I’m
sure you’ve experienced the following situation: A COPD patient drops his sats.
You’re about to start him on oxygen yet someone shouts, “Wait. This patient has
COPD. Don’t give oxygen!” Hmm…is that true? Maybe – maybe not.
You’ve just
experienced the great oxygen debate! What do you do?
To
provide the very best care to COPD patients and "win" the debate, you must first understand what
stimulates the body to breath.
Actually, we have two stimuli:
1.
High CO2
In a normal, healthy person, the first
stimulus to make us breath is a high CO2 level. We breathe in O2
and breath out CO2. Therefore, CO2 is retained whenever
we hold our breath. CO2 is converted to carbonic acid, which is why
our post-op patients can easily go into respiratory acidosis when given too
many opioids or anesthetics (respiratory rate of 8!!). As our CO2
level rises, the brain says, “Okay. Too high, time to breathe.” Which then
lowers our CO2 levels. This pattern repeats itself over and over
again FOR THE REST OF OUR LIVES.
2.
Low O2
A person who has COPD has difficulty
exhaling their CO2. They are in a hyperinflated state with too much
residual volume. This is “air” that the lungs can never get rid of (need to
understand PFTs for this). Over time, their brain gets desensitized to the high
CO2 levels and starts to ignore them. So glad we have a security
blanket – a low O2 level. When a COPD patient’s oxygen levels drops,
the brain snaps out of it and says, “Okay. Time to breathe.”
This
is why you hear people say NOT to give a COPD patient oxygen. If you give
him/her oxygen, you’ve wiped out their only stimulus to breath!!
However, if a patient is admitted who
has COPD and his oxygen saturation is only 80%, if you DON'T give him oxygen, HE WILL DIE!!!
What to do?
Okay, here’s the deal:
If
I came into your hospital (normal, healthy lungs) and my oxygen saturation was
80%, you would start me on 100% oxygen via facemask or high flow nasal cannula.
If a COPD patient came in
with the same, start lower. Perhaps you start with 4 liter nasal cannula and
see how he does.
The
key is to understand the mechanism behind our stimulus to breathe and respond
accordingly. Your COPD patient may still need oxygen, but not as much as
someone with normal, healthy lungs.
I
hope this helps you to understand the great oxygen debate!!
Thanks
for reading. Take care and stay connected!
Renee
For more great tips, make sure you "like" me on Facebook,"follow" me on Twitter and YouTube and subscribe to my blog. Also, check out my new book on nurse-to-nurse bullying!
Dear Renee,
ReplyDeleteThis was so helpful and now I understand alot more about oxygen and COPD! Thank youuuuu!!!!
~Carli Gaetano
Hi Carli
DeleteThanks so much for taking the time to comment. Glad I could help!
Cheers!
REnee
Nice refresher/reminder, simple to understand. Thanks
ReplyDeleteThanks Louise!!!
Delete