What is the role of oxygen therapy in the treatment of hypoventilation syndromes?

Updated: Jul 22, 2021
  • Author: Jazeela Fayyaz, DO; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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Because many patients with hypercapnia also are hypoxemic during the day, oxygen therapy may be indicated.

Oxygen therapy is indicated to prevent the sequelae of long-standing hypoxemia. Patients with COPD who meet the criteria for oxygen therapy have a decreased mortality when treated with continuous supplemental oxygen therapy. Oxygen therapy also has been shown to reduce pulmonary hypertension.

Use oxygen therapy with caution because it may worsen hypercapnia in some situations. In patients with COPD, the presence of worsening hypercapnia following oxygen therapy is a consequence of ventilation-perfusion mismatching rather than reduced ventilatory drive secondary to reduction in hypoxia.

Hypercapnia is best avoided by titration of oxygen delivery to maintain oxygen saturations in the range of 90-94% and PaO2 between 60 and 65mm Hg.

Approximately 50% of patients with OHS require oxygen therapy in addition to nocturnal bilevel PPV. [2] However, breathing 100% oxygen may cause worsening hypercapnia in stable patients with obesity-associated hypoventilation, due to a reduction in minute ventilation, resulting in alveolar hypoventilation and an associated increase in the volume of dead space-to-tidal volume ratio. Therefore, oxygen therapy should be administered with caution in patients who are morbidly obese. [21] Oxygen use alone is often an inadequate therapy for OHS.

Patients with neuromuscular disease should not usually be given oxygen therapy without ventilatory support.

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