Posted by Steve Schromm on December 11, 1999 at 18:23:35:In Reply to: Re: Hypoxemia posted by Stuart Holtby on March 30, 1998 at 19:20:59:
I do titrations on patients in the hospital. Each one these bilevel ones can be unique.
I had a patient who had low basline SPO2's, about 88-90% when they were sitting on the side of the bed. She was a smoker which means the baseline SPO2 would be falsely high due to the carbon monoxide levels. Also she was obese.
When she laid down and was still awake the SPO2's decreased further. Oxygen was started at 2 and then 3 LPM to increase the levels to about her sitting up levels.
As the test continued she was found to have the OSA that we suspected and, after the Medicare criteria was met, CPAP was initated. O2 flow was bled in and it needed to be increased due to the dilution that tends to happen when adding O2 to CPAP. So we are now at 4 LPM and titrating CPAP and O2 at the same time.
A CPAP of 7 was sufficient to eliminate the OSA/Hypopneas.
Of course the patient went into hypoventilation during REM. Bilevel was started 11/7 brought the patient back up to her basline levels while using the oxygen.
I'm trying to figure out the strategy that should be used with this type of patient.
It seems that we needed to stabilize her waking O2 first using bilevel eariler.
Any ideas?
Steve Schromm