How Much Oxygen to Give a Patient with COPD? (TMC Practice Question)

This video breaks down a TMC Practice Question about providing oxygen therapy to a patient with COPD. What should you be aware of in this case?
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➡️A 61-year-old male patient with emphysema is receiving oxygen via air-entrainment mask at 45%. One hour after oxygen therapy was initiated, the patient appears lethargic and obtunded. Which of the following is the most likely cause in the change of the patient’s status?
A. Hypotension
B. Refractory hypoxemia
C. Respiratory muscle fatigue
D. Oxygen-induced hypoventilation

Do you know the answer? Let's break it down.

First and foremost, you needed to recognize that emphysema in an obstructive disease that is classified as a type of COPD. Patients with COPD are typically chronic CO2 retainers which means that their ABG results would show: Compensated (Chronic) Respiratory Acidosis.
 
These patients are prone to oxygen-induced hypoventilation which means that receiving high levels of oxygen can affect their ventilation-to-perfusion balance in the lungs. It ultimately causes an increase in deadspace ventilation and, thus, an increase in the PaCO2 level. So for COPD patients, it is recommend to provide an FiO2 that is low enough to keep their PaO2 in the 50-60 torr range. This is equivalent to an SpO2 85-90%.

With that said, this is where a lot of confusion comes into play for many students when covering this topic. Because sometimes they are scared to give any oxygen to the patient, just because they have COPD. That's the big misconception. Yes, you should be careful and be mindful of their condition. But always remember: You should NEVER deprive oxygen from a patient in need just because they are a CO2 retainer. Hypoxemia is still hypoxemia, no matter if the patient has COPD or not. So as a Respiratory Therapist, you still need to treat these patients by providing adequate amounts of oxygen.

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🚑MEDICAL DISCLAIMER
Medicine and Respiratory Therapy are continuously changing practices. The information in this video is for educational and entertainment purposes only. For medical advice, please consult with a physician or qualified medical professional.

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⏰TIMESTAMPS
0:00 - Intro
0:30 - Practice Question
1:07 - Explanation
3:08 - Correct Answer

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