Respiratory Therapist/What to expect
We thought my mother had the flu and needed to be seen at the doctors office. I took her and while they were taking her vitals, the nurse ran out of the room and came back with the Dr. in a panic. Her oxygen saturation was only at 30 and they listened to her chest and she had major congestion in all four quads. They sent her to the hospital in an ambulance.Once there they discovered her CO levels were at 103. they tried a few different ways to reduce the levels and have now had to intibate her. They say her lungs are severely damaged and that she has COPD. My father also has COPD, but we have not had this severe of an episode. What is the typical treatment for someone with the situation my mother has and should we be preparing for the worst?
Thank you so much for trusting me with this difficult question. Anything I tell you should be strictly understood as one front-line Respiratory Therapist's opinion, and by no means a definitive medical opinion...I am only able to provide an opinion based on the info you have given me. That being said, you DID give me plenty of stuff to work with.
First things first, those Oxygen and CO2 levels are critical/toxic, and not easy to bounce back from in a patient with COPD. With a CO2 of 103, in my experience, patients generally aren't alive and breathing... and if they are, they are so somnolent (knocked out/drowsy) that they are not aware of their condition or surroundings. I have never seen an O2 level as low as 30, unless you are referring to something called PaO2, which is a way of judging a person's oxygenation status from an arterial blood gas sample. The hospital personnel did the right thing in trying to normalize her before intubating her and placing her on a ventilator. Anytime an "invasive" approach can be avoided, it's better for the patient. But in many cases, intubation is the last and only resort to save a person.
A person with COPD is generally a long-time smoker with lungs that are not fully capable of healing themselves adequately. The toxins in cigarettes, such as tar, nicotene, formaldahyde (yes, the stuff body's are embalmed with) cling to the lungs over the long term and lead to damage to the walls of the lungs that block normal expansion and oxygenation. That congestion the doctor heard was likely a combination of lung sounds we call "crackles" and "rhonchi", which relate to thick mucus the lungs are too weak to clear, along with air pockets (alveoli) that are collapsed and not functioning.
"Typical" treatment is supporting the lungs on the ventilator so that the lungs can be forced to properly ventilate and oxygenate, along with suctioning the lungs out aggressively to remove as much of the problematic mucus as possible. At times, a procedure called a "bronchoscopy" will be performed (both diagnostically and/or therapeutically) so that a doctor can see all the way down into the lowest regions of the lungs to pinpoint exactly where the lungs are failing. I would also anticipate a large amount of of inhaled bronchodilators and steroids in an attempt to open the airways up and decrease the inflammation that may be contributing to the problems. Also, I am sure she will be given doses of antibiotics, flu and pneumonia vaccines if she hasn't had them already, and just good old fashioned time to allow the lungs to rest and heal. Best scenario is a complete recovery, and she quits smoking completely. Worst case scenario is that her lungs are too sick to fully accept and respond to the course of treatment, and her body's systems start failing one by one. I sincerely hope this is NOT the case, but I feel that you deserve complete honesty as to what can happen in cases similar to your mother's.
I sincerely help this response was helpful. I realize it was not the most optimistic response, but again, I am simply going by what I see every day in critical care clinical practice. Best of luck and health to you and your family.