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Tuesday, October 8, 2013

Hospitalists: Under and over oxygenating no more

I have done a tone of talking and writing about how wrong the hypoxic drive theory is a hoax based on an experiment with only 4 COPD patients back in the 1960s.  Regardless, I have witnessed many COPD patients suffer and die needlessly because a doctor refused to allow him the oxygen he required based on this popular myth.

By clicking on the link above, you will see that the myth has been disproved many times since that infamous experiment in the 1960s, but there continue to be an amalgamate of doctors who don't care; they continue to worship the myth as a primitive medicine man worships his favorite gods.

Physicians educated back in the 1980s either haven't seen the evidence, or refuse to accept it.  I asked one of our Interists once his thoughts on the myth, and he said, "It just sounds to good to be true."  Another Internist said, "I think it's a sound theory."  Another said, "I feel it's a valid theory."

There's this old theory:  Priests believe, lovers hope, and science knows.  Science is not an art.  In science, something either is or it is not.  The evidence has pointed for years to the hypoxic drive theory, that it is not true.  Yet based on the feelings of some physicians, it has lingered long in the medical profession, to the disadvantage of many poor COPD souls.

Then along came our hospitalists. These doctors even came with their own oxygen protocol: Maintain SpO2 of 90% or greater.  That's it.  There were no exceptions for anemia or COPD.  When someone is not oxygenating, we oxygenate.  When someone is over oxygenating, we turn down the oxygen.  It's that simple.

No more do we place oxygen on a patient just because they had anesthetics.  No more do we place oxygen on someone just because they are in critical care.  No more do we place oxygen on someone just because they have chest pain.

To the contrary, no more do we take oxygen off a patient just because they have COPD.  No more are we under oxygenating the very people who need oxygen the most.

Instead, we keep oxygen at a safe and comfortable level that is right for the individual patient:
  1. COPD patients do quite well at 90-92% (some do well with less)
  2. Anemia patients are saturated with oxygen, they simply have no seats on the train
  3. Chest pain patients do not require supplemental oxygen when their SpO2 is > 92% (sorry, more O's will not increase the supply of O's to the heart when there is already an ample supply)
  4. Post operative patients do not require supplemental oxygen when their SpO2 is > 92% 
  5. Critical Care patients do not all automatically require oxygen
I would love to thank the hospitalists.  They have seen the evidence in real life and in the lab that the hypoxic drive theory is a hoax.  For that, we RT are greatly appreciative. 

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