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Sunday, January 8, 2017

How do you define small-town hospital?

Where I work is relatively considered a small-town hospital. So what is a small town hospital? How is a small-town hospital any different than any other hospital? Are all so called small-town hospitals the same; do things operate the same?

Where I work there are 64 registered hospital beds. Actually, they just closed down the psyche unit, so that eliminates about ten. So, we are down to 54. And some of the remaining rooms are offices. So, is a small town hospital defined as a hospital with less than 100 beds? Can we define it that way. 

I live just outside the city. The City has a population of just outside 10,000. The total number of people in the entire county is about 60,000. The region is set up in such a way that there is a county east, north, and south of us. 

Shoreline (fake name I have always used) is a port city: Lake Michigan is to the west of us. Unlike the city 20 minutes to the North of us, our hospital is centrally located in such as way that we draw in quite a few patients from these surrounding counties. This makes Shoreline quite a bit busier than that hospital to our North. 

I know they are less busy than us, because I worked there and my friends work there. When I worked there all I did was sit and wait for something to happen. Okay, it was that slow. So, is small-town defined by regional population? Does a population of, say, less than 100 define small-town? Or is it defined by how busy you are?

If it's defined by population, then Shoreline is a small-town hospital today just as it was in 1997 when I started working here. However, if it's defined by how busy you are, then Shoreline used to be something else -- something bigger -- and is now considered a small-town hospital. I say this because we used to be very busy most of the time, now we are very busy very little of the time (I can delve into the reason why in a future post). 

At Shoreline we used to be very busy. At hospital-just-north-of us they have never been busy. Okay, so that makes us bigger than them. So, are they small-town and we bigger-town, or medium-town. And another hospital about two hours east of us is probably busier than us, as they have a college to deal with. So, are they considered even-bigger town hospital? 

Our critical care unit holds six patients. When I first started working for Shoreline in 1997, we used to have a vent on a regular basis. In fact, I remember quite a few days we had five, maybe even six, vents. And there was always someone on the vent long-term. 

Those days are gone. The reason is a story for another day. Today, most of the patients in our CCU are probably step-down patients at a larger hospital, or a city hospital. So, the acuity of our patients is not what it used to be. People with heart attacks are immediately shipped. Neuro patients are shipped. Traumas are shipped. Kids, for the most part, are shipped. They go to the experts at the larger hospitals. 

Basically, if you want to put it this way, we are an adult hospital. I mean, that's basically what a small-town hospital is these days. And if you really want to get specific, we specialize in your common surgeries and basic medical issues. That's pretty much it these days. 

For instance, we take care of people in the end stages of COPD to help them get over their flare-ups. We take care of patients with heart failure. We give them lasix. Our doctors order lots of breathing treatments (Not because they are needed, but because respiratory therapists need something to justify their existence). 

Sure, there's a few other things we do. We have an occasional kid. We have an occasional broken bone. We have an occasional diabetic. We have an occasional asthmatic. We have an occasional person with cystic fibrosis (although it's been a long time). We basically, as a respiratory therapy department, dole out breathing treatments for pneumonia and heart failure. We treat that audible wheeze caused by fluid overload with more fluid. 

So, back to the question: what is a small-town hospital? How do we define it? I personally think the definition has changed in the 20 years I've been doing this. Do we define it by geography (less than, say, 60,000 people in the surrounding county? Do we do it by patient load: fewer than 100 beds?  

So, how do you define small town hospital? 

Monday, January 2, 2017

COPD Resolutions You Should Keep

The following was written by me and published at healthcentral.com/copd on January 4, 2016

COPD Resolutions You Should Keep

A New Year's Resolution can be a powerful aide to helping you live well with COPD. Here are some we think would be perfect for you to choose from.
 
1.  Learn about your disease.  Both COPD and Asthma are complex diseases that researchers are learning more and more about every day. It's a good idea purchase a book so you can become a pseudo expert on your disease. Or, at the very least, continue to hang out at sites like this, as we do our best to keep you updated with the latest wisdom. This is also important because there are a lot of new respiratory medicines in the pipeline, and you'll want to be aware of them when they come out. Who knows, the next discovery might lead to a cure for our disease.
 
