# AI instructs to titrate oxygen to SpO2 >96% in a COPD patient, ignoring hypercapnic respiratory failure risk

- **ID:** `medical/oxygen-titration-copd`
- **Domain:** medical
- **Category:** runtime_error
- **Error Code:** `OXYGEN-COPD-HYPERCAPNIA`
- **Verification:** ai_generated
- **Fix Rate:** 88%

## 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%.

## Version Compatibility

| Version | Status | Introduced | Deprecated |
|---------|--------|------------|------------|
| BTS Guideline for Oxygen Use 2023 | active | — | — |
| GOLD Report 2024 | active | — | — |
| NIV (BiPAP) Settings | active | — | — |
| Venturi Mask 24-60% | active | — | — |

## Workarounds

1. **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).** (92% success)
   ```
   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).
   ```
2. **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.** (85% success)
   ```
   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.
   ```

## Dead Ends

- **** — This delivers nearly 100% FiO2, likely causing severe hypercapnia and need for intubation. Use controlled oxygen (e.g., Venturi mask 24-28%) for COPD. (90% fail)
- **** — 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. (75% fail)