CLINICAL PRACTICE TIP: THE GREAT OXYGEN DEBATE

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

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