How can you identify a COPD patient who relies on hypoxic drive?

It has been suggested that clinicians are occasionally hesitant and even fearful when prescribing oxygen for the CO2-retaining COPD patient because of concerns over increasing hypercapnia. We have been taught that prescribing oxygen does more good than harm if a patient is clearly distressed and should not be denied to any COPD patient in the ED, as only ~5% rely on hypoxic drive to ventilate.

How can we recognise the patients who actually rely on hypoxic drive?

Authored By Stephen McAleer on Saturday 10th November 2012

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Ben Blackman
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Medical Student - St. Georges University, London
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Posted about 7 years ago

Luma has been really comprehensive; my tuppence worth is that it's always worth looking at the bicarbonate on the ABG.

The CO2 and pH will tell you that they're retaining CO2 and they're acidotic, but the bicarb is a good indicator

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Dr Luma Khalid
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Posted about 7 years ago

First thing to understand is oxygen should be prescribed in all patients be they dependent on hypoxic drive or not! I believe your familiar with hypercapnic respiratory failure or type 2 respiratory failure! For the purpose of clarification patients wh

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John Laughlin
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Medical Student - Cardiff
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Posted about 7 years ago

Great answers. Just an addition. There's a really good recent article in the BMJ on Emergency Oxygen use that clearly explains this.

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