Originally posted by Olanzapine
Hmm. Well, forgive my ignorance, but I thought this was a real issue with certain chronic COPDer's. They get dependent on their low oxygen saturation for their respiratory drive, so they no longer ventilate secondary to high CO2. Therefore, when you give them too high of an oxygen saturation, their respiratory drive can stop, requiring you to intubate them. I've always wondered what to do with them in this case (ie watch them on the floor if you get them oxygen, or withhold giving them "too much" oxygen, whatever that means).
Which is worse... Letting them stay hypoxic with a sat of 60% long enough so they code, or bumping their O2 up and knocking out their hypoxic drive thus putting them on a vent for a few days.
A couple of teaching points here:
1. If your patient is hypoxic, give them O2. Lack of O2 kills, knocking out the hypoxic drive does not.
2. The actual prevalence of individuals with true hypoxic drive stimulated respirations is very, very low. It is estimated that less than 1 in 100 individuals have a true hypoxic drive.
3. If you knock out the hypoxic drive, all you have to do is place the patient on a ventilator and gradually wean him/her off the vent until they begin breathing on their own. Yes, this can be a pain in the butt, but what's the alternative? If you withhold O2 in a patient who is hypoxic, you have more chance killing the patient with their marked hypoxia than by killing them by knocking out their hypoxic drive. Imagine withholding O2 from someone you thought had a hypoxic drive, but they were in that statistically unlikely group of 99 in 100 who actually did NOT have a true hypoxic drive.
4. Codes (respiratory and cardiac arrest) deserves 100% oxygen until a blood gas is obtained. Patients can be titrated down to desired oxygen levels once on the vent, in the unit, and an ABG has been obtained. FWIW, usually <50% (generally around 40%) is used.
5. Nobody is advocating throwing a patient on a non-rebreather when their O2 sat is 88% on room air. COPD'ers have low O2 sats. 88% may be a normal sat for a COPD'er... However, not even a COPD'er can approach normal, resting sats of 60-70%.
I hope this clarifies a few things.