Oxygen induced hypercapnia

Jonathan Ilicki is back with a bedtime story for new docs about oxygen-induced hypercapnia

Imagine a hypoxic COPD patient in the resus room. After some inhalations and oxygen the patient is no longer hypoxic, but now you see a pCO2 of 12.3. Why is the patient retaining carbon dioxide? What should you do? Watch the lecture for a 5 minute summary (including bad puns), or read the summary below!


Guaranteed the internet’s best (and only) bedtime story about blood gas physiology

What causes oxygen induced hypercapnia?

To date we are aware of three different mechanisms:

1. Hypoxic drive – COPD patients’ respiratory rate is affected by pO2 levels (not only pCO2 as normal)

2. Ventilation/perfusion mismatch – the additional oxygen opens up flow to alveoli which are functioning poorly

3. Haldane effect – the additional oxygen makes hemoglobin release carbon dioxide
Different researchers have different opinions about the magnitude of these different effects.

Key takehomes

1. Always give oxygen to a hypoxic patient. Hypoxia is a fast killer, whereas you can sort out hypercapnia later

2. Normal respiratory rate doesn’t rule out hypercapnia, since there are several mechanisms at play. Follow repeated ABGs!

3. Oxygeninduced hypercapnia can affect patients with other chronic lung disease, not just COPD patients


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Medical doctor and clinical innovation fellow passionate about Emergency Medicine and the intersection of science, EBM and technology. Currently leading medical innovation and development at a Scandinavian healthtech company.

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1 year ago

What a sweet story :D

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