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Chest. 2000 Mar;117(3):728-33.

Uncontrolled oxygen administration and respiratory failure in acute asthma.

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  • 1Division of Pulmonary and Critical Care Medicine of University Hospitals of Cleveland, and the Department of Medicine of Case Western Reserve University School of Medicine, Cleveland, OH 44106-5067, USA.

Abstract

STUDY OBJECTIVES:

To determine if 100% oxygen administration adversely influences gas exchange in acutely ill asthmatic subjects.

DESIGN:

Prospective preinterventional and postinterventional comparison.

SETTING:

University hospital emergency department.

PATIENTS:

Thirty-seven asthmatic subjects seeking care for symptomatic exacerbations.

INTERVENTIONS:

Twenty minutes of 100% oxygen administration by face mask.

MEASUREMENTS AND RESULTS:

Arterial blood gases and FEV(1) were measured before and during the last minute of oxygen administration. On presentation, the subjects had moderately severe airway obstruction (FEV(1), 49.1 +/- 3.6% of predicted); hypocarbia (PaCO(2), 36.8 +/- 1.1 mm Hg); hypoxemia (PaO(2), 70.2 +/- 2.5 mm Hg); and respiratory alkalosis (pH, 7.43 +/- 0.01). During oxygen breathing, 25 patients (67.6%) experienced elevations in PaCO(2) ranging from 1 to 10 mm Hg (mean, 4.1 +/- 0.6 mm Hg; p = 0.0003). The increase was considered to be a physiologic manifestation of the Haldane effect (ie, < or = 2 mm Hg) in 10 subjects, but in the remaining 15 subjects (40.5% of the total studied), the elevation represented worsening gas exchange. In seven of these patients (46.7%), hypercapnic respiratory failure developed (PaCO(2) before oxygen, 39.6 +/- 0.6; during oxygen, 44.7 +/- 0.7 mm Hg; p = 0.005), and in six patients (40%), it worsened (PaCO(2) before oxygen, 46.8 +/- 1.9; during oxygen, 52.0 +/- 3.1 mm Hg; p = 0.03). In general, the tendency toward hypercarbia was the greatest in the participants with the most severe airway obstructions.

CONCLUSIONS:

Our data demonstrate that the administration of 100% oxygen to acutely ill asthmatics may adversely influence carbon dioxide elimination.

PMID:
10712998
[PubMed - indexed for MEDLINE]
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