Oxygen Therapy Sarah Stanton Respiratory Physiotherapist
Objectives <ul><li>Understand the indications for oxygen therapy </li></ul><ul><li>Identify and understand the use of diff...
<ul><li>Living cells must be fuelled with oxygen in order to survive! </li></ul><ul><li>The respiratory system functions t...
<ul><li>How much oxygen is in the air? </li></ul><ul><li>Illness and injury increase tissue oxygen demand </li></ul>
Indications for oxygen therapy <ul><li>Respiratory compromise </li></ul><ul><ul><li>Cyanosis </li></ul></ul><ul><ul><li>Ta...
Indications for oxygen therapy <ul><li>Cardiac compromise </li></ul><ul><ul><li>Chest pain </li></ul></ul><ul><ul><li>Shoc...
Aims of oxygen therapy <ul><li>to increase PaO 2  to acceptable level with concentration of oxygen </li></ul><ul><li>to de...
Types of oxygen delivery <ul><li>Nasal cannulae </li></ul><ul><li>Medium concentration mask </li></ul><ul><li>Fixed concen...
Nasal Cannulae <ul><li>Flow rate up to 4l/min </li></ul><ul><li>Unable to determine exact concentration </li></ul><ul><li>...
Medium concentration mask <ul><li>‘ Hudson’/ MC mask </li></ul><ul><li>Flow rate must be at least 5l/min </li></ul><ul><li...
Fixed concentration <ul><li>‘ Venturi’ masks </li></ul><ul><li>Deliver a fixed concentration of oxygen </li></ul><ul><li>M...
14 l/min air entrained 14 l/min air entrained 2 l/min oxygen jet 2 l/min oxygen jet 30 l/min The Bernoulli Effect
Oxygen flow rate and concentration Respiratory distress Non-respiratory distress Minute vol (RR x TV) O 2  flow rate Oxyge...
Non Rebreathe bags <ul><li>‘ Reservoir bags’ </li></ul><ul><li>Deliver FiO 2  0.6 – 0.8 </li></ul><ul><li>Flow rate must b...
Humidification <ul><li>Prevents cilia destruction </li></ul><ul><li>Prevents damage to mucus glands </li></ul><ul><li>Aids...
Indications for humidification <ul><li>Oxygen therapy at higher flow rates </li></ul><ul><li>Patients with copious secreti...
Complications with humidified oxygen <ul><li>Bronchoconstriction </li></ul><ul><li>Decreased lung function if over-humidif...
High flow oxygen <ul><li>30-50 l/min </li></ul><ul><li>Same concentration </li></ul><ul><li>Severely hypoxic patients </li...
Summary <ul><li>Oxygen is required for cell metabolism </li></ul><ul><li>Oxygen requirements are higher in critically ill ...
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C:\fakepath\oxygen therapy ns

  1. 1. Oxygen Therapy Sarah Stanton Respiratory Physiotherapist
  2. 2. Objectives <ul><li>Understand the indications for oxygen therapy </li></ul><ul><li>Identify and understand the use of different oxygen delivery systems </li></ul><ul><li>Implications for humidification </li></ul>
  3. 3. <ul><li>Living cells must be fuelled with oxygen in order to survive! </li></ul><ul><li>The respiratory system functions to supply oxygen to the cells and remove carbon dioxide from the tissues </li></ul>
  4. 4. <ul><li>How much oxygen is in the air? </li></ul><ul><li>Illness and injury increase tissue oxygen demand </li></ul>
  5. 5. Indications for oxygen therapy <ul><li>Respiratory compromise </li></ul><ul><ul><li>Cyanosis </li></ul></ul><ul><ul><li>Tachypnoea </li></ul></ul><ul><ul><li>Hypoxaemia </li></ul></ul><ul><ul><li>Partially obstructed airway </li></ul></ul>
  6. 6. Indications for oxygen therapy <ul><li>Cardiac compromise </li></ul><ul><ul><li>Chest pain </li></ul></ul><ul><ul><li>Shock </li></ul></ul><ul><ul><li>Tachycardia </li></ul></ul><ul><ul><li>Arrhythmias </li></ul></ul><ul><li>Neurological deficits </li></ul><ul><ul><li>CVA </li></ul></ul><ul><ul><li>Spinal injuries </li></ul></ul><ul><ul><li>Coma </li></ul></ul>
