Warning: What follows is top secret information recently leaked to me from one of the nation’s most prestigious pulmonologists at a highly respected teaching institution. Read at your own risk. This is not edited.
The following is an excerpt from a lecture given by Dr. Ven Tolin, MD, PhD, MBA, at some point in the recent past.
Warning: What follows is top secret information recently leaked to me from one of the nation’s most prestigious pulmonologists at a highly respected teaching institution. Read at your own risk. This is not edited.
The following is an excerpt from a lecture given by Dr. Ven Tolin, MD, PhD, MBA, at some point in the recent past.
Transcript:
<pre style="font-family: Courier New, monospace; font-size: 14px; line-height: 1.4;">
Read at your own risk. This is not edited.
The following is an excerpt from a lecture given by
Dr. Ven Tolin, MD, PhD, MBA,
at some point in the recent past.
T R A N S C R I P T
</pre>
It has come to our attention that respiratory therapists continue to express concern when physicians lower oxygen on patients who appear, at least on the surface, to require it.
This is understandable.
RTs are trained to focus on things like oxygen saturation, work of breathing, and basic human survival. However, what they often fail to grasp is the deeper biochemical strategy at play.
Today I will once again explain why reducing oxygen remains one of the most effective ways to manage elevated CO₂ levels.
It all comes down to the Krebs Cycle.
You may remember this from your early training, although it is unlikely you fully understood it. Oxygen is required for aerobic metabolism, and aerobic metabolism produces CO₂.
So if you think about it:
More oxygen leads to more metabolism.
More metabolism leads to more CO₂.
Therefore, if a patient has too much CO₂, the logical solution is simple:
Lower the oxygen.
At this point, the RT may begin to object.
They may say things like, “The PaO₂ is 47,” or “The patient looks terrible,” or even “They need oxygen to survive.”
These are surface-level observations.
We must think deeper.
By lowering oxygen, we limit aerobic metabolism and therefore reduce the production of CO₂ at its source. In this way, we are not just treating numbers—we are solving the problem at the cellular level.
In fact, one could argue that the most effective way to eliminate CO₂ is to eliminate the conditions required to produce it.
RTs often struggle with this concept.
They may quietly increase the oxygen when you leave the room. They may document concerns. They may even attempt to explain physiology.
Remain calm.
You are the physician.
If necessary, place a note in the chart stating:
"DO NOT INCREASE OXYGEN UNDER ANY CIRCUMSTANCES."
This usually restores order.
A word of caution: do not attempt to fully explain this theory to a respiratory therapist. Excessive exposure to advanced medical reasoning may result in confusion, frustration, or spontaneous eye rolling. In rare cases, it may cause the RT’s head to swell to dangerous proportions.
We do not want that.
In conclusion, while RTs may continue to rely on outdated concepts such as oxygenation, ventilation, and patient comfort, we as physicians must remain committed to higher-level thinking.
Remember:
Not everything that appears necessary... actually is.
END TRANSCRIPT
Editor’s note (RT Cave, 2026):
Sometimes the best way to understand a bad idea...
is to take it seriously all the way to the end.
Editor’s note (RT Cave, 2026): Sometimes the best way to understand a bad idea… is to take it seriously all the way to the end.
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