For patients with COPD and others at risk of hypercapnic respiratory failure, titrate supplemental oxygen to a saturation of 88-92%, not the 94-98% used for most acutely unwell adults. Uncontrolled high-flow oxygen can worsen carbon dioxide retention and precipitate respiratory acidosis.
Prescribe oxygen to a target range, use controlled delivery (such as a Venturi mask) when retention is a risk, and check an arterial or capillary blood gas if the patient is deteriorating or newly drowsy. The goal is enough oxygen to correct hypoxaemia without over-oxygenating.
- Target SpO2 88-92% in COPD and others at risk of hypercapnic failure.
- Avoid uncontrolled high-flow oxygen, which can worsen CO2 retention.
- Prescribe oxygen to a target range and use controlled delivery when retention is a risk.
- Check a blood gas if the patient deteriorates or becomes drowsy.
Why it matters
Over-oxygenation in COPD is a common, avoidable cause of hypercapnic acidosis and deterioration.
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