  7. 7. Aims of oxygen therapy <ul><li>to increase PaO 2 to acceptable level with concentration of oxygen </li></ul><ul><li>to decrease respiratory rate and work of breathing </li></ul><ul><li>Hypoxaemia with high PaCO 2 </li></ul><ul><ul><li>24% initially </li></ul></ul><ul><ul><li>careful monitoring with regular ABG’s </li></ul></ul>
  8. 8. Types of oxygen delivery <ul><li>Nasal cannulae </li></ul><ul><li>Medium concentration mask </li></ul><ul><li>Fixed concentration mask </li></ul><ul><li>Non-rebreathe bag </li></ul><ul><li>Humidified circuits </li></ul><ul><li>High flow systems </li></ul>
  9. 9. Nasal Cannulae <ul><li>Flow rate up to 4l/min </li></ul><ul><li>Unable to determine exact concentration </li></ul><ul><li>Comfortable – allows patient to eat, drink talk </li></ul><ul><li>Can still be used if patient is mouth breathing </li></ul>
  10. 10. Medium concentration mask <ul><li>‘ Hudson’/ MC mask </li></ul><ul><li>Flow rate must be at least 5l/min </li></ul><ul><li>Exact concentration of oxygen depends on patient’s respiratory pattern </li></ul><ul><li>Poor humidification </li></ul><ul><li>Useful post-operatively </li></ul>
  11. 11. Fixed concentration <ul><li>‘ Venturi’ masks </li></ul><ul><li>Deliver a fixed concentration of oxygen </li></ul><ul><li>Must be set at minimum flow rate as shown on barrel </li></ul><ul><li>FiO 2 0.24 – 0.6 </li></ul><ul><li>Able to increase flow rate without altering concentration </li></ul><ul><li>Bernouilli principle </li></ul>
  12. 12. 14 l/min air entrained 14 l/min air entrained 2 l/min oxygen jet 2 l/min oxygen jet 30 l/min The Bernoulli Effect
  13. 13. Oxygen flow rate and concentration Respiratory distress Non-respiratory distress Minute vol (RR x TV) O 2 flow rate Oxygen concentration 30 l/min (40bpm x 750ml) 2 l/min 2 l/min of 100% oxygen + 28 l/min air drawn into mask (21%) = 30 l/min minute volume FiO 2 = (1.0x2) + (0.21x28) ./ 30 = 0.26 (26%) 5 l/min (10bpm x 500ml) 2 l/min 2 l/min of 100% oxygen + 3 l/min air drawn into mask (21%) = 5 l/min FiO 2 = (1.0x2) + (0.21x3) / 30 = 0.53 (53%)
  14. 14. Non Rebreathe bags <ul><li>‘ Reservoir bags’ </li></ul><ul><li>Deliver FiO 2 0.6 – 0.8 </li></ul><ul><li>Flow rate must be set to 15l/min </li></ul><ul><li>Fill reservoir 2 thirds before applying </li></ul><ul><li>Useful in acute situation </li></ul><ul><li>Should not be worn >24hrs </li></ul>
  15. 15. Humidification <ul><li>Prevents cilia destruction </li></ul><ul><li>Prevents damage to mucus glands </li></ul><ul><li>Aids sputum clearance </li></ul>
  16. 16. Indications for humidification <ul><li>Oxygen therapy at higher flow rates </li></ul><ul><li>Patients with copious secretions </li></ul><ul><ul><li>Systemic hydration </li></ul></ul><ul><ul><li>IV fluids </li></ul></ul><ul><ul><li>Saline nebulisers </li></ul></ul>
  17. 17. Complications with humidified oxygen <ul><li>Bronchoconstriction </li></ul><ul><li>Decreased lung function if over-humidified </li></ul><ul><li>Increased risk of infection </li></ul>
  18. 18. High flow oxygen <ul><li>30-50 l/min </li></ul><ul><li>Same concentration </li></ul><ul><li>Severely hypoxic patients </li></ul><ul><li>Used in high dependency setting </li></ul>
  19. 19. Summary <ul><li>Oxygen is required for cell metabolism </li></ul><ul><li>Oxygen requirements are higher in critically ill patients </li></ul><ul><li>Be aware of different delivery systems </li></ul><ul><li>Always consider humidification </li></ul><ul><li>Safety aspects </li></ul>

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