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Some are more sensitive than others.

Posted Jun 18 2008 6:09pm


Over the years of being a Respiratory Therapist I have learned a few different schools of though on the use of oxygen and how effective it is at different levels.



It has varied from:











  • 100%Nonrebreatherto in reality a 70-80%nonrebreather. A lot of nurses actually believe it is really 100% oxygen theNRBis giving.
  • OWL protocol, or Oxygen With Love. This actually really seemed to work and what it was used for was to decrease theoccurrencesof retinal detachment in babies in theNICU. Theprotolwas to keep theSPO2 level between 88-92%. We all know that high levels of oxygen can cause retinal detachment in infants, well this protocol actually worked, it decreased the amount of infant that needed eye surgery due retinaldetachmentfrom around 60% down to below 20% at the hospital I worked at. So did it work, I think so.
  • You need abubblerwith oxygen. No you don't, not always. I do give them our for levels over 4lpmon the nasal cannula IF they are at that level for awhile, or they are getting bloody or burningnares.
  • All Post-Op patient need 2lpmof O2 for 12hrs after surgery. I think not.
  • Anything under 2lpmwith a Nasal Cannula is a worthless on a adult.
That last one is a area that I'm dealing with right now. All of the other hospitals that I have worked for we were in the school of thought that under 2lpm, you might as well just take them off because it doesn't do anything for that patient.



For some reason that has been true so far for me and my patients, until I started here at my current hospital. I recently had 3 different patient who I just couldn't wean off of oxygen. They were a 15 month old, a 60 year old and a 83 year old and they were all on the under 2lpmlevels of oxygen, which seemed to be the kicker.



Now that 15 month old I do understand that pediatric patients do respond to lower levels of oxygen flow, which is why they make a low flow oxygenflowmeterwhich goes from 0.1 to 1lpm. This patient had a possible pneumonia but great sounding lung sounds after a day, but we could not get this child off of the 0.1-0.2lpmof oxygen. Shewoulddrop to the mid to low 80's without it and as soon as I put it back on, poof back up to the high 90's.



Then the 60 year old I had. This person was a long term smoker, probably hadCOPDalso so I would assume that this person lived in the low 90s to the high 80s. But what was interesting is that on RA this patient would drop down to 80% so we would put 0.5lpmO2 on and thesatswould jump back up to 97% right away. Seriously 1/2lpmand thespo2 would jump that high. I was amazed. I had always learned that under 2lpmwas a waste of oxygen and equipment.



Now the last patient, my 83 year old was the same way. I was doing my oxygen rounds and I checked herspo2 on 1lpmand she was 99% on the 1 liter. Great I though, I can take her off the oxygen, which I did. I then came back in a hour just to make sure that thesatswere fine and wow was I shocked. 78% on RA!!!! I'm thinking, "Really no kidding, that 1 liter made that much difference with her!!!". Well it did, I put her back on the 1 liter of O2 andBoooYahhh, it shot right up to 97%. Amazing.



This was in the same night, all three of them had their oxygen issues. This night right heredisapprovedthe idea to me that anything under 2 liters per minute of oxygen is worthless in adults, I was a skeptic but now I think I might be a believer. Even most of the books say a nasal cannula is set between 2-6lpmand 24-36%. Now 1/2lpmis 23% according to the formula:



21% + (oxygen liters per minute *3) =fio2.



That there is under the book definition of the nasal cannula, but it seems to do some good. Oh well as long as they are not dying on me and it's that 1lpmthat is keeping them from doing so, I will keep using the lower levels now as needed.



if anyone has any information or web sites about the lower levels of oxygen on adults I would be very interesting in that information, because like I said I have always heard it worthless under 2lpm, but apparently some patients are more sensitive than others.



Drive onRT'sand thanks for reading.
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