This recommendation was studied in a prehospital care setting of 405 patients with COPD exacerbations: When O 2 was delivered via nasal prongs with a target percentage of oxygen saturation of arterial blood of 88-92%, measured by pulse oximetry (SpO 2), a significantly lower in-hospital mortality (4% versus 9%, p = 0.02) was observed when compared with standard O 2 delivery using a non-rebreathing mask. To avoid carbon dioxide (CO 2) narcosis, O 2 must be provided in a controlled fashion with a target saturation of only 88–92%. High inspired O 2 concentrations should be used with caution, because COPD patients may breathe with a hypoxic drive. Oxygen (O 2) delivery to COPD patients with an acute disease exacerbation remains challenging. In 2011, chronic obstructive pulmonary disease (COPD) had a global prevalence of 12% and was the third leading cause of death in the USA. These patients are more safely managed using a nasal cannula with an oxygen flow of 1–2L/minute or a simple face mask with an oxygen flow of 5L/minute. Nevertheless, arterial blood gases must be analyzed regularly for early detection of a rise in partial pressure of carbon dioxide in arterial blood in patients with chronic obstructive pulmonary disease and a hypoxic ventilatory drive. Non-rebreathing masks (with oxygen reservoir bags) must be used cautiously by experienced medical staff and with an appropriately high oxygen flow of 10–15 L/minute. Moreover, the risk of carbon dioxide rebreathing dramatically increases if the flow of oxygen to a non-rebreathing mask is lower than the minute ventilation, especially in patients with chronic obstructive pulmonary disease and low tidal volumes. If not, the amount of oxygen delivered will be too small to effectively increase the arterial oxygen saturation. Non-rebreathing masks with oxygen reservoir bags must be fed with an oxygen flow exceeding the patient’s minute ventilation (>6–10 L/minute.). The patient developed carbon dioxide narcosis and had to be intubated and mechanically ventilated. For fear of removing the hypoxic stimulus to respiration the oxygen flow was inappropriately limited to 4L/minute. Oxygen was administered using a non-rebreathing mask with an oxygen reservoir bag attached. Case presentationĪ 72-year-old Caucasian man with severe chronic obstructive pulmonary disease was admitted to the emergency department because of worsening dyspnea and an oxygen saturation of 81% measured by pulse oximetry. However, some oxygen delivery systems such as non-rebreathing face masks with an oxygen reservoir bag require high oxygen flow for adequate oxygenation and to avoid carbon dioxide rebreathing. Oxygen delivery to patients with chronic obstructive pulmonary disease may be challenging because of their potential hypoxic ventilatory drive.
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