Controlled oxygen therapy and carbon dioxide retention during exacerbations of chronic obstructive pulmonary disease

• Published in: The Lancet (British edition) Vol. 357; no. 9255; pp. 526 - 528
• Main Authors: Moloney, Edward D, Kiely, John L, McNicholas, Walter T
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 17.02.2001; Lancet; Elsevier Limited
• Subjects: Aged; Biological and medical sciences; Carbon dioxide; Carbon Dioxide - blood; Chronic obstructive pulmonary disease; Chronic obstructive pulmonary disease, asthma; Female; Humans; Hypercapnia - etiology; Lung Diseases, Obstructive - blood; Lung Diseases, Obstructive - complications; Lung Diseases, Obstructive - therapy; Male; Medical sciences; Oxygen; Oxygen - adverse effects; Oxygen - therapeutic use; Pneumology; Prospective Studies; Respiratory diseases; Respiratory therapy; Retention; Risk Assessment; Human; Lung disease; Corticosteroid; Respiratory disease; Bronchodilator; Carbon dioxide; Retention; Hypercapnia; Oxygen addition; Antibiotic; Hypoxemia; Bronchus disease; Obstructive pulmonary disease
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(00)04049-6

Hypoxaemic patients with exacerbations of chronic obstructive pulmonary disease (COPD) are at some risk of carbon dioxide (CO 2) retention during oxygen therapy. We quantified the risk of CO 2 retention with oxygen therapy in COPD in 24 consecutive patients presenting to the accident and emergency department with acute exacerbations associated with hypercapnic respiratory failure (partial arterial pressure of oxygen [PaO 2] <8 kPa and partial pressure of CO 2 [PaCO 2] ⩾6·5 kPa). Only three patients developed clinically important CO 2 retention (defined as a rise in PaCO 2 <1 kPa) with controlled oxygen therapy (24–40% by Venturi mask to maintain the oxygen saturation at 91–92%). These patients presented with more severe hypercapnia, but all three required only low-flow oxygen (24–28%). These findings suggest only a small risk of aggravating hypercapnia with controlled oxygen supplementation.