High-Dose Oxygen Therapy and Acute Hypercapnia in Elderly Patients: A Case Series Analysis
Abstract
Case series Patients: Female in her late 80s • Female in her 90s • Female in her 90s Final Diagnosis: Oxygen-induced hypercapnia Symptoms: Shortness of breath Clinical Procedure: Supplemental inhaled oxygen therapy Specialty: General and Internal Medicine • Pulmonology Objective: Mistake in diagnosis Background: Detection of episodes of desaturation on pulse oximetry in elderly people in community settings is now a common occurrence. Transfer of such patients to hospital by ambulance has led to a greatly increased exposure to high-dose (FiO2 > 50%) inhaled oxygen therapy in this group. Current British Thoracic Society (BTS) guidelines recommend administration of oxygen, 15 L/min via a non-rebreather mask (NRB) to acutely hypoxemic patients with an SpO2 below 85% on room air. In some elderly subjects, such high-dose oxygen therapy induces significant hypercapnia in the absence of an identifiable risk factor for oxygen-induced CO2 retention. Case Reports: This case series describes 3 very elderly (>85 years old) female patients developing acute hypercapnia shortly after initiation of high-dose inhaled oxygen therapy. In each of these cases, hypercapnia developed in the absence of an accepted risk factor for oxygen-induced CO2 retention. In 2 cases, CO2 narcosis resolved within hours of the establishment of controlled oxygen therapy on bi-level positive airway pressure (BPAP). The possibility of oxygen-induced CO2 retention was not considered by the treating physicians in the…
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Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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