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Oxygen is one of the key elements that sustains life. Patients with Chronic Obstructive Pulmonary Disease (COPD) benefit from oxygen therapy, but an overdose may lead to hyperoxia, causing carbon retention or hypercapnia.
Care givers and COPD patients using an oxygen concentrator need to understand how their device works and use the recommended settings as prescribed by their doctor. We have compiled this guide on the safe use of an oxygen concentrator while managing COPD. Our information is based on extensive research, medical journals, and the experiences and reviews of patients with COPD.
In this article, you will learn about hypercapnia, its key symptoms, and warning signs. We will also include how oxygen overdose is diagnosed in hospitals and at home. The article also provides a guide on the safe use of supplemental oxygen for COPD patients and offers tips on using portable oxygen concentrators (POCs).
Hypercapnia is an adverse health effect resulting from the overdose of oxygen. It is a condition that causes elevated carbon dioxide retention in patients with COPD due to overexposure to supplemental oxygen. Hypercapnia manifests when the partial pressure of carbon dioxide (PaCO2) rises above 45 mm HG.
Causes of Hypercapnia include any condition that increases carbon dioxide levels or inhibits the lungs from expelling the gas. These conditions can lead to hypoventilation or a V/Q mismatch.
Hypoventilation occurs when the breathing rate is low, despite the presence of breathing, resulting in carbon dioxide retention in the body.
V/Q mismatch is when you are breathing in enough air (ventilation, or V), but you don't have enough blood flow to the lungs (perfusion, or Q), or vice versa. In COPD patients using oxygen due to the presence of dead air sacs (alveoli), it causes the lungs to fill with oxygen but fails to remove all the CO2 from the blood.
A patient who is having excessive carbon dioxide retention may experience mild to severe effects, and in the worst cases, it can be fatal. Carbon dioxide retention affects the haemoglobin function. In severe cases, it can affect both the pulmonary system and the central nervous system (CNS).
The groups of people who are likely to experience Hypercapnia include hyperbaric oxygen therapy patients, patients exposed to high levels of oxygen over an extended time, scuba divers, and neonates.
So, what action should you take if a COPD patient exhibits signs of Hypercapnia while using an oxygen concentrator? First, you need to lower the output level of the patient device. You can adjust this by reconfiguring your oxygen concentrator's flow rate and output concentration.
In normal circumstances, air intake stimulation occurs due to an increase in carbon dioxide in the blood. However, some COPD patients chronically have high levels of carbon dioxide, which makes them lose the sensitivity of breathing, triggering of air intake in such patients due to low oxygen levels, known as a hypoxic drive.
Too much oxygen in COPD patients poses the following risks. (watch video)
COPD patients can detect the mild symptoms of hypercapnia caused by oxygen overdose. Prolonged oxygen overdose can lead to a critical medical condition with severe symptoms. If you're a COPD patient using oxygen therapy, it is essential to monitor your health condition and report any changes to your healthcare provider.
Caregivers and other family members should also help in the day-to-day monitoring of the patient for any signs of hypercapnia.
If you exhibit the above signs, reduce the oxygen concentrator flow rate and seek medical assistance for medication to reverse overdoses.
Accurate diagnosis and continuous monitoring of oxygen levels are critical in managing COPD and preventing hypercapnia.
Caregivers and loved ones should remain attentive and regularly observe the patient’s changes in breathing patterns, alertness, or the development of symptoms that may suggest oxygen toxicity or low oxygen supply.
There are two primary methods for testing oxygen saturation in the blood: through a blood test at a clinic or with a pulse oximeter used at home.
In hospitals, a healthcare provider can perform either a pulse oximetry test or an arterial blood gas (ABG) analysis. Although the pulse oximetry test is noninvasive, it can be inaccurate.
ABG, on the other hand, is more precise and guides oxygen therapy, though it requires taking a blood sample from an artery in the wrist and laboratory analysis. This test measures oxygen, carbon dioxide, and blood pH.
ABG is invasive, takes time, and may not be available in all settings. For patients with COPD, the optimal oxygen range is SaO₂ of about 88–92% on ABG, with an arterial PaO₂ of approximately 55–65 mmHg.
Home management and monitoring of COPD patients using oxygen require proper use of the oxygen concentrator and regular monitoring with a pulse oximeter. The optimal SpO₂ range when using a pulse oximeter is 88–92%. This level ensures a reduced risk of oxygen overdose and carbon dioxide retention.
Always follow your prescribed oxygen settings and observe daily for signs of hypercapnia.
We also recommend seeking medical attention if you experience any of the mild symptoms above. Always ensure you are using the right oxygen concentrator at the correct settings.
You can purchase a pulse oximeter for use at home. To use the device, attach a clip-like sensor to a finger or earlobe to measure blood oxygen levels.
However, the device, as mentioned above, can give inaccurate readings due to various reasons, including:
Supplemental oxygen is vital for COPD patients who exhibit low blood oxygen saturation levels. However, oxygen therapy for COPD patients should aim for an SpO₂ of 88–92% when tested with a pulse oximeter. SpO₂ levels above 92% in COPD patients may increase the risk of hypercapnia.
Thanks to the invention of portable oxygen concentrators (POC), COPD patients can lead an everyday life.
The compact and lightweight devices use electricity and sucks in surrounding air, filter nitrogen, and deliver up to 95% of concentrated oxygen. POCs support both pulse rate and continuous flow settings, making them ideal for patients with different needs.
Tips on proper usage of a portable oxygen concentrator
Oxygen concentrators are available in various models to cater to different needs. Home oxygen concentrators are larger and heavier, although they come with a cart for improved mobility. There are also smaller models known as portable oxygen concentrators that come with a carry-on bag.
You need to thoroughly understand the functions and capabilities of your portable oxygen concentrator. Some devices have lower output levels and fewer flow settings, which may not meet the needs of all patients.
Oxygen concentrator settings vary depending on the model. However, most devices support both pulse rate and continuous flow settings. You need to use the device's correct settings as instructed by your doctor to avoid hypercapnia.
An example is when you need oxygen during sleep and use a CPAP or BiPAP device; in this case, a continuous flow portable oxygen concentrator would be the most suitable option. Pulse flow settings are ideal for patients who require low oxygen volumes.
Portable oxygen concentrators use rechargeable batteries. Always ensure you have enough power to last more than 1 ½ times the duration you expect to use the device when not connected to the mains.
If you plan to use your portable oxygen concentrator for travel, ensure you pack fully charged spare batteries and carry with you charger adaptors for compatibility at the destination or in the car.
The best portable oxygen concentrator for travel should be compact, lightweight, and ergonomically designed to facilitate easy carrying. Look for a device that supports longer battery life and has varying charger adaptors.
If you are flying or traveling to high-altitude areas, look for a device that can operate at altitudes above 8,000 feet. Some devices, due to the lower air pressure at high altitudes, may deliver lower oxygen volumes.
COPD patients in need of oxygen therapy can now enjoy a more active life by using portable oxygen concentrators as an alternative. However, there needs to be control during treatment to avoid too much or inadequate oxygen.
Oxygen therapy helps COPD patients continue enjoying life without difficulties. POCs, in particular, increase a patient's mobility.
If you are using oxygen, you should always consult with your doctor during the therapy period. Always follow the prescription and use the correct settings on your device.
