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oxygen therapy  oxygen therapy Presentation Transcript

  • IntroductionIntroduction 07/06/13 1
  • OXYGEN THERAPYOXYGEN THERAPY J.NaNdhakumar mSc (N) I YEar collEgE of NurSINg mTPg & rIhS 07/06/13 2
  • 07/06/13 3
  • Oxygen was discovered by JB Priestley in 1773
  • Composition of Room AirComposition of Room Air Nitrogen 78.08% ~78% Oxygen 20.946% ~21% Trace gases ~1%
  • Definition:Definition: *Oxygen therapy is the administration of oxygen at concentrations greater than room air ( 21%)  *With goal of treating or preventing the symptoms and manifestations of hypoxia(a state of oxygen deficiency reaching the tissues) 07/06/13 6
  • Topics of DiscussionTopics of Discussion *Types of Hypoxia *Signs and symptoms of Hypoxia *Indications *O2 delivery Systems *Hazards o2 therapy 07/06/13 7
  • HYPOXIAHYPOXIA Inadequate oxygen being delivered to the cells 07/06/13 8
  • Types of HypoxiaTypes of Hypoxia 1-Hypoxic Hypoxia 2-Circulatory Hypoxia 3-Hemic Hypoxia 4-Demand Hypoxia 5-Histotoxic Hypoxia 07/06/13 9
  • Hypoxic HypoxiaHypoxic Hypoxia *Low PaO2(arterial oxygen tension) which is secondary to FiO2 < 21% or decreased barometric pressure( high altitude ) *Impaired ventilation secondary to neuromuscular weakness or narcotic overdose *Impaired oxygenation secondary to Pulmonary Fibrosis, ARDS 07/06/13 10
  • Circulatory HypoxiaCirculatory Hypoxia *Inadequate pumping of the blood from the lungs 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. 07/06/13 11
  • Hemic HypoxiaHemic Hypoxia Decreased oxygen carrying capacity as in anemia or carbon monoxide poisoning 07/06/13 12
  • Demand HypoxiaDemand Hypoxia Increased tissue consumption of oxygen in hypermetabolic states : like fever, malignant hyperthermia 07/06/13 13
  • Histotoxic HypoxiaHistotoxic Hypoxia Utilization of oxygen is abnormal such as in cyanide poisoning 07/06/13 14
  • Signs and Symptoms of HypoxiaSigns and Symptoms of Hypoxia Tachypnea, dyspnea Tachycardia, dysrythmias, pulse change, hypertension Anemia, Restlessness, disorientation, lethargy, Cyanosis, clubbing 07/06/13 15
  • IndicationsIndications  1)PaO2 <60mmHg or SaO2 <90% in subjects breathing room air.  PaO2=partial pressure of oxygen as measured in the arterial blood, SaO2=hemoglobin’s saturation  2)Acute situation where hypoxemia is suspected  3)Severe trauma  4)Acute myocardial infarction  5)Short term, post operative 07/06/13 16
  • DefinitionsDefinitions  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 cytoxic 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 50 % for 2-7 days usually does NOT result in toxicity.07/06/13 17
  • DEVICESDEVICES The oxygen delivery devices can be categorized as Low flow systems Reservoir systems High flow systems Enclosure systems 07/06/13 18
  • Oxygen TherapyOxygen Therapy Design & PerformanceDesign & Performance ◦ Low flow Devices  Flow does not meet inspiratory demand  O2 is diluted with air on inspiration  Devices deliver Fio2 ranging from 22-60% E.g  Nasal cannula  Transtracheal catheter 19
  • Nasal CannulaNasal Cannula 20
  • 07/06/13 21
  • NASAL CANNULANASAL CANNULA low oxygen devicelow oxygen device This device delivers an unpredictable amount of oxygen ranging from 25-45 % at 1 - 6 L/min depending on how much the patient inhales through the mouth Higher flow rates are uncomfortable for the patient A high flow rate can quickly dry out the nasal mucosa and become rapidly uncomfortable 22
  • NASAL CANNULA Cont…NASAL CANNULA Cont… low oxygen devicelow oxygen device Delivers 25-45% FIO2 at 1-6 L/min flow 1. Flow 0 liters per minute: 21% (Room Air) 2. Flow 1 liters per minute: 25% 3. Flow 2 liters per minute: 29% 4. Flow 3 liters per minute: 33% 5. Flow 4 liters per minute: 37% 6. Flow 5 liters per minute: 41% 7. Flow 6 liters per minute: 45% 23
  • Reservoir SystemReservoir System  Simple oxygen face mask  Partial rebreathing mask  Nonrebreathing mask 07/06/13 24
