The Effect of Supplemental Oxygen on Hypoxemia and Hypercapnia in COPD Patients with Acute Respiratory Failure

Abstract

Background: Hypoxemia and hypercapnia are frequently encountered in chronic obstructive pulmonary disease (COPD) patients with acute attack. Objectives: To investigate the effect of 2 L/min oxygen given with nasal cannula on hypoxemia and hypercapnia in COPD patients with respiratory failure. Methods: Twenty-six type I (Group I) and 36 type II (Group II) respiratory failure patients were included in the study. The patients' initial clinical and laboratory findings were obtained. Spirometric examination and arterial blood gas (ABG) analysis were repeated after the administration of optimal medical therapy including 2 L/min oxygen given with nasal cannula. The patients whose PaCO2 values increased more than 10 mmHg with the treatment were also grouped as Group III, and their comparison was made with the rest of the patients (Group IV). Results: Among the initial laboratory parameters; PaO2 was lower in Group II (p<0.001). Increases in PaO2 values with the treatment in both groups were statistically significant (p<0.001). With the treatment PaO2 value stayed under 60 mmHg in 23 patients (88.5%) and 26 patients (77.2%) in Group I and II, respectively (p<0.05). Final PaCO2 values were found higher in 21 patients (28.8%), and this was more than 10 mmHg in 7 (11.3%) patients (Group III). All but one of these patients belonged to Group II (p>0.05). In Group III, longer disease duration and higher rate of cor pulmonale were found to be statistically significant when compared with Group IV (p<0.05). Conclusion: Two L/min oxygen given with nasal cannula is usually not sufficient to improve hypoxemia in COPD patients with acute attack, and oxygen therapy mentioned increases PaCO2 further in 15-20% of hypercapneic patients. Key words: COPD, Supplemental oxygen therapy, Hypoxemia, Hypercapnia.

Keywords

• COPD, Supplemental oxygen therapy, Hypoxemia, Hypercapnia.

Akut Solunum Yetmezliği Olan KOAH Hastalarında İlave Oksijen Tedavisinin Hipoksi Ve Hiperkapniye Etkisi

Öz

Giriş: Kronik obstruktif akciğer hastalığı (KOAH) akut atağında; hipoksemi ve hiperkapniye sıklıkla rastlanılmaktadır. Amaç: Solunum yetmezliği olan KOAH hastalarında, nazal kanül ile verilen 2 L/dk oksijenin, hipoksemi ve hiperkapniye etkisini araştırmaktır. Gereç ve Yöntem: Yirmi altı tip I (Grup I) ve 36 tip II (Grup II) solunum yetmezlikli hasta çalışmaya alındı. Hastaların başvuru klinik ve laboratuar bulguları kaydedildi. Hastalar tam tıbbi tedavi yanısıra nazal kanülle 2 L/dk ilave oksijen aldıktan sonra, solunum fonksiyon testleri ve arter kan gazı (AKG) ölçümleri tekrar edildi. Tedavi ile PaCO2 değerleri 10 mmHg'dan daha fazla yükselenler Grup III'ü oluşturdu ve geri kalan hastalarla (Grup 4) karşılaştırılmaları yapıldı. Bulgular: Başlangıç laboratuvar parametrelerinden; PaO2 Grup II'de daha düşüktü. Her iki grupta tedavi sonrası saptanan PaO2 değerlerindeki artış istatistiksel olarak anlamlıydı (p<0.001). Tedavinin sonunda PaO2 değerleri, Grup I ve II'de sırasıyla 23 hasta (%88.5) ve 26 hastada (%77.2) 60 mmHg'nın altında kaldı. Tedavi sonrası PaCO2 değeri 21 hastada (%28.8) yüksek bulunurken, 7 hastada (%11.3) 10 mmHg'nin üzerinde artış saptandı (Grup III). Biri hariç bu hastaların tümü Grup II'ye aitti (p>0.05). Grup 3'de Grup 4'e göre hastalık süresinin daha uzun olması ve kor pulmonale'nin daha fazla olması istatistiksel olarak anlamlı saptandı (p<0.05). Sonuçlar: KOAH akut atak hastalarında nazal kanülle 2 L/dk oksijen verilmesinin hastaların önemli bir kısmında hipokseminin düzeltilmesinde yeterli olmayacağı ve hiperkapnik hastalarda söz konusu oksijen tedavisinin %15-20 olguda PaCO2'yi daha fazla yükseltebileceği bulunmuştur. Anahtar kelimeler: KOAH, İlave oksijen tedavisi, Hipoksi, Hiperkapni.

