Oxygen & CO2 Retention

#1 Dee

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08 November 2011 - 02:12 PM

From our friends at COPD CANADA

Oxygen & CO2 Retention

Hi Mark
I am really confused about co2 retention. My nurse that comes to my house says all copd'ers are co2 retainers. If that is so how come some patients use highflo o2 and they tell patients like me never go over 3 L no matter what I'm doing. Please explain how some can use high and some can't. Thank you Georgia

A. Hi Georgia,

The first comment I have to make is that your nurse is unequivocally WRONG. Not “all” COPD’ers are CO2-retainers. ONLY those whose FEV-1 has dropped severely – most prevalently, those whose FEV-1 is below 25 % of predicted and often, not until it drops below 20 % of predicted – are seen to retain CO2. She is misconstruing the long-standing notion about CO2-retention and its impact upon those who use supplemental oxygen, that if they use too much oxygen, they will somehow be inhibited from breathing effectively, even losing their drive to breathe and potentially facing consequences that can be as severe as to include death.

I have written about this extensively and fairly recently on COPD Canada in an effort to try to alleviate concern while dispelling the often professed dangers of using what is ACTUALLY ‘enough’ oxygen to keep organ health in a safe range AND to avoid earlier demise that predictably results from inadequate use of oxygen to keep saturation in a safe range.

Only a blood gas test can determine if one is a CO2-retainer. Unless you have had such a test, neither you nor she can say that you are indeed retaining CO2. Even then, it depends upon how much you retain. Mild retainers are NOT at risk for any problems or danger. Only those who retain significant amounts of CO2 would be included in the risk population according to the long-standing (but, unproven) theory. As well, as proponents who understand the theory well will tell you, we would ONLY see the purported effects in a VERY FEW of those who are considered most at risk. So, even if it were true, the number of folks at risk is few and far between. AND, it is not enough folks, in the end, to warrant or justify the practice of withholding adequate oxygen from EVERYONE, as she suggests. So, unless your doctor has measured your CO2 AND determined that you not only retain CO2, but also retain it in significantly, you are NOT at risk for any problems or danger.

The bottom line Is that folks like you are much more at risk for ill effects from not using enough oxygen than you will EVER be from using too much. And, in reference to your question, there aren’t folks who can use high flows while others can only use low flows. How much oxygen one uses should be dependent STRICTLY upon the results of measurements under the conditions of rest, exertion/exercise and sleep, all of which most often require different flows, sometimes QUITE different from the low flow at rest that will adequately correct one’s hypoxia (low oxygen level) You should ALWAYS, try to keep your oxygen saturation above 90 %, if at all possible, using whatever flow is necessary to get it up there.

Best Wishes,

Mark Mangus, Sr. BSRC, RRT, RPFT, FAARC


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