Abstract
There is evidence that the potential for high concentration oxygen therapy to increase PaCO2 is not limited to stable and acute exacerbations of COPD, but also to other acute respiratory disorders with abnormal gas exchange such as asthma and pneumonia, and chronic respiratory conditions with hypercapnia such as obesity hypoventilation syndrome. This evidence forms the basis of consensus guidelines which recommend that oxygen therapy is titrated in COPD and other respiratory conditions, to ensure the maximal benefits of oxygen therapy are achieved while reducing the potential for harm due to hyperoxia.Electronic supplementary materialThe online version of this article (doi:10.1186/2213-0802-1-8) contains supplementary material, which is available to authorized users.
Highlights
There is evidence that the potential for high concentration oxygen therapy to increase PaCO2 is not limited to stable and acute exacerbations of chronic obstructive pulmonary disease (COPD), and to other acute respiratory disorders with abnormal gas exchange such as asthma and pneumonia, and chronic respiratory conditions with hypercapnia such as obesity hypoventilation syndrome
As a result it would be expected that high concentration oxygen therapy would cause an increase in PaCO2 in severe asthma and pneumonia, similar to its administration in acute exacerbations of COPD
The clinical significance of this physiological effect is suggested by the observation that 10% of patients randomised to high concentration oxygen therapy had an increase in PtCO2 of ≥10 mmHg and a PtCO2 ≥45 mmHg after 60 minutes of treatment, whereas no patients receiving titrated oxygen therapy to maintain the arterial oxygen saturations between 93 and 95% had this response (Figure 1) [15]
Summary
There is evidence that the potential for high concentration oxygen therapy to increase PaCO2 is not limited to stable and acute exacerbations of COPD, and to other acute respiratory disorders with abnormal gas exchange such as asthma and pneumonia, and chronic respiratory conditions with hypercapnia such as obesity hypoventilation syndrome. The main mechanisms responsible for the increase in PaCO2 with high concentration oxygen therapy are a reduction in respiratory drive and worsening ventilation/
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