OXIGEN THERAPY

Kusman Ibrahim, Ph.D

Fakultas Keperawatan Universitas Padjadjaran
Out line presentation
Introduction
Conditions for oxygen therapy
Administration
Monitoring Monitoring
Side effects
Conclusion
Introduction
Oxygen is a colourless, odourless and
tasteless gas that is essential for the
body to function properly and survive
The air we breathe contains 21%
oxygen (O2), 78% nitrogen (N2) and oxygen (O2), 78% nitrogen (N2) and
1% of other gases
Oxygen therapy is the administration
of oxygen as an intervention, which
can be for a variety of purposes in
both chronic and acute patient care
administration of oxygen at concentrations
greater than that in room air to treat or prevent
hypoxemia (not enough oxygen in the blood).
Purpose:
increase oxygen saturation in tissues where the
Introduction
increase oxygen saturation in tissues where the
saturation levels are too low due to illness or
injury
increases the amount of oxygen in the blood
reduces the extra work of the heart
decreases shortness of breath
Delivery of oxygen to tissues depends on :
- Inspired oxygen concentration
- Alveolar ventilation
- Ventilation-perfusion distribution within the
lungs
Introduction
lungs
- Hb concentration
- concentration of CO
- Cardiac output
- Distribution of capillary blood flow within the
tissues
Oxygen levels in the blood can be helpful or
damaging
Conditions for oxygen therapy
Acute Conditions : in emergency care
1. Resuscitation
2. Documented hypoxia
3. Severe respiratory distress (acute asthma or 3. Severe respiratory distress (acute asthma or
pneumonia)
4. Shock
5. Cor pulmonale
6. Acute myocardial infarction
7. Severe trauma
8. Pulmonary hypertension
9. Major hemorrhage
10. Convulsion
11. Hypothermia
Conditions for oxygen therapy
11. Hypothermia
12. As home therapy to abort cluster headache
attacks,due to its vasoconstrictive effect
13. Used as a drug delivery route as nebulizer
mask for delivery of Salbutamol or Epinephrine
Three forms of oxygen therapy:
1. Normobaric oxygen (NBO), also called surface or sea level
oxygen, is the administration of supplemental oxygen (24 to
100%) at atmospheric pressure. Examples of medical
conditions include asthmas, congestive heart failure,
pulmonary oedema or as a first-aid treatment in search and
rescue operations. It is also used for anaesthesia during
surgeries.
2. Hyperbaric oxygen (HBO): In this treatment, 100 % oxygen is
breathed at elevated pressure. It is an essential treatment
in many conditions, including decompression illness,
carbon monoxide poisoning, burns and mountain sickness.
3. Hypobaric or altitude oxygen: Because of the physiological
limitation of humans when operating at altitude, they require
an O2 concentration greater than that inspired at sea level to
prevent hypoxia.
Chronic Conditions :
1. COPD
2. Lung fibrosis
3. Sleep apnea
Conditions for oxygen therapy
3. Sleep apnea
4. Kyphoscoliosis
5. Myopaties/muscular dystrophy
6. Brain stem lesion
7. Right-to-left shunts
Administration
Source Pressure regulator flow meter (L/min)
Supplemental oxygen:
1. Nasal cannula (nasal prongs):
- The most common and inexpensive , easy to
apply, does not interfere with the clients ability to

apply, does not interfere with the clients ability to

talk or eat, comfortable
- Delivering 0 low concentration of 24-45% at 2-
6LPM
- > 6 LPM, tend to swallow air and the Fi 0 is not
increased
- Limitation: inability to deliver high concentrations
of 0, and can be drying and irritating to mucous
membranes
Administration
2. Face Mask
- Simple face mask delivering 0 concentration of 40-
60% at liter flows of 5 8 LPM
- Partial rebreathing mask delivering 0 concentration of
60-90% at liter flows of 6 10 LPM
- Nonrebreathing mask delivering 0 concentration of

- Nonrebreathing mask delivering 0 concentration of

95-100% at liter flows of 10 15 LPM
- Venturi mask delivering 0 concentration varying from
24% to 40%, or 50% at liter flows of 4 10 LPM. It
has wide bore tubing and color-coded jet adapters
that correspond to a precise oxygen concentration
and liter flow
Slmple lace Mask
(low flow sysLem)
arLlal 8ebreaLher Mask
non-8ebreaLher Mask
Administration
2. Face Tent
- Can replace oxygen masks when masks are
poorly tolerated by clients
- Provide varying concentration of oxygen, e.g
30% - 50% at 4 8 LPM
- Frequently inspect for dampness, dry, and
treat as needed
Cx?CLn 1Ln1
Low flow oxygen devlce, usually lndlcaLed for
pedlaLrlc paLlenLs.
High concentration (40-60%) 0 via high flow
mask are particularly useful in acute type I
respiratory failure because respiratory drive
is high, such as acute asthma, pneumonia,
pulmonary edema, pulmonary embolus,
Administration
pulmonary edema, pulmonary embolus,
ARDS. when used for prolonged periods, it
should be humidified by passing over warm
water
Low concentration (Venturi masks 24-28%)
are particularly useful in delivering controlled
0 therapy in type II respiratory failure.0
delivery through a nasal cannula vary
depending on minute ventilation, nasal
Administration

depending on minute ventilation, nasal
blockage, and tendency to mouth-breath.
humidification is not necessary as a high
proportion of atmospheric air is mixed with 0
In COPD, and type II respiratory failure, patient
develop an abnormal tolerance to raised CO
and may become dependent on hypoxic drive to
breath. In these patients, lower 0 concentration
is needed to avoid precipitating worsening
Administration

is needed to avoid precipitating worsening

respiratory depression.
Positive pressure delivery system is used in
patient who are unable to breathe on their own.
use of AMBU bag, Resuscitator used in surgery
with anesthetic machines.
MonlLorlng
In patient with acute respiratory failure, close
monitoring is essential and arterial blood
gases taken on presentation should be
repeated within 20min to establish that it has
achieved acceptable Pa0 levels 55mmHg or

achieved acceptable Pa0 levels 55mmHg or

0 saturation of 88%
Side Effects
Vasoconstrictive effect on the circulatory system
May increase the effect of stroke
Seizures
In infants, may cause blindness (promoting In infants, may cause blindness (promoting
overgrowth of blood vessels in the eye
obstructing sight, this is retinopathy of
prematurity.
Also in infant, it may contribute to construction of
a ductus arteriosus
In adult ,pulmonary 0 toxicity manifested
by pulmonary edema and free radical
damage leading to fibrosis.
Administration of high levels of 0 in
patient with type II respiratory failure which
Side Effects

patient with type II respiratory failure which

reduces respiratory drive precipitating
respiratory failure and can lead to death
RISK OF FIRE!!!
Conclusion
Oxygen is essential for cell metabolism, and in
turn, tissue oxygenation is essential for all
normal physiologic functions.
Prompt recognition of life threatening situations Prompt recognition of life threatening situations
and immediate administration of oxygen
appropriately will benefit the patient in reducing
morbidity and mortality.
4/12/2012 34