Oxygen Uses and Precautions
Giving oxygen, without proper monitoring, can be life threatening to a person with Duchenne who has pulmonary dysfunction (breathing issues). It is important to follow the recommended care below for giving supplemental oxygen and monitoring carbon dioxide closely.
Risk of Respiratory Failure
Because people with with Duchenne have weak respiratory muscles, their diaphragms do not move up and down well and their intercostal muscles (the muscles that move the chest walls) do not expand the ribs well. Therefore, as the disease progresses, it becomes difficult to cough and clear the airway, and to take deep breaths. Shallow breathing can provide the body with adequate oxygen supply and adequate removal of carbon dioxide. That delicate balance of oxygen and carbon dioxide allows breathing to continue.
When extra or supplemental oxygen is given, this delicate balance is disturbed. The respiratory center may get the false impression that the body has enough oxygen and no longer needs to breathe. Without breathing, carbon dioxide can build to dangerous levels (called hypercapnia) that can result in death.
Ways of giving supplemental oxygen and monitoring carbon dioxide safely include:
- Monitoring End-tidal CO2: Oxygen should never be given without constantly monitoring the level of carbon dioxide (CO2) in the expired (exhaled) breath (the “end-tidal CO2”) or the CO2 level in blood. A normal end tidal CO2 is between 30-45 mmHg. A CO2 level of greater than 45 mmHg is too high, and indicates that CO2 is not being expelled from the body.
- Testing Hemoglobin: Hemoglobin in the blood becomes saturated with oxygen that the blood takes to the body. If hemoglobin is tested and is found to not be saturated with oxygen, that too can be an indication that there is too much CO2 in the body and that not enough oxygen is getting into the blood.
- Providing Non-invasive Ventilation: Bi-PAP via mouthpiece or nasal cannula will assist with the mechanical process of breathing, delivery of oxygen, and removal of CO2.
Be sure to present this information to professionals during an emergency and prompt them to monitor your child closely.