Article
1 March 1968

Studies of Oxygen Administration in Respiratory Failure

Publication: Annals of Internal Medicine
Volume 68, Number 3

Abstract

The effects of low-flow oxygen administration on arterial blood oxygen tension (PO2) carbon dioxide tension (PCO2), and pH were studied in patients with acute exacerbations of chronic pulmonary disease and who had hypoxemia and hypercapnia while breathing room air. Increases of arterial PO2 in these patients almost always led to rises in arterial PCO2. However, the majority of patients tolerated increases in arterial PO2 to adequate levels without developing large increases in either PCO2 or hydrogen ion concentration. Although there were wide variations in the rise in PCO2 for a given increase in PO2, it was found that patients with low initial PO2 tended to have greater PCO2 rises and that in a given patient the greater the increase in PO2, the greater was the resulting increase in PCO2.
The findings suggest that a majority of patients with respiratory failure consequent to chronic obstructive respiratory disease can be managed with controlled oxygen during an acute exacerbation of their disease, without recourse to tracheostomy and machine-supported respiration. A suggested approach to this method of management is given. The necessity for repeated blood gas analyses for arterial PO2, PCO2, and pH during the care of these patients is stressed.

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References

1.
DONALD K: Neurologic effects of oxygen. Lancet 2: 1056, 1949.
2.
COMROE JHBAHNSON ER, and COATES EO: Mental changes occurring in chronically anoxemic patients during oxygen therapy. JAMA 143: 1044, 1950.
3.
HICKAM JBSIEKER HOPRYOR WW, and RYAN JM: Carbon dioxide retention during oxygen therapy. N. Carolina Med. J. 13: 35, 1952.
4.
WILSON RHHOSETH W, and DEMPSEY ME: Effect of decreasing respiratory minute volume in patients with severe chronic pulmonary emphysema with specific reference to oxygen, morphine and barbiturates. Amer. J. Med. 17: 464, 1954.
5.
WESTLAKE EKSIMPSON T, and KAYE M: Carbon dioxide narcosis in emphysema. Quart. J. Med. 24: 155, 1955.
6.
SIEKER H and HICKAM JJ: Carbon dioxide intoxication: the clinical syndrome, its etiology and management with particular reference to the use of mechanical respirators. Medicine (Balt.) 35: 389, 1956.
7.
PATTERSON JLHEYMAN A, and DUKE TW: Cerebral circulation and metabolism in chronic pulmonary emphysema with observations on effects of inhalation of oxygen. Amer. J. Med. 12: 382, 1952.
8.
BARACH AL: Physiologic methods in the diagnosis and treatment of asthma and emphysema. Ann. Intern. Med. 12: 454, 1938.
9.
BARACH AL: Inhalational therapy, advances and retreats. Anesthesiology 22: 367, 1961.
10.
DONALD KW: Acute respiratory insufficiency. Lancet 1: 495, 1953.
11.
MASSARO DJKATZ S, and LUCHSINGER PC: Effect of various modes of oxygen administration on arterial gas values in patients with respiratory acidosis. Brit. Med. J. 2: 627, 1962.
12.
CAMPBELL EJ: Respiratory failure. The relation between oxygen concentrations of inspired air and arterial blood. Lancet 2: 10, 1960.
13.
CAMPBELL EJ: A method of controlled oxygen administration which reduces risk of carbon dioxide retention. Ibid, p. 12.
14.
CAMPBELL EJ: Oxygen therapy in diseases of the chest. Brit. J. Dis. Chest 58: 149, 1964.
15.
HUTCHINSON DCFLENLEY DC, and DONALD KW: Controlled oxygen therapy in respiratory failure. Brit. Med. J. 2: 1159, 1964.
16.
SEVERINGHAUS JW: Oxyhemoglobin dissociation curve correction for temperature and pH variation in human blood J. Appl. Physiol. 12: 485, 1958.
17.
REFSUM HE: Relationship between state of consciousness and arterial hypoxaemia and hypercapnia in patients with pulmonary insufficiency, breathing air. Clin. Sci. 25: 361, 1963.
18.
