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Uncontrolled Oxygen Administration and Respiratory Failure in Acute Asthma

      Study objectives

      To determine if 100% oxygen administration adversely influences gas exchange in acutely ill asthmatic subjects.

      Design

      Prospective preinterventional and postinterventional comparison.

      Setting

      University hospital emergency department.

      Patients

      Thirty-seven asthmatic subjects seeking care for symptomatic exacerbations.

      Interventions

      Twenty minutes of 100% oxygen administration by face mask.

      Measurements and results

      Arterial blood gases and FEV1 were measured before and during the last minute of oxygen administration. On presentation, the subjects had moderately severe airway obstruction (FEV1, 49.1 ± 3.6% of predicted); hypocarbia (Paco2, 36.8 ± 1.1 mm Hg); hypoxemia (Pao2, 70.2 ± 2.5 mm Hg); and respiratory alkalosis (pH, 7.43 ± 0.01). During oxygen breathing, 25 patients (67.6%) experienced elevations in Paco2 ranging from 1 to 10 mm Hg (mean, 4.1 ± 0.6 mm Hg; p = 0.0003). The increase was considered to be a physiologic manifestation of the Haldane effect (ie,≤ 2 mm Hg) in 10 subjects, but in the remaining 15 subjects (40.5% of the total studied), the elevation represented worsening gas exchange. In seven of these patients (46.7%), hypercapnic respiratory failure developed (Paco2 before oxygen, 39.6 ± 0.6; during oxygen, 44.7 ± 0.7 mm Hg; p = 0.005), and in six patients (40%), it worsened (Paco2 before oxygen, 46.8 ± 1.9; during oxygen, 52.0 ± 3.1 mm Hg; p = 0.03). In general, the tendency toward hypercarbia was the greatest in the participants with the most severe airway obstructions.

      Conclusions

      Our data demonstrate that the administration of 100% oxygen to acutely ill asthmatics may adversely influence carbon dioxide elimination.

      Key words

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