Chronic Obstructive Lung Disease - Oxygen-Replacement Therapy

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Transtracheal Oxygen. Transtracheal oxygen is delivered directly into the windpipe (trachea) through a catheter tube implanted by a surgeon. The device is inconspicuous, and patients are very likely to use it. Long-term complications may include infection, dislodgment, and blockage by mucus, which can be very serious. Complications of the procedure itself occur in 3 - 5% of cases and can include lung spasms and uncontrollable coughing.

Electronic Demand Devices. Electronic devices that sense the beginning of a breath and deliver a pulse of oxygen are also available, although they are complicated, expensive, and have a risk for mechanical failure. Newer units have a continuous flow bypass switch that allows oxygen to still be delivered if the battery runs down.

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Devices to Assist Breathing

In emergency situations, oxygen may be delivered to the patient in various ways:

Noninvasive Positive Pressure Ventilation (NPPV). If the patient is able to breathe naturally, oxygen is delivered through a tube using a tightly fitted oxygen mask to maintain airway pressure during breathing. Some physicians now believe such devices should be first-line treatments (in addition to medications) for managing respiratory failure after an acute exacerbation. NPPV allows the patient to talk and drink fluids, and is much easier to tolerate than nose or throat tubes. It cannot be used on patients with rapidly deteriorating COPD, those who are uncooperative, or those who have a facial shape that does not allow the mask to seal tightly.

Intubation. When standard oxygen therapy does not meet a patient's needs, endotracheal intubation may be required to deliver high concentrations of oxygen. With intubation, a tube is inserted down through either the nose or the mouth, and oxygen is given through the tube.

Mechanical Ventilation. In very serious cases such as acute respiratory failure, a mechanical ventilator can be used to take over the function of breathing. The primary goal of ventilation is to remove carbon dioxide and restore a balanced exchange of gases.

Most patients have a low tolerance for intubation, and the tubes are often removed early due to discomfort. Patients with these tubes may need painkillers, sedatives, or muscle relaxants.

There are also several complications that lead to the removal of breathing tubes:

• Bleeding
• Ejection of the tube after coughing
• Mucus plugs

Review Date: 04/10/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).