  • SIMPLE FACEMASKSIMPLE FACEMASK low oxygen devicelow oxygen device  The simple facemask at an oxygen flow of 6 L/min delivers approximately 35-40 % oxygen  Increasing the flow to 10 L/min may increase oxygen concentration to about 50 %  If the flow rate is less than 6 L/min (as cylinder nears empty), the patient may re-breathe much of his own exhalation and thus, the concentration of oxygen delivered will be low, possibly severely hypoxic  25
  • 26
  • Partial Rebreathing Mask with reservoirPartial Rebreathing Mask with reservoir Moderate oxygen deviceModerate oxygen device Delivers 35-60% Oxygen at 6-10 L/min flow rate Ω First third of exhaled gases mix with reservoir Ω Exhaled gases from upper airway are oxygen rich 27 Reservoir
  • Non-Rebreathing Mask with reservoirNon-Rebreathing Mask with reservoir High oxygen deviceHigh oxygen device Delivers 95% Oxygen at 10-12 L/min Two valves added to Rebreathing mask prevents: ◦ Entrainment of room air during inspiration ◦ Retention of exhaled gases during expiration 28 Valves
  • High Flow systemHigh Flow system  It provide oxygen at flow rates high enough to satisfy patient’s inspiratory demands.  Such high flows( i.e. 35-40 lit approx) are possible by 1. Entrainment of room air 2. High flow rates and reservoirs E.g  Venturi masks  07/06/13 29
  • Oxygen TherapyOxygen Therapy High Flow Devices - EntrainmentHigh Flow Devices - Entrainment AE Devices ◦ AEM (Venti-Mask) ◦ AE Nebulizer (Large Volume Nebulizer)  cool/heated Aerosol 30
  • Oxygen TherapyOxygen Therapy High Flow DevicesHigh Flow Devices Air Entrainment system ◦ What is Entrainment? 31
  • VENTURI EFFECTVENTURI EFFECT Oxygen is forced through a jet orifice entering the mask. As there is pressure drop across jet orifice, room air entrainment occurs through side ports 07/06/13 32
  • Venturi MasksVenturi Masks Venti-MasksVenti-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. 07/06/13 33
  • Air Entrainment Mask 34
  • Copyright ©1998 BMJ Publishing Group Ltd. Bateman, N T et al. BMJ 1998;317:798-801
  • Reference ChartReference Chart 07/06/13 36 Method FiO2 (Approximate) Flowrate (L/min) Non rebreather Mask 60-80% 10-15 Venti Mask 24% 26% 28% 31% 35% 40% 50% 3 3 6 6 9 12 15 Simple Face Mask 35-55% 5-10lpm Nasal Cannula 24% 28% 32% 36% 40% 44% 1 2 3 4 5 6
  • Enclosure systemsEnclosure systems  Tents  Hoods 07/06/13 37
  • Oxygen HoodOxygen Hood High oxygen deviceHigh oxygen device  Clear plastic shell encompasses the baby's head  Well tolerated by infants  Size of hood limits use to younger than age 1 year  Allows easy access to chest, trunk, and extremities  Allows control of Oxygen Delivery: o Oxygen concentration o Inspired oxygen temperature and humidity  Delivers 80-90% oxygen at 10-15 liter per minute 38
  • CPAPCPAP   Administering oxygen by CPAP(continuous positive airway pressure):   1-Nasal CPAP. 2-Endotracheal CPAP.   07/06/13 39
  • Nasal CPAPNasal CPAP:: Nasal CPAP: It consists of a single nasopharyngeal tube that deliveries 2-8 cm of positive pressure with or without o2.   Nursing care :  - Frequent suction . - Tube care. - Change the nasal tube. 07/06/13 40
  • Endotracheal CPAPEndotracheal CPAP   Endotracheal CPAP: Positive pressure delivering via an ETT.   Nursing care :  - Use sterile suctioning techniques - Mouth care - Change the ETT every seven days . 07/06/13 41
  • Oxygen HazardsOxygen Hazards Fire ( airway fires) Tissue toxicity, pulmonary and retina Decreased hypoxemic drive and increased in COPD. Seizures (hyperbaric) Mucosal damage due to lack of humidity
  • Complications of oxygen adm…Complications of oxygen adm… 1- Air way obstruction(thickened secretions, mechanical problems with artificial airway or ventilator circutory. 2- Tracheal damage 3- pulmonary infection 4- Barotrauma (pneumothorax or tension pneumothorax) 07/06/13 43
  • Cont….Cont…. 5- Decrease cardiac output. 6- Atelectasis. 7- Alteration in GI(dilation,bleeding). 8- Alteration in renal function. 9- Alteration in cognitive perceptual status 07/06/13 44
  • Take home messageTake home message  Acute empiric oxygen treatment is ok but hypoxemia should be verified with pulse oximetry and /or ABG’s when situation more stable.  Oxygen is a drug and should be administered keeping following things in mind: mode of administration, flow rate, FiO2 (venturi), treatment goal, monitoring, when to stop.
  • Merci …..Merci ….. 07/06/13 46