Oxygen-Induced Hypercapnia: A Bedtime Story for Doctors

Why does oxygen make a patient retain carbon dioxide? Do only COPD patients suffer from oxygen-induced hypercapnia? Should one give oxygen if the patient’s carbon dioxide is increasing? This bedtime story for doctors answers these questions and delves into medical history, as Red Riding Hood struggles to save her granny from a hypercapnic coma. This video explains why administering oxygen can cause patients to retain carbon dioxide and illustrates the three main causes (that we know of today): decreased respiratory drive, V/Q Mismatch and the Haldane Effect. Thank you to - Jenny Dahlström Ilicki - Illustrations - DALL-E - AI generated book cover art - Pixabay – Stock footage of the moon - Howie Mitchell & Ruth Meyer – Music - ______________________________________________________ References 1. West JB. Joseph Priestley, oxygen, and the enlightenment. Am J Physiol Lung Cell Mol Physiol. 2014;306(2):L111-9. 2. Scheele CW. Chemische Abhandlung von der Luft und dem Feuer1777. 3. Grainge C. Breath of life: the evolution of oxygen therapy. J R Soc Med. 2004;97(10):489-93. 4. Donald K, Simpson T, Mcmichael J, B. L. Neurological Effects of Oxygen. The Lancet. 1949;254(6588):1056-7. 5. Campbell EJ. Respiratory Failure. Br Med J. 1965;1(5448):1451-60. 6. Campbell EJ. The J. Burns Amberson Lecture. The management of acute respiratory failure in chronic bronchitis and emphysema. Am Rev Respir Dis. 1967;96(4):626-39. 7. Aubier M, Murciano D, Milic-Emili J, Touaty E, Daghfous J, Pariente R, et al. Effects of the administration of O2 on ventilation and blood gases in patients with chronic obstructive pulmonary disease during acute respiratory failure. Am Rev Respir Dis. 1980;122(5):747-54. 8. Sassoon CS, Hassell KT, Mahutte CK. Hyperoxic-induced hypercapnia in stable chronic obstructive pulmonary disease. Am Rev Respir Dis. 1987;135(4):907-11. 9. Christiansen J, Douglas CG, Haldane JS. The absorption and dissociation of carbon dioxide by human blood. J Physiol. 1914;48(4):244-71. 10. Lenfant C. Arterial-alveolar difference in PCO2 during air and oxygen breathing. J Appl Physiol. 1966;21(4):1356-62. 11. Luft UC, Mostyn EM, Loeppky JA, Venters MD. Contribution of the Haldane effect to the rise of arterial Pco2 in hypoxic patients breathing oxygen. Crit Care Med. 1981;9(1):32-7. 12. Dick CR, Liu Z, Sassoon CS, Berry RB, Mahutte CK. O2-induced change in ventilation and ventilatory drive in COPD. Am J Respir Crit Care Med. 1997;155(2):609-14. 13. Robinson TD, Freiberg DB, Regnis JA, Young IH. The role of hypoventilation and ventilation-perfusion redistribution in oxygen-induced hypercapnia during acute exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2000;161(5):1524-9. 14. Budinger GRS, Mutlu GM. Balancing the risks and benefits of oxygen therapy in critically III adults. Chest. 2013;143(4):1151-62. 15. Gay PC, Edmonds LC. Severe hypercapnia after low-flow oxygen therapy in patients with neuromuscular disease and diaphragmatic dysfunction. Mayo Clinic proceedings. 1995;70(4):327-30. 16. Vollenweider DJ, Frei A, Steurer-Stey CA, Garcia-Aymerich J, Puhan MA. Antibiotics for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2018;10:CD010257.