It is common to hear the term that your patient is a "CO2 retainer". But what does that mean? and how do you use oxygen on a patient who is a "CO2 retainer"? The following video by ED4Nurses provides some assistance to answer these questions, as well as an overview of the physiology of COPD. After reviewing the video, reflect on your practice in the ward setting. How do you currently use oxygen therapy on your patient who is a CO2 retainer? What changes could you make to your practice to ensure that your patient does not become acutely hypoxic? How can you better monitor your patient when providing oxygen therapy?

Video 2. Administering oxygen in COPD. Source

You can see from this video, that it is important to keep the oxygen saturation of a patient with COPD to 90-92% however more importantly, monitoring of respiratory rate and arterial blood gases are the keys to managing a patient with an acute exacerbation of COPD. Whilst a patient's chemoreceptors may have adjusted to higher levels of CO2 in the blood, cells cannot function properly without oxygen. Hypoxia at tissue level will result in anaerobic respiration and further contribute to acidosis (see 'what does a decrease in oxygen saturation mean?').

A patient with a high respiratory rate, in obvious distress and using accessory muscles to breath needs prompt medical attention as they will tire easily due to depletion of blood oxygen concentration. Such a patient will develop changes in their arterial blood gases that if not managed carefully will lead to your patient's condition rapidly deteriorating. This may involve a patient requiring non-invasive ventilation such as BiPAP (Bi level positive airways pressure) or invasive ventilation in extremely serious cases. Patients in acute respiratory distress with a high respiration rate should be attended to urgently by a medical officer.