Redhy Sindharta

Anesthesiologist

Faculty of Medicine
Palangkaraya University

Sept 2018
 Most patient with Acute Respiratory Failure (ARF) 
require suplemental Oxygen
 In most cases of ARF  PAO2 can be substantially
increased by use of suplemental oxygen 
increasing the gradient across the membrane and
improving the PaO2
 Suplemental Oxygen can be provided by a variety of
devices
 Important to document to interpret the result properly
 The effectiveness is determined by:

Capacity of the device deliver sufficient oxygen

at high enough flow rate
with
The patient inspiratory flow rate
Nasal Cannula
- Short Prongs of the nasal cannula are inserted into the nares
- Oxgen 100% is delivered, but at a flow rate between 0,5 and 5 L/m.
FiO2 depends on MV. Low-Flow, Low-Oxygen Device

Advantages Disadvantages
Comfortable and well tolerated Cannot be controlled precisely
Easy to use Maximal FiO2 below 0,4-0,5
Higher flow rates  drying and irritating
nasal mucosa
Reservoir Face Mask
- When the mas properly applied  maximized but
rarely exceed an FiO2 0f 0,6-0,9
- A reservoir mask is frequently used for improving
oxygenation in patients with severe hypoxemia until
further evaluation and treatment are accomplished
- High oxygen-flow device

Advantages Disadvantages
Greater ability to control Must create a tight seal
Low Flow Oxygen Inhalation
Systems
The FiO2 delivered may be
estimated as follow:
1. Nasal Prongs (2-4 L/mnt):
21% + 4% every litre per minute
1. Standard Mask (6-8 L/mnt):
FiO2 50-60%
1. Reservoir Mask (Non Rebreather Mask):
FiO2 80-85%
The Dark Site of Oxygen

Unregulated & overzealous

Toxic Metabolites

 Potential powerful and lethal toxin

-
Diagnostic Criteria for ALI and ARDS
1. Acute Onset
2. Presence of a presdiposing condition
3. Bilateral infiltrat on frontal chest x-ray
4. PaO2/ FiO2 < 200 mmHg for ARDS, or < 300 mmHg
for ALI
5. Pulmonary artery oclussion presure ≤ 18 mmHg or
no clinical evidence of left atrial hypertension.
Literatures
1. Society of Critical Care Medicine. Fundamental
Critical Care Support. 4th ed. Mount Prospect, 2007.
2.Marino, Paul L.. Th ICU Book. 3rd edition. Lipipincot
Williams and Wilkins : Philadelphia, 2007.
3. Ooi, Shirley and P.Manning. Emergency Medicine. Mc
Graw Hill: Singapore, 2004.