Oxygen Therapy


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Oxygen Therapy

  2. 2. <ul><li>What is oxygen? </li></ul><ul><li>Hypoxia /Hypoxemia </li></ul><ul><li>Indications for oxygen therapy </li></ul><ul><li>Oxygen delivery systems </li></ul><ul><li>Complications of oxygen therapy </li></ul><ul><li>Conclusions </li></ul>Oxygen therapy
  3. 3. <ul><li>Oxygen is a gas with chemical formula of O2 </li></ul><ul><li>Colourless, odorless, tasteless </li></ul><ul><li>Boiling point -183 C </li></ul><ul><li>Melting point –216.6C </li></ul><ul><li>Critical temp. –118.4C , Critical pressure 736.9psi </li></ul><ul><li>Constitutes about 20.95% of atmosphere </li></ul><ul><li>Used at cellular level as the final electron acceptor in the electron transport chain in the mitochondria of cell </li></ul>WHAT IS OXYGEN?
  4. 4. <ul><li>Inadequate delivery of O2 to the tissue </li></ul><ul><li>Type of hypoxia </li></ul><ul><li>1. Hypoxic hypoxia ( decrease diffusion of O2 across the alveolar-capillary membrane </li></ul><ul><li>-low inspired FiO2 </li></ul><ul><li>-V/Q inequalities </li></ul><ul><li>-increased shunt(eg cardiac anomalies) </li></ul><ul><li>2. Stagnant hypoxia (decreased cardiac output resulting in increased systemic transit time </li></ul><ul><li>-Shock </li></ul><ul><li>-Vasoconstrictio </li></ul><ul><li>3. Anaemic hypoxia ( decreased O2 carrying capacity in the blood) </li></ul><ul><li>-Anaemia </li></ul>HYPOXIA
  5. 5. <ul><li>-Carbon monoxide poisoning </li></ul><ul><li>4. Histotoxic hypoxia ( inability the tissue utilize available O2) </li></ul><ul><li>- Cyanide poisoning </li></ul><ul><li>Reduced O2 concentration/tension in the blood </li></ul><ul><li>PaO2<80mmhg. </li></ul>Hypoxemia
  6. 6. <ul><li>Should be determined through evaluation of the patient </li></ul><ul><li>(clinical assessment and blood gas result) </li></ul><ul><li>In general the indication are:- </li></ul><ul><li>Hypoxemia/hypoxia </li></ul><ul><li>Excessive work of breathing </li></ul><ul><li>Excessive myocardial work </li></ul><ul><li>Improvement of oxygenation in patient with decreased O2 carrying capacity ( anaemia) </li></ul><ul><li>Promotion of absorption of air in the body cavity </li></ul>Indication for O2 therapy
  7. 7. <ul><li>THIS PERSON NEED O2 ???????? </li></ul>
  8. 8. <ul><li>Many devices for administering supplemental O2 are available </li></ul><ul><li>Classification </li></ul><ul><li>Low-Flow Systems/Variable performance </li></ul><ul><li>Definition : Do not provide all gases necessary to meet the patient minute ventilation </li></ul><ul><li>- Nasal canula </li></ul><ul><li>- Face mask </li></ul><ul><li>- Partial rebreathing mask </li></ul><ul><li>- Nonrebreathing mask </li></ul>Oxygen delivery systems
  9. 9. High-Flow Systems/Fixed performance Definition : Flow sufficient to meet all of patient Mv and ensure patient receive constant inspired O2 concentration - Venturi masks - Head box - Semi closed/closed anaesthetic circuit
  10. 10. <ul><li>Nasal canula </li></ul><ul><li>Capable to deliver an FiO2 ranging from 0.24-0.44 depending on the amount of flow </li></ul><ul><li>Maximum of 6LPM Why ? </li></ul><ul><li>causes crusting of the secretion, drying of the nasal mucosa and epistaxis </li></ul><ul><li>Advantages –inexpensive,well tolerated, comfortable </li></ul><ul><li>patient can eat and drink </li></ul><ul><li>Disadvantages – pressure sore, irritant to the mucosal </li></ul><ul><li>Flow FiO2 </li></ul><ul><li>1LPM 0.24 </li></ul><ul><li>2LPM 0.28 </li></ul><ul><li>3LPM 0.32 </li></ul><ul><li>4LPM 0.36 </li></ul><ul><li>5LPM 0.40 </li></ul><ul><li>6LPM 0.44 </li></ul>
