OXYGEN THERAPY

Hasanul Arifin

7/25/2013

Definition:

*Oxygen therapy is the administration of oxygen at concentrations greater than ambient air(21%)

*With the intent of treating or preventing the symptoms and manifestations of hypoxia(a deficiency of oxygen reaching the tissues of the body)
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Topics of Discussion
*Types of Hypoxia *Signs and symptoms of Hypoxia *Indications *Contraindications and Precautions *Delivery Systems

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Types of Hypoxia
1-Hypoxic Hypoxia 2-Circulatory Hypoxia 3-Hemic Hypoxia 4-Demand Hypoxia 5-Histotoxic Hypoxia

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Hypoxic Hypoxia

*Low PaO2(arterial oxygen tension) secondary to FiO2< 0.21 or decreased barometric pressure(altitude) *Impaired ventilation secondary to neuromuscular weakness or narcotic overdose *Impaired oxygenation secondary to Pulmonary Fibrosis, ARDS

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Circulatory Hypoxia

*Inadequate pumping of the blood from the heart to tissues , maybe secondary to disorders causing decreased cardiac output such as MI,low fluid volume, hypotension,poor supply of arteries. If the patient has myocardial ischemia supplemental O2 is definitely indicated.

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Hemic Hypoxia

Decreased oxygen carrying capacity as in anemia or carbon monoxide poisoning

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Demand Hypoxia

Increased tissue consumption of oxygen in hypermetabolic states: like fevers

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Histotoxic Hypoxia

Utilization of oxygen is abnormal such as in cyanide poisoning

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Signs and Symptoms of Hypoxia

Tachypnea,dyspnea,hyperpenea, Tachycardia,dysrythmias,pulse change,hypertension Anemia, polycythemia Restlessness, disorientation, lethargy, Cyanosis, digital clubbing
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Indications

1)PaO2 <60mmHg or SaO2 <90%, or as ordered by the MD for a specific clinical situation. PaO2=partial pressure of oxygen as measured in the arterial blood, SaO2=hemoglobins saturation of oxygen in the arterial blood 2)Acute situation where hypoxemia is suspected 3)Severe trauma 4)Acute myocardial infarction 5)Short term, post operative

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Contraindications & Precautions

1)with PaO2 > 60, patients with chronic CO2 elevations may experience ventilatory depression 2)With FiO2 > 0.50, oxygen toxicity, absorption atelectasis, or depression of ciliary and/or leukocytic function 3)Administer with caution to patients receiving bleomycin cancer therapy 4)Fire hazard is increased in the presence of oxygen concentration.
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Definitions

FiO2= Fraction of inspired oxygen, or the percent of oxygen in the inspired gas
Oxygen toxicity is cellular injury of the lung parenchyma and airway epithelium due to release of cytotoxic free oxygen radicals. There is no exact threshold at which O2 toxicity occurs, however signs of gas exchange abnormalities occur within 24-48 hours if on 100% oxygen.Atelectasis leading to drop in PO2,decreased lung compliance, infiltrates on x-ray. Breathing FiO2 up to 0.5 for 2-7 days usually does NOT result in toxicity.
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Additional Information

The national fire protection association requires a no smoking, oxygen in use sign be placed at the entrance of any patients room where oxygen is being delivered regardless of the fact that smoking is prohibited throughout the hospital

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Delivery Systems

Low Flow deliver 100% O2 to the patient at flows less than the patients full breath. Therefore, the patients inspired oxygen concentration is supplemented by the device, and the actual concentration of oxygen depends on the flow from the device, the reservoir for storing the oxygen between breaths, and the size and speed of the patients breath. With low flow devices, flowrate is stable, but FiO2 varies.
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Delivery Systems

Nasal Cannula Simple Mask Venturi Mask Aerosol Devices Non Rebreather Masks

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Nasal Cannulas

Can provide 23-45% oxygen to patients with flowrates up to 6lpm depending on the ventilatory pattern. The reservoir for a nasal cannula is the patients nose. Once the reservoir is filled between breaths, the oxygen is directed into the room. During inspiration, the first part of the patients breath includes the oxygen stored in the nose, and then is supplemented with the oxygen flowing out of the cannula.
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Nasal Cannulas cont.

Each liter of flow will increase the FiO2 approximately 2%-4%. Flowrates in excess of 6 lpm do not augment the inspired gas significantly because the extra gas is directed out to the room and is not available for inspiration. High flows can also result in drying of the nasal mucosa. Humidification of nasal cannulas with a bubble device is recommended for flow rates in excess of 4 lpm.
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Simple Masks

Can provide 31-61% oxygen to patients at flowrates between 5-10 lpm. The reservoir in a simple mask is the space between the mask and the patients face. Since this space is larger than the space in the nose, more oxygen is stored and is available for the next breath, resulting in higher potential of FiO2.
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Simple Masks cont.

Less than 5 lpm is not recommended because a minimum of 5 lpm is needed to flush the exhaled CO2 from the mask. If the PaO2 is too high on 5 lpm, a switch to a nasal cannula would be recommended. The popularity of simple masks has fallen because of the availability of VentiMasks, with control of the FiO2, and are not subject to the changes in FiO2 that occur with a simple mask
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Venturi Masks
Venti-Masks

Can provide 24%-50% oxygen by mixing room air with a precise amount of oxygen thereby delivering a precise FiO2. The size of the port and the oxygen liter flow determine the FiO2. The mask should be fitted to the patient as best as possible to prevent entrainment of room air around the mask which would alter the FiO2.
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Aerosol Devices
Face tents, face masks,trach collar,t-piece

Use the same principle as venturi masks however the FiO2 is dialed in on the top of the aerosol bottle. To provide an FiO2 > or = 0.50 use two aerosol bottles connected using a wye system to provide adequate flow to ensure the FiO2. A heater is added to the trach collar and t-piece because the trach has bypassed the natural warming and humidifying system-the nose
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Non-rebreather masks

Deliver the highest FiO2 of our simple oxygen devices. With a perfect fit the FiO2 may approach 1.0 however the FiO2 is usually in the range of 60%-90% depending on the fit of the mask. The flowrate must be high enough to keep the bag inflated during inspiration. The flow is set at 10+ lpm
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Reference Chart
Method Non rebreather Mask Venti Mask FiO2 (Approximate) 60-80% 24% 26% 28% 31% 35% 40% 50% 35-55% 24% 28% 32% 36% 40% 44% Flowrate (L/min) 10-15 3 3 6 6 9 12 15 5-10lpm 1 2 3 4 5 6
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Simple Face Mask Nasal Cannula

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