2.  Walk more frequently.  I recently wrote a post about titled, "9 Ways Exercise Improves Asthma Control."  You should go ahead and read that article (and then come back here), because the same is true for COPD. The more you exercise, the stronger your heart and lungs become, and the more efficient they become at pumping oxygen and nutrients through your body. This leads to better breathing.  As a bonus, it also improves your mood and your overall sense of wellbeing. Look, there are even victims of COPD who walk marathons.
 
3.  Join a pulmonary rehabilitation program.  This kind of goes along with walking more frequently. Pulmonary rehabilitation programs can help you get the exercise you need while educating you about your disease, and helping you meet others just like you to give you the support you need.  Actually, Pulmonary Rehabilitation is now a top-line recommendation for anyone with a COPD diagnosis, especially if you get winded doing normal routines (like going to the bathroom or brushing your teeth). Again, exercise makes your cardiovascular system work better, making you more tolerent to exercise.
 
4.   Eating healthier.  Look, many of us have difficulty maintaining a healthy weight. But if you have a breathing disorder, it's almost essential that you eat healthier.  Most experts recommend eating five or six smaller meals, rather than three large ones. The reason is that a full stomach pushes up on your diaphragm, making less room for your lungs to expand. You could try to do this on your own, or, better yet, you could have your doctor refer you to a dietician who can give you tips to healthier eating.
 
5. Eliminate carbonated beverages from your diet.  A good idea for any person with a lung disease is to lay off the pop and beer. For one thing, they can cause gas and bloating, and this causes your stomach to push up on your diaphragm making less room for your lungs to move.  They may also increase the carbon dioxide in your blood, which is chronically elevated in some COPD patients anyway. A good idea is to avoid them altogether, or at least limit your intake to one or two a day.
 
6.  Go on vacations.  Even if you need supplemental oxygen 24/7, the equipment is now so modernized you should be able to go anywhere. You can travel across the state to visit relatives you haven't seen in a while, or simply go on a vacation for fun (like to Disney World).  The idea here is that you can still keep living, you can still have fun, even with a chronic lung disease like COPD.
 
7.  Participate in a COPD community like ours.  The best place to learn about your disease is to hang out at communities like ours.  Here you will get the expert advice from doctors, nurses, and respiratory therapists like me.  We will educate you about your disease, provide tips to help you live better with it, and sometimeseven share our own stories. Along with experts like me, you will also meet other people living with it just like you. So feel free to hang out with us, sign up for our newsletters if you want, and have a Happy Easy Breathing New Year!
 
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Sunday, January 1, 2017

A different take on the 2017 Detroit Tigers

Michael Fulmer, 2016 MLB Rookie of the Year
"So in all likelihood, this will be the last go-round for the team as it's constructed."

This is what we have been hearing about the Detroit Tigers for the past couple years. The above was written in a cbsssports.com post by Jason Beck calle, "Tigers try to might be in store for another shakeup."

Can sportswriters get more creative than this? It doesn't matter if you read articles at cbssports.com, espn.com, or any other site: they all say the same thing. If I were a sportswriter and couldn't say anything unique, then I'd be inclined to quit writing. 

Here at the RT Cave, it has been a mission that we don't rehash what is written on other writers. In fact, this is so important here that we have made it our written mission. In fact, our mission statement reads:

"Respiratory Therapy Cave was established to portray an accurate, non-politically correct view of the profession of respiratory therapy. The goal is: "Do not write like everyone else."

For crying out loud, I think I would quit writing if I wrote what other authors were saying and it was the same stuff I was saying. 

So, I think the Detroit Tigers are far from an elite team at the present moment, but I fail to believe they are on their last leg. 

For one thing, they missed the playoffs by a measly 2.5 games. This was true despite losing a freakish 14 times to the Cleveland Indians. I cannot fathom how that could possibly happen again. 

Likewise, they took almost half the season to establish their pitching staff. This was mainly due to fluke injuries, and to the fact it takes time to establish young pitchers, which was the case with Michael Fulmer and Daniel Norris. 

They have made few changes this offseason, despite a threat by GM Al Avila that all cards would be on the table, including possible trades of big names like Miguel Cabrera, Victor Martinez, Ian Kinsler, Justin Verlander, and J.D. Martinez. 

However, as of this writing, all of those guys are still on the team. Plus, Kinsler, J.D. Martinez and Upton will be free agents at the end of the 2017 season. So, it makes sense for the Tigers to keep their current team together with the hopes that they can make a shot at the playoffs this year. 

