSN, RN]

It was a great question. The take-home points from most of the current research are that:

- a very small percentage of COPD pts are susceptible to this problem

- many more patients die from hypoxia R/T withholding oxygen

- even in susceptible pts, it generally takes hours to knock out someone's hypoxic drive

[traumahawk99]

excellent discussion.

[NOLA RN]

Patients, no matter who they are, need to have adequate O2 to their tissue. What should be emphasized is that it is not the FiO2 that compromises the drive to breath, but the SpO2/SaO2. If sats are less than 88ish, the patient should receive increased O2. The important part is to monitor sat levels and titrate FiO2 as tolerated.