Oxygen therapy

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Oxygen therapy

  1. 1. OXYGEN THERAPY: PRINCIPLES & PRACTICE Dr.NARASIMHA REDDY PROFFESSOR &H.O.D DEPT.OF ANESTHESIOLOGY
  2. 2. <ul><li>Oxygen is also like a drug. </li></ul><ul><li>It must be used meticulously & deligently. </li></ul><ul><li>If abused it can cause complications. </li></ul>
  3. 3. <ul><li>FEW IMPORTANT QUESTIONS : </li></ul><ul><li>1.What are the indications for O2? </li></ul><ul><li>2.How to administer optimally? </li></ul><ul><li>3.What are the hazards? </li></ul>
  4. 4. <ul><li>Enrichment of inspired gases with O2 . </li></ul><ul><li>The major reason for O2 therapy is hypoxia. </li></ul><ul><li>Hypoxia is defiency of O2 at tissue levels. </li></ul><ul><li>Hypoxemia refers to reduced O2 tension in arterial blood. </li></ul>
  5. 5. TYPES OF HYPOXIA <ul><li>1.HYPOXIC HYPOXIA : </li></ul><ul><li>Dec. in O2 saturation of Hb like alveolar hypoventilation& low FiO2. </li></ul><ul><li>O2 therapy fruitful results. </li></ul>
  6. 6. <ul><li>2.STAGNANT HYPOXIA : </li></ul><ul><li>Due to low cardiac output states & vascular occlusion. </li></ul><ul><li>O2 therapy helps to less extent. </li></ul>
  7. 7. <ul><li>3.ANEMIC HYPOXIA : </li></ul><ul><li>O2 carrying capacity is reduced like anemia,hemodilution,CO poisoning. </li></ul><ul><li>O2 therapy useful to some extent. </li></ul>
  8. 8. <ul><li>4.HISTOTOXIC HYPOXIA : </li></ul><ul><li>Due to cyanide poisoning. </li></ul><ul><li>Cells cannot utilise O2. </li></ul><ul><li>O2 therapy least likely useful. </li></ul>
  9. 9. INDICATIONS FOR O2 THERAPY <ul><li>1.Hypoxia – when PaO2 comes down to 60mmhg. </li></ul><ul><li>2.Normoxic hypoxia – like low cardiac output states,M.I,anemia,hemodilution,CO poisoning,acute hypermetabolic states. </li></ul><ul><li>3.Trapped gases – like obstruction,pneumo encephalus. </li></ul><ul><li>4.Special situations – like anesthesia. </li></ul>
  10. 10. GUIDELINES FOR O2 THERAPY <ul><li>1.To alleviate hypoxemia. </li></ul><ul><li>2.To alleviate endorgan dysfunction due to hypoxia. </li></ul><ul><li>3.To avoid deleterious effects of O3 therapy. </li></ul>
  11. 11. <ul><li>O2 DELIVERY SYSTEMS : </li></ul><ul><li>1.Low flow or variable performance systems. </li></ul><ul><li>2.High flow fixed performance systems. </li></ul>
  12. 12. <ul><li>LOW FLOW SYSTEMS : </li></ul><ul><li>1.Nasal catheters . </li></ul><ul><li>8-14 G ,passed through into oropharynx. </li></ul><ul><li>Reservoir of O2 builds up in pharynx. </li></ul>
  13. 13. <ul><li>2.Nasal prongs : </li></ul><ul><li>The prongs protrude 1cm into nares. </li></ul><ul><li>Well tolerated. </li></ul><ul><li>Less interference in day to day activities. </li></ul><ul><li>Useless in mouth breathers. </li></ul><ul><li>No reservoir system. </li></ul><ul><li>FiO2 unpredictable. </li></ul>
  14. 14. <ul><li>3.Simple O2 masks : </li></ul><ul><li>Covers the nose & mouth. </li></ul><ul><li>4-6 lits/min. </li></ul><ul><li>0.4 -0.6 FiO2 </li></ul><ul><li>Feeling of suffocation. </li></ul><ul><li>Interference with daily activities. </li></ul><ul><li>FiO2 unpredictable. </li></ul><ul><li>Displacement at nights. </li></ul>
  15. 15. <ul><li>4.Mask with reservoir bags : </li></ul><ul><li>-Polymask with 2 chambers. </li></ul><ul><li>-High FiOP2 with 5-6 lits of O2. </li></ul>
  16. 16. <ul><li>HIGH FLOW SYSTEMS : </li></ul><ul><li>- Total flow is high with or without entrainment. </li></ul><ul><li>VENTURI MASKS : </li></ul><ul><li>Works on Bernoulli principle. </li></ul><ul><li>Can deliver O2 at accurate concs. </li></ul>
  17. 17. <ul><li>O2 hood : </li></ul><ul><li>Used in bed bound infants not intubated. </li></ul><ul><li>Made of plexi glass. </li></ul><ul><li>Humidified O2 3 times M.V. </li></ul>
  18. 18. <ul><li>O2 tent : </li></ul><ul><li>Used in pediatric practise. </li></ul><ul><li>10-12 lits/min. </li></ul><ul><li>Fire accidents. </li></ul>
  19. 19. <ul><li>CYLLINDERS: </li></ul>
  20. 20. <ul><li>HOME O2 CONCENTRATOR </li></ul>
  21. 21. <ul><li>JET VENTILATION : </li></ul><ul><li>High frequency oscillation. </li></ul>
  22. 22. HAZARDS OF O2 THERAPY <ul><li>1.Drying of mucous membrane. </li></ul><ul><li>2.Depression of ventilation in COPD. </li></ul><ul><li>3.Reversal of compensatory hypoxic vasoconstriction. </li></ul><ul><li>4.Atelectasis due to absorption collapse. </li></ul><ul><li>5.O2 toxicity. </li></ul>
  23. 23. OXYGEN TOXICITY <ul><li>1.Pulmonary oxygen toxicity (Lorrain-Smith effect): </li></ul><ul><li>100%O2 given for 12 hours or more. </li></ul><ul><li>80% O2 for more than 24hrs. </li></ul><ul><li>60%O2 more than 36hrs. </li></ul><ul><li>Symptoms : substernal pain,irresistable cough,dyspnoea,V.C dec.,compliance dec.,pulmonary interstitial edema leading to fibrosis. </li></ul>
  24. 24. <ul><li>2.Retrolental fibroplasia : </li></ul><ul><li>Occurs when PaO2 more than 80mmhg for more than 3 hrs in new born. </li></ul><ul><li>Very premature babies are more susceptible. </li></ul><ul><li>O2 saturation must be around 90-92 %. </li></ul>
  25. 25. <ul><li>3.C.N.S O2 toxicity (Paul-Bert effect ): </li></ul><ul><li>O2 is given in hyperbaric chambers. </li></ul>
  26. 26. THANK U.

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