And, if they fail to stay healthy, or if their young players fail to live up to expectations, and they are out of the playoff running in July, they can trade Kinsler, J.D. Martinez and Upton at the trade deadline for potential big payoffs. This might not be unlike the blockbuster trades made midseason in 2015 when the Tigers traded big names for the likes of Fulmer and Norris among others. 

So, if the Tigers are in contention in July of 2017, then they should stay put. If they are out of contention, that they can trade upcoming free agents for prospects that can help them get to the playoffs in 2018. 

Plus, look at David Ortiz. He was 40 years old last year and had his third best season. He almost single handedly drove the Red Sox into the playoffs (and, along the way, drove my fantasy baseball team to our league championship). So, while many players see a decline in their mid to late 30s, there's no guarantee we will see with the likes of Cabrerra and Verlander. 

Being realistic here, they may fall flat on their face. But there are still many options for the Tigers to continue to stay in contention, at least so long as they have an owner like Mike Ilich who is salivating for a Detroit Tiger's World Series. 

So, my argument here, is the Tigers are far from "a last go around," as most other writers seem to contend. They might be right, but it would be boring for me to rehash what their pessimism about the 2017 Tigers. 

Tuesday, December 20, 2016

Asthma Christmas Wish List

The following was written by me and published at healthcentral.com/asthma on December 18, 2015.

Our Asthma Christmas Wish List

I recently participated in a brainstorming session with a group of respiratory therapists.  Our goal was to create a list of medicines asthmatics would like to find under the Christmas tree. That in mind, here’s our list of fake, or yet to be developed, asthma medicines.  This is our wish list we sent to Santa.

1. Probiotic Magic.  Probiotic is a fancy way of saying good, or healthy, bacteria that are essential for maintaining a healthy body.  Microflora is a fancy term for describing all the microbes inside our body, good and bad, such as parasites and bacteria.  The Microflora Hypothesis states that a normal balance of good and bad microflora inside our gut prevents an abnormal immune response that leads to asthma and allergies.  It also states that our modern diet, and antibiotic use, is killing off good microflora, leaving a microflora imbalance. A probiotic pill would, when swallowed, help the gut and immune system prevent allergic asthma.

2. Pig Vaccine.  The Hygiene Hypothesis states that our own cleanliness causes an abnormal immune response that leads to asthma. The idea is that, lacking certain “good bacteria” early in life when our immune systems are developing, it gets bored and starts attacking innocuous substances ingested or inhaled, leading to asthma and allergies.  This theory first came to light when it was observed that asthma rates were relatively low in underdeveloped countries. Studies actually showed asthma rates were lower among children who grew up on farms, particularly near pigs. A theory was postulated that animals, like pigs, carry the “good bacteria” our immune systems need to mature properly.  So our vaccine would involve a one time injection during the first month of life when the immune system is still developing, particularly in those infants shown to have an asthma gene.

3. Super Safe Steroid.  Systemic steroids are often used in emergency situations to end asthma attacks by reducing inflammation and swelling in asthmatic lungs.  Even though they make breathing easy, they cannot be taken long term due to some pretty awful side effects.  What we need is a synthetic version of this medicine that allows us to get the desired effects without the unwanted side effects. Ingesting a super safe steroid pill would prevent asthma symptoms.  A bonus is that it would also prevent other inflammatory diseases from flaring up, like arthritis.  So, along with better breathing, you’d also be pain free, too.  

4Anti-Allergy Drops.  Three drops in the morning, placed gently on your tongue, would prevent your immune system from attacking innocuous substanceswithout causing drowsiness.  In other words, it would prevent allergies from happening sans side effects.  If we can prevent and control allergies, we can also prevent asthma attacks in those with allergic asthma.  This would allow those with allergic asthma to live normal lives, as they no longer would have to avoid their asthma triggers. No more avoiding dusty basements.  No more avoiding your aunt with all the dogs and cats.  Yes, you could just be a normal person for a change (aside from having to use the drops every day, but that’s an acceptable trade off).  

5Fortnight Asthma Puffs.  This is an inhaler that is inhaled once every two weeks to prevent and control asthma. It’s a combination inhaler that contains both Probiotic Magic and Super Safe Steroid. It’s timed delayed action lasts two weeks, making it an ideal asthma medicine.  All you have to do is remember to mark your calendars, or download the Fortnight Asthma App for your iPhone which will remind you when your puffs are due.