MCNICOL MW and CAMPBELL EJ: Severity of respiratory failure: arterial blood-gases in untreated patients. Lancet 1: 336, 1965.
19.
LAL S: Blood gases in respiratory failure. State on admission to hospital and management. Ibid., p. 339.
20.
BRACKETT NCCOHEN JJ, and SCHWARTZ WB: Carbon dioxide titration curve of normal man. Effect of increasing degrees of acute hypercapnia on acid-base equilibrium. New Eng. J. Med. 272: 6, 1965.
21.
ROBIN ED: Abnormalities of acid-base regulation in chronic pulmonary disease, with special reference to hypercapnia and extracellular alkalosis. New Eng. J. Med. 268: 917, 1963.
22.
VAN YPERSELE DE STRIHOU CBRASSEUR L, and DE CONINCK J: The "carbon dioxide response curve" for chronic hypercapnia in man. New Eng. J. Med. 275: 117, 1966.
23.
PENMAN RW: The hypoxic drive in respiratory failure. Clin. Sci. 22: 155, 1962.
24.
FROEB HJLEFTWICH CI, and MOTLEY HL: The induction of respiratory acidosis by oxygen breathing. Amer. Rev. Tuberc. 77: 737, 1958.
25.
PAIN MCREAD DJ, and READ J: Changes of arterial carbon-dioxide tension in patients with chronic lung disease breathing oxygen. Aust. Ann. Med. 14: 195, 1965.
26.
ARNOLD WH and GRANT JL: Oxygen-induced hypoventilation. Amer. Rev. Resp. Dis. 95: 255, 1967.
27.
CHERNIACK RM and HAKIMPOUR K: The rational use of oxygen in respiratory insufficiency. JAMA 199: 146, 1967.
28.
CULLEN JH and KAEMMERLEN JT: Effect of oxygen administration at low rates of flow in hypercapnic patients. Amer. Rev. Resp. Dis. 95: 116, 1967.
29.
DRIPPS RD and COMROE JH: The effect of the inhalation of high and low oxygen concentrations on respiration, pulse rate, ballistocardiogram and arterial oxygen saturation (oximeter) of normal individuals. Amer. J. Physiol. 149: 277, 1947.
30.
HORNBEIN TFGRIFFO ZJ, and ROOS A: Quantitation of chemoreceptor activity: interrelation of hypoxia and hypercapnia. J. Neurophysiol. 24: 561, 1961.
31.
MARSHALL EK and ROSENFELD M: Depression of respiration by oxygen. J. Pharmacol. 57: 437, 1936.
32.
GREEN M and WIDDICOMBE JG: The effects of ventilation of dogs with different gas mixtures on airway caliber and lung mechanics. J. Physiol. (London) 186: 363, 1966.
33.
LEVINE BEBIGELOW DBHAMSTRA RDBECKWITT HJMITCHELL RSNETT LNSTEPHENS TA, and PETTY TL: The role of long-term continuous oxygen administration in patients with chronic airway obstruction with hypoxemia. Ann. Intern. Med. 66: 639, 1967.
34.
CEDERBERG AHELLSTEN S, and MIÖRNER G: Oxygen treatment and hyaline pulmonary membrane in adults. Acta Path. Microbiol. Scand. 64: 450, 1965.
35.
NASH GBLENNERHASSETT JB, and PONTOPPIDAN H: Pulmonary lesions associated with oxygen therapy and artificial ventilation. New Eng. J. Med. 276: 368, 1967.

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Information & Authors

Information

Published In

cover image Annals of Internal Medicine
Annals of Internal Medicine
Volume 68Number 31 March 1968
Pages: 569 - 578

History

Published in issue: 1 March 1968
Published online: 1 December 2008

Keywords

Authors

Affiliations

FREDERIC ELDRIDGE, M.D., F.A.C.P.
CHARLES GHERMAN, M.D.
From the Department of Medicine, Stanford University School of Medicine and Veterans Administration Hospital, Palo Alto, Calif.
This work was supported in part by grant HE-03224 National Institutes of Health, Bethesda, Md.
Dr. Gherman was supported in this study by a postdoctoral fellowship from the U. S. Public Health Service, Washington, D. C.
Requests for reprints should be sent to Frederic Eldridge, M.D., Stanford University Medical Center, Room C228, Palo Alto, Calif. 94304.

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FREDERIC ELDRIDGE, CHARLES GHERMAN. Studies of Oxygen Administration in Respiratory Failure. Ann Intern Med.1968;68:569-578. doi:10.7326/0003-4819-68-3-569

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