Transforming clinical research into everyday practice: are respiratory care practitioners proactive or reactive?

In 1949 Davies and Mackinnon examined the neurological effects of carbon dioxide (CO2) in the presence of heart and lung disease [1]. They hypothesized that hyper-oxygenation could lead to CO2 retention in individuals with chronic obstructive pulmonary disease (COPD). In their published findings they described “hypoxic drive” and cautioned physicians on using oxygen with COPD patients. Their work captured the attention of the medical community and other investigators [2]. Many in the medical community continued to fear oxygen administration in the presence of COPD, despite ongoing investigation in the field of oxygen therapy in the 1960s and 1970s. Those investigations include the exceptional work of Dr. Tom Petty, considered the father of home oxygen therapy [3]. Thinking began to change slowly following a significant finding by Aubier et al [4, 5] who were investigating oxygen administration in COPD with a new hypothesis; they were looking for a different mechanism as the cause of elevated CO2 levels in the blood. They found that mechanism in the form of “hypoxic pulmonary vasoconstriction” which, like hypoxic drive, is a protective mechanism [5]