Look, pharmaceuticals have come a long way to creating some great asthma medicines to help us live better lives.  Yet there is still some work to do, and this is where Santa comes in handy.  Here’s hoping Santa keeps us asthmatics in mind this Christmas season. Wishing you easing breathing this Holiday season!

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Monday, December 19, 2016

Christmas-time COPD triggers

The following was written by me and published at healthcentral.com/copd on December 18, 2015.

8 Christmas COPD Triggers

In order to get the most out of the Christmas season, those of us with lung disorders have to be wary of Christmas asthma triggers. Here are those seven triggers along with some tips to help you get around them.   

1. Real Christmas Trees.  Christmas trees are a common decoration in homes during the Christmas season.  But they may also be filled with unseen substances that can get into the air, such as dust mites, pollen and mold spores.  When you carry them into your home, and shake them, these allergens end up in the air of your home for you to inhale, possibly causing flare-ups. While some experts recommend avoiding them altogether, others suggest that rinsing them off with water, and letting them air dry, prior to bringing them into your home should remove most of these allergens. It may be best, however, to delegate this job to someone else.

2. Artificial Christmas Trees. So, if real trees are full of COPD triggers, fake trees should be better, right? Well, experience shows this not to be the case.  Artificial trees may be fine the first time you set them up.  But after storing them in boxes in closets and basements, they become breeding grounds for dust mites.  When you open the box and put the branches on the tree, you’re inadvertently  freeing these microscopic critters into the air and inhaling them. The best solutionhere, other than avoiding them, is to rinse the tree off with water and letting it dry before setting it up. But this job should be delegated to someone other than you.  Another solution is to store your tree in an airtight container.  

3. Decorations. Dust mites are the culprits here too.  Decorations are stored in boxes in closets, attics, and basements.  Like fake trees, they become infested with dust mites.  One way to avoid this is to store decorations in plastic storage bins to keep dust mites out.  Another solution is to let someone else set up the decorations.

4. Visitors. Okay, so the greatest joy of the holiday season is spending time with friends and family. Still, visitors carry germs that can get you sick, and even a common virus (common cold) can cause a flare-up.  The greatest culprits here are little children, who love to share their germs through their sniffles and sneezes, but also their hugs and kisses.  We certainly recommend spending time with those you love, just make sure they know that their germs might take your breath away. As best you can, try to stay away from sick people. And, no matter who you’re spending time with, just note that the single best method of avoiding the spread of germs is by frequent hand washing with antimicrobial soap or hand sanitizer.

5. House Cleaning.  Of course part of the holiday season is getting your home ready for guests. While this may seem like no big deal, chemicals inside some cleaning supplies can act as rather potent COPD triggers.  Just make sure you are careful not to use cleaning supplies that may cause problems for you. One solution here is to simply stick with the cleaning solutions you’ve already been using. Or, better yet, let someone else do the cleaning.  

6. Scented Candles. Candles and incense can make your home smell good for the holiday season.  But it’s also good to remember that strong smells may also act as COPD triggers.  Likewise, smoke from candles and incense may also act as triggers.  It’s probably best just to avoid them altogether.

7. Wood Fires.  A fire in the fireplace can make a home feel very cozy for the holiday season.  The problem is that wood smoke in and of itself may trigger flare ups. Also posing a problem is the stack of wood next to the fireplace, which may contain mold spores and pollen. So it’s best to just avoid lighting the fire and keep the logs outside.  However, newer fireplaces can be lit by electricity or gas, and these should be fine.

8. Stress. So you’re known for shopping long hours searching for that perfect gift.  You’re known for spending hours decorating your home just right, and preparing the perfect meal.  These are things that can cause ongoing pressure during the holiday season, causing a rise in hormones that may weaken your immune system and cause flare-ups.  The best solution here may be to delegate some of the responsibilities that come with the holiday season to others.  And, chances are, they will be more than willing to help you.

Enjoy the holiday season!  So long as you are aware of them, these eight potential COPD triggers should not stop you from having a joyous holiday season. Here’s our opportunity to wish you and your family a Merry Christmas and a Happy New Year!

Further Reading

Saturday, November 19, 2016

5.5 Million Clicks on This Blog

I just realized that we are now over 5.5 million views on this blog. That's pretty impressive, at least I think so. For a blog that I started on October 13, 2007, just so I could have something to do while working the night shift, that's pretty good.

