Adequate oxygen should be given to relieve hypoxia. A belief (ingrained from medical school) is held widely that too much oxygen causes significant respiratory depression. Multiple studies in the literature dispute this view. With administration of oxygen, PO2 and PCO2 rise but not in proportion to the very minor changes in respiratory drive. However, a prehospital study of patients with acute exacerbations of chronic obstructive pulmonary disease by Austin et al documented lower morbidity and mortality with titrated versus standard high-flow oxygen treatment. In a cluster randomized, controlled parallel group trial in 405 patients, titrated oxygen treatment significantly reduced mortality, hypercapnia, and respiratory acidosis. [6]
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Chronic obstructive pulmonary disease (COPD). Histopathology of chronic bronchitis showing hyperplasia of mucous glands and infiltration of the airway wall with inflammatory cells.
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Chronic obstructive pulmonary disease (COPD). Histopathology of chronic bronchitis showing hyperplasia of mucous glands and infiltration of the airway wall with inflammatory cells (high-powered view).
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Posteroanterior (PA) and lateral chest radiograph in a patient with severe chronic obstructive pulmonary disease (COPD). Hyperinflation, depressed diaphragms, increased retrosternal space, and hypovascularity of lung parenchyma is demonstrated.
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Chronic obstructive pulmonary disease (COPD). A lung with emphysema shows increased anteroposterior (AP) diameter, increased retrosternal airspace, and flattened diaphragms on lateral chest radiograph.
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Chronic obstructive pulmonary disease (COPD). A lung with emphysema shows increased anteroposterior (AP) diameter, increased retrosternal airspace, and flattened diaphragms on posteroanterior chest radiograph.
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Subcutaneous emphysema and pneumothorax.