Anahtar Kelimeler

• KOAH, İlave oksijen tedavisi, Hipoksi, Hiperkapni.

References

1. www.goldcopd.org. GOLD Scientific Committee. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: NHLBI/WHO Global Initiative for chronic obstructive pulmonary disease (GOLD) workshop report. Updated 2004.
2. Siafakas NM, Vermeire P, Pride NM. Optimal assessment and management of chronic obstructive pulmonary disease (COPD). Eur Respir J 1995; 8: 1398-420.
3. Goldstein RS, Ramcharan V, Bowes G, McNicholas WT, Bradley D, Phillipson EA. Effects of supplemental nocturnal oxygen on gas Exchange in patients with severe obstructive lung disease. N Engl J Med 1984; 310: 425-9.
4. Bateman NT, Leach RM. ABC of oxygen: Acute oxygen therapy. BMJ 1998; 317: 798-801.
5. ATS Statement. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1995; 152: 77-120.
6. Murphy R, Driscoll P, O’Driscoll R. Emergency oxygen therapy for the COPD patient. BMJ 2001; 18(5): 333-9.
7. Malloy R, Pierce M. Oxygen therapy. In: Dantzker DR, MacIntyre NR, Bakow ED, eds. Compherensive Respiratory Care. Philadelphia: Saunders Company. 1995: 499- 519.
8. Rees PJ, Dudley F. ABC of oxygen: Provision of oxygen at home. BMJ 1998;317: 935-8.

9. Murphy R, Mackway-Jones K, Sammy I, Driscoll P, Gray A, O’Driscoll R, O’Reilly J et al. Emergency oxygen therapy for the breathless patient. Guidelines prepared by North West Oxygen Group. BMJ 2001; 18(6): 421-3.
10. Lavery GG. Fear of hypercapnia is leading to inadequate oxygen treatment. BMJ 1999; 318: 872.
11. Williams AJ. ABC of oxygen: Assessing and interpreting arterial blood gases and acid- base balance. BMJ 317; 1998: 1213-6.
12. Light RW. Acute respiratory failure. In: George RB, Light RW, Matthay RA, eds. Chest Medicine. New York: Churchill Livingstone, 1983: 609.
13. Sassoon CSH, Hassell KT, Mahutte CK. Hyperoxic-induced hypercapnia in stable chronic obstructive pulmonary diseases. Am Rev Respir Dis 1987; 135: 907-11.
14. Bedon GA, Block AJ, Ball WC. The “28%” Venturi mask in obstructive airway disease. Arch Intern Med 1970; 125: 106-13.
15. Bone RC, Pierce AK, Johnson RL. Controlled oxygen administration in acute respiratory failure in chronic obstructive pulmonary disease: a reappraisal. Am J Med 1978; 65: 896-902.
16. Moloney ED, Kiely JL, McNicholas WT. Impact of controlled oxygen therapy on gas exchange in patients with respiratory failure due to an acute exacerbation of COPD. Thorax 1998; 53: Suppl 4S: 11A.
17. Hlastala MP, Swenson ER. Blood-gas transport. Fishman’s Pulmonary Diseases and Disorders. In: Fishman AP (editor- in-chief). New York: McGraw-Hill Companies, Inc; 1988: 203-20.
18. Corresponding Author: Dr.Levent Cem Mutlu
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