Here we are, nine years later. I knew that I was going to focus on respiratory, but I had no idea what specific topics I was going to cover. I had no idea that this blog would take off the way it did, and the other opportunities that would transpire as a direct result of this blog.

I wrote my first post about a Beeper. How stupid! Much of my earlier writings were poorly written. Still, I was dedicated to it and would end up publishing at least one post every day for the first five years.

About a year after I started this blog, I received an email from a publisher at healthcentral.com. She wrote: "I love your blog. I especially love your humor. I love the way you write about 'stupid doctor orders,' and 'Bronchodilator reform.' We would love to have someone like you writing for us. We are willing to pay."

Of course, when you get emails like this, your first quest is to make sure it's real and not spam. This would spawn a writing career at healthcentral.com for the next seven years, and now at asthma.net and copd.net.

I have not been writing so much for this blog in recent years. This is not because I don't want to, more so that I now work day shift, have two more kids than I had back then, and don't have as much time for telling the truth about the respiratory therapy profession.

I would like to thank everyone who comes around here once in a while to see if there's anything new. I thank all those who have come here in the past. I thank all those of you who have written me emails or written comments such as, "I love your blog." It motivates me.

I will probably take a break for a while, but chances are pretty good I will keep this blog going. If you have questions, I will continue to answer them. In the meantime, I just want to say, "Thank YOU!!!" Thank you for making this blog such a success. The RT Cave is still the most popular respiratory therapy blog on the Internet, and that's all because of YOU. Thanks!

Monday, October 17, 2016

Debunking The Hypoxic Drive Theoery: The Truth About The Affects Of Oxygen On COPD

Originally published January 6, 2016.

I was recently interviewed by Rebecca Knutsen, a staff writer working for Advance for Respiratory Therapists.  She said she was working on a brief article that explores when to administer oxygen to hypoxemic patients with chronic obstructive pulmonary disorder.

The following are her questions followed by my answers.  

1.  Please describe hypoxic and hypercapnic drive:

Hypercapnic Drive: The central chemoreceptors on the medulla monitors the partial pressure of arterial CO2 (PaCO2). A normal PaCO2 level is 35-45 mmHG. When PaCO2 is high (>45 mmHg) a signal is sent to the medulla oblongata at the base of the brain to speed up breathing in order to blow off excess PaCO2. When PaCO2 levels are low (<35 mmHg) a signal is sent to the medulla oblongata at the base of the brain to decrease breathing in order to allow PaCO2 to accumulate. This is the main drive to breathe.

Hypoxic Drive: The peripheral chemoreceptors located at the bifurcations of the aortic arteries and the aortic arch monitor partial pressure of arterial oxygen (PaO2). This drive only becomes active when the PaO2 is less than 60 mmHg. This hypoxic response is far slower than signals sent by central chemoreceptors, and therefore the hypoxic drive has only a minor role in breathing.

2.  What tests does your organization use and what do they measure?

ABG: This is a blood draw from the radial, brachial or femoral artery that measures PaO2, PaCO2 and arterial pH.

Pulse oximeter: It’s a noninvasive device that slips over a finger, toe, or ear lobe. It determines the SpO2, which is an estimation of hemoglobin in the blood that are saturated with oxygen. This percentage can be used to estimate PO2. Generally, an SpO2 of 90 indicates the PO2 is about 60.

End Tidal CO2 Monitor: It’s a noninvasive device that can be connected to special nasal cannulas or endotracheal tubes. It determines the ETCO2, which is an estimation of the amount of CO2 exhaled. This percentage can be used to estimate PaCO2. In a person with healthy lungs, the EtCO2 is about 2-5 mmHg less than PaCO2.

3.  When is it recommended to administer oxygen to hypoxemic patients with COPD? 

Most medical experts now recommend administering the lowest amount of oxygen needed to maintain an SpO2 of 88-92%, or as directed by a physician.

4.  Why is hypoxic drive so controversial? 

The hypoxic drive is not controversial, it’s the hypoxic drive theory that’s controversial. To understand why it is so controversial it’s important to understand a little of the history of it. 

Back in the late 1940s and 50s, when oxygen first started to be used for patients with chronic obstructive pulmonary disease, it was observed that some of them became lethargic or lapsed into a coma after receiving high levels of oxygen.

