2003 OPEN FORUM Abstracts
EFFECTS OF PROVIDING OXYGEN SATURATION GREATER THAN 90% TO ALL PATIENTS HAVING COPD AND/OR CO2 RETENTION
Author: John W. Earl RRT, BS
Director Respiratory Care Service (retired)
VA Medical Center, White River Jct. Vermont 05009
Objective To investigate if there are any harmful side effects resulting from administering oxygen that provides SpO2 levels above 90% to patients having COPD and/or CO2 retention.
Methods: Over a three-year period oxygen rounds were performed on 262 patients involving more than 5,000 patient days annually. Patient response was monitored and documented along with FiO2, and SpO2 or blood gases. Variances were also noted and corrected. Rounds were performed on day, evening, and night shifts. Oxygen delivery ranged from 1 LM nasal cannula to NRB mask at or above 60 LM.
RESULTS: Over a three-year period we encountered no harmful side effects despite occasional PCO2 levels that rose above 25 mmHg following oxygen administration. No patient stopped breathing or became obtunded. Patients tolerated pH levels as low as 7.23 when well oxygenated. Alert patients having pH < 7.25, PaO2 levels > 70 mmHg, SpO2 > 93%, and PaCO2 levels above 80 were photographed and documented with their permission. Seventeen patients experienced respiratory failure requiring intubation. Oxygen administration did not contribute to their failures.
Conclusions: Current literature confirms our finding that patients with COPD and /or CO2 retention who are provided blood oxygen levels above 90% saturation do not become obtunded or stop breathing despite some who exhibit substantial increases in PaCO2 levels. Most of these patients are elderly and may have compromised cardio-vascular systems. Given this, it seems reasonable and prudent to provide oxygen to all patients at a liter flow or FiO2 that will ensure adequate oxygenation. Prescriptions for fixed liter flow or FiO2 should be avoided. A policy that assures this practice has been drafted. In no instance is a patient limited or deprived of oxygen in an attempt to stimulate breathing. Patients unable to breath are intubated and ventilated.