{
  "id": "medical/oxygen-titration-copd",
  "signature": "AI instructs to titrate oxygen to SpO2 >96% in a COPD patient, ignoring hypercapnic respiratory failure risk",
  "signature_zh": "AI指示将COPD患者的氧饱和度滴定至>96%，忽略高碳酸血症性呼吸衰竭风险",
  "regex": "(?i)(COPD|chronic.*obstructive|hypercapn|O2|oxygen|saturat|SpO2).*(titrat|target|goal|>96|high.*flow|100%)",
  "domain": "medical",
  "category": "runtime_error",
  "subcategory": null,
  "root_cause": "In COPD patients with chronic CO2 retention, high-flow oxygen can suppress hypoxic drive, leading to worsening hypercapnia and respiratory acidosis. Target SpO2 should be 88-92% in most COPD exacerbations, not >96%.",
  "root_cause_type": "generic",
  "root_cause_zh": "在伴有慢性CO2潴留的COPD患者中，高流量氧疗可能抑制缺氧驱动，导致高碳酸血症和呼吸性酸中毒加重。大多数COPD急性加重期目标SpO2应为88-92%，而非>96%。",
  "versions": [
    {
      "version": "BTS Guideline for Oxygen Use 2023",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "GOLD Report 2024",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "NIV (BiPAP) Settings",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "Venturi Mask 24-60%",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    }
  ],
  "os_specific": {},
  "dead_ends": [
    {
      "action": "",
      "why_fails": "This delivers nearly 100% FiO2, likely causing severe hypercapnia and need for intubation. Use controlled oxygen (e.g., Venturi mask 24-28%) for COPD.",
      "fail_rate": 0.9,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "1 L/min may be insufficient for severe hypoxemia (SpO2 <85%). The correct approach is to use the lowest FiO2 that achieves SpO2 88-92%, not a fixed flow rate.",
      "fail_rate": 0.75,
      "condition": "",
      "sources": []
    }
  ],
  "workarounds": [
    {
      "action": "For COPD exacerbation with suspected hypercapnia, start with Venturi mask at 24% FiO2 (2 L/min). Titrate upward in 2% increments to achieve SpO2 88-92%. Check arterial blood gas after 30-60 minutes. If pCO2 rises >5 mmHg or pH falls <7.35, consider non-invasive ventilation (BiPAP).",
      "success_rate": 0.92,
      "how": "For COPD exacerbation with suspected hypercapnia, start with Venturi mask at 24% FiO2 (2 L/min). Titrate upward in 2% increments to achieve SpO2 88-92%. Check arterial blood gas after 30-60 minutes. If pCO2 rises >5 mmHg or pH falls <7.35, consider non-invasive ventilation (BiPAP).",
      "condition": "",
      "sources": []
    },
    {
      "action": "If Venturi mask not available, use nasal cannula at 1-2 L/min and titrate by 0.5 L/min increments. Maximum safe flow for COPD without hypercapnia risk is typically 4 L/min (approx 36% FiO2). Document target range and ABG results.",
      "success_rate": 0.85,
      "how": "If Venturi mask not available, use nasal cannula at 1-2 L/min and titrate by 0.5 L/min increments. Maximum safe flow for COPD without hypercapnia risk is typically 4 L/min (approx 36% FiO2). Document target range and ABG results.",
      "condition": "",
      "sources": []
    }
  ],
  "workarounds_zh": [
    "对于疑似高碳酸血症的COPD急性加重期，从24% FiO2的文丘里面罩开始（2 L/min）。以2%的增量向上滴定，使SpO2达到88-92%。30-60分钟后检查动脉血气。如果pCO2升高>5 mmHg或pH下降<7.35，考虑无创通气（BiPAP）。",
    "如果无法使用文丘里面罩，使用鼻导管1-2 L/min，以0.5 L/min增量滴定。COPD患者无高碳酸血症风险的最大安全流量通常为4 L/min（约36% FiO2）。记录目标范围和ABG结果。"
  ],
  "transition_graph": {
    "leads_to": [],
    "preceded_by": [],
    "frequently_confused_with": []
  },
  "official_doc_url": "https://www.brit-thoracic.org.uk/quality-improvement/guidelines/oxygen/",
  "official_doc_section": null,
  "error_code": "OXYGEN-COPD-HYPERCAPNIA",
  "verification_tier": "ai_generated",
  "confidence": 0.9,
  "fix_success_rate": 0.88,
  "resolvable": "true",
  "first_seen": "2024-09-18",
  "last_confirmed": "2024-06-01",
  "last_updated": "2024-06-01",
  "evidence_count": 1,
  "tags": [],
  "locale": "en",
  "aliases": []
}