Initial studies showed a decrease in ventilation in 26 of 35 patients with COPD given oxygen therapy, with a rise in CO2 and a fall in pH. A further study showed that stopping and starting oxygen therapy led to a fall and rise in CO2 respectively.

The concern became so great that in the 1950s a study was performed that ultimately lead Dr. EJM Campbell to give a lecture to pulmonologists in 1960 about the dangers of giving too much oxygen to COPD patients. It was this lecture that forever linked hypoxic drive with COPD, and gave birth to the hypoxic drive theory.

What is the hypoxic drive theory? The hypoxic drive theory states that some patients with COPD develop chronically elevated arterial CO2 levels, and so their hypercapnic drive becomes blunted, so they use their hypoxic drive to breathe instead. 

Therefore, giving high amounts of oxygen to these patients may blunt the hypoxic drive as well, thus completely blunting their drive to breathe. This may cause PaCO2 levels to rise to critical levels, resulting in narcosis and possible death. For this reason, COPD patients with suspected CO2 retention are limited to 2-3 lpm by nasal cannula, or 40% by venturi mask.

What’s wrong with this theory? The problem with this theory is that it’s a myth concocted on incomplete evidence. The study cited by Campbell included only four patients with COPD, and later studies failed to validate this theory. Yet it has continued to be a gold standard theory when dealing with COPD patients.

Under the guise of this theory, many patients who desperately need higher levels of supplemental oxygen to survive are deprived of it. Plus, as many respiratory therapists, nurses, and physicians have observed, when these patients are given the oxygen they need, rarely does this lead to complications.

When these patients go into respiratory failure, it’s going to happen regardless of how much oxygen they receive. And while higher levels of oxygen may cause CO2 to rise, it’s not due to oxygen blunting their hypoxic drive, which the hypoxic drive theory postulates, it’s due to either the Haldane effect or V/Q mismatching.

The Haldane effect: This was postulated by John Haldane, a pioneer in oxygen therapy. He proved that the Deoxygenation of arterial blood increases its ability to carry carbon dioxide. In other words, as fewer oxygen molecules are attaching to hemoglobin, more CO2 are attaching to hemoglobin.

Oxygen is more soluble in water and therefore has a higher affinity for hemoglobin, so if you increase oxygen in the blood, CO2 molecules are forced off hemoglobin and oxygen takes its place. This causes an increase PaCO2.

Add into this the fact that patients with COPD have limited reserves to increase their respiratory rate to blow off excessive CO2. Also add into this that many COPD patients already have an elevated hemoglobin levels, and so these patients are going to have lots of extra arterial CO2 molecules.

Out of respect for this theory, COPD patients should be maintained on the lowest level of oxygen required to maintain an oxygen saturation between 88-92%.

The Haldane effect was proven by a study described in 1996 in Critical Care Medicine, "Causes of hypercarbia with oxygen therapy in patients with chronic obstructive pulmonary disease."

V/Q Mismatching: The air passages of COPD lungs become narrow due to remodeling, increased mucus production, and bronchospasm. Where this occurs the lungs are perfused but poorly ventilated. CO2 returning to these areas remain in arterial bloodstream, thus causing PaCO2 to rise.

Add into this that when alveoli are poorly ventilated the vasculature around them will constrict so oxygen goes to alveoli that are ventilated well. This is how these patients make efficient use of their diseased lungs.

Now add 100% oxygen and you screw up this naturally occurring phenomenon. Now the vasculature around that non-ventilating alveoli dilates, and this causes blood to be sent to the non functioning alveoli. Now you have even greater V/Q mismatching and more CO2 that doesn't get out of arterial blood. The end result is an increase in PaCO2.

If a patient with COPD is going to fail this is going to be the reason. If they need oxygen you give it to them, because doing otherwise will further compromise them. If they go into respiratory failure, you treat it with either noninvasive ventilation or mechanical ventilation.

V/Q Mismatching was proven via a study completed in 1980 and reported in American Review of Respiratory Disorders, "Effects of the administration of O2 on ventilation and blood gases in patients with chronic obstructive pulmonary disease during acute respiratory failure,"

Conclusion: Modern evidence suggests that the hypercapnic drive is never completely blunted, and therefore even COPD patients with chronically elevated PaCO2 will not stop breathing in the presence of higher oxygen levels. There is such a thing as the hypoxic drive, but the hypoxic drive theory is a myth.

To read the final published version of my interview read "Oxygen and COPD: Debunking the hypoxic drive theory."

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