please help
why can't let a patient with COPD have a lot amount of oxygen
Excessive oxygen administration can lead to hypercapnic respiratory failure in some COPD patients
COPD patients with more severe hypoxemia are at higher risk of CO2 retention from uncontrolled O2 administration
# MECHANISM :-
The traditional theory is that oxygen administration to CO2 retainers causes loss of hypoxic drive, resulting in hypoventilation and type 2 respiratory failure. This is a myth.
Patients suffering from COPD exacerbation, regardless of whether they have CO2 retention, generally have supra-normal respiratory drive (unless there is impending hypercapnic coma)
The real explanation involves:
increased V/Q mismatch (most important)
the Haldane effect
1. V/Q mismatch
In COPD, patients optimise their gas exchange by hypoxic vasoconstriction leading to altered alveolar ventilation-perfusion (Va/Q) ratios
Excessive oxygen administration overcomes this, leading to increased blood flow to poorly ventilated alveoli, and thus increased Va/Q mismatch and increased physiological deadspace
this increase in Va/Q mismatch occurs in both CO2 retainers and non-retainers, the difference is presumably one of degree
2. The Haldane effect
deoxygenated hemoglobin (Hb) binds CO2 with greater affinity than oxygenated hemoglobin (HbO2)
hence oxygen induces a rightward shift of the CO2 dissociation curve, which is called the Haldane effect
in patients with severe COPD who cannot increase minute ventilation, the Haldane effect accounts for about 25% of the total PaCO2 increase due to O2 administration
# MANAGEMENT
- Target SpO2 88-92% in these patients
- the targeted approach is associated with decreased mortality in COPD patients and less respiratory acidosis
- The oxygen flow rate administered is not important, the (alveolar) PAO2 (and, indirectly, the SaO2) achieved is important.
- Never withhold oxygen from a seriously ill hypoxic patient due to fear of cause hypercapnic respiratory failure
please help why can't let a patient with COPD have a lot amount of oxygen
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