  11. 11. <ul><li>Simple face mask </li></ul><ul><li>Increases the O2 reservoir- higher FiO2 </li></ul><ul><li>O2 flow must be more than 5LPM Why ? </li></ul><ul><li>- To prevent rebreathing </li></ul><ul><li>Flow FiO2 </li></ul><ul><li>5-6LPM 0.40 </li></ul><ul><li>6-7LPM 0.50 </li></ul><ul><li>7-8LPM 0.60 </li></ul><ul><li>>10LPM ? </li></ul><ul><li>Advantages – simple, light, deliver higher FiO2 </li></ul><ul><li>Disadvantages – need to remove for eat, drink, speak </li></ul><ul><li>- uncomfortable for facial trauma </li></ul>
  12. 12. <ul><li>Partial rebreathing and Non rebreathing mask </li></ul><ul><li>Similar to simple mask with addition of the O2 reservoir </li></ul><ul><li>to increase FiO2 greater than 0.60 </li></ul><ul><li>Non rebreathing mask – one way valve to prevent rebreathing </li></ul><ul><li>Partial rebreathing </li></ul><ul><li>Flow FiO2 </li></ul><ul><li>7LPM 0.65 </li></ul><ul><li>8-15LPM 0.70-0.80 </li></ul><ul><li>Non rebreathing </li></ul><ul><li>Flow FiO2 </li></ul><ul><li>Set to prevent collapse of bag 0.85-1.0 </li></ul>
  13. 13. <ul><li>Venturi mask </li></ul><ul><li>Operate on Bernoulli principle </li></ul><ul><li>- As gas flow under pressure at rapid flow rate an area of pressure develops lateral to the small opening and lead to entrainment of room air through the side port. </li></ul><ul><li>Advantages – delivery of very predictable FiO2 </li></ul><ul><li>- may use in COAD patient </li></ul><ul><li>Disadvantages – same like face mask </li></ul><ul><li>Flow FiO2 </li></ul><ul><li>4 0.24 </li></ul><ul><li>6 0.28 </li></ul><ul><li>8 0.35-0.40 </li></ul><ul><li>12 0.60 </li></ul>
  14. 14. <ul><li>Hypoventilation and Carbon Dioxide Narcosis </li></ul><ul><li>the increased PO2 decreased and eliminates the hypoxic drive ( esp. in pt. with chronic CO2 retention ) </li></ul><ul><li>Under this circumstances O2 must be given at low concentration <30% </li></ul><ul><li>Absorption Atelectasis </li></ul><ul><li>- Nitrogen a relatively insoluble and exists 80% by volume of the alveolar gas.N2 assists in maintaining alveolar stability.O2 therapy replaced N2. Once O2 absorb into the blood the alveolar will collapse esp. in alveolar distal to the obstruction. </li></ul>Complications of O2 therapy
  15. 15. <ul><li>Pulmonary Oxygen Toxicity </li></ul><ul><li>The exposure of the high O2 and for prolonged period </li></ul><ul><li>can lead to parenchymal changes </li></ul><ul><li>In general FiO2 > 50% for prolonged period shows increased O2 toxicity </li></ul><ul><li>Pulmonary changes mimic ARDS (Exudative changes and proliferative changes.) </li></ul><ul><li>Sx –cough, burning discomfort, nausea and vomiting, headache, malaise and etc </li></ul><ul><li>Retrolental Fibroplasia </li></ul><ul><li>Excessive O2 to pre-mature infants may result in constriction of immature retinal vessels, endothelial damage, retinal detachment and possible blindness </li></ul><ul><li>Recommended that PO2 be maintained between 60-90 mmHg range in neonate </li></ul>
  16. 16. <ul><li>Fire </li></ul><ul><li>O2 support combustion </li></ul><ul><li>Do not smoke while receiving O2 therapy </li></ul>
  17. 17. <ul><li>Patient on Chemotherapy </li></ul><ul><li>Patient on chemotherapy especially bleomycin will develop pulmonary fibrosis if get excessive O2 therapy </li></ul>
  18. 18. <ul><li>O2 can be store either </li></ul><ul><li>1)Cylinder </li></ul><ul><li>Oxygen can be stored under pressure in cylinders made of molybdenum steel. </li></ul><ul><li>Cylinders are black with white shoulders. </li></ul><ul><li>The pressure inside at 15°C is 137 bar. </li></ul><ul><li>2)Oxygen concentrators </li></ul><ul><li>An oxygen concentrator is a device which extracts oxygen from atmospheric air using canisters </li></ul>
  19. 20. <ul><li>Nitrogen is filtered out and oxygen produced. </li></ul><ul><li>3)Vacuum Insulated Evaporator (VIE) . </li></ul><ul><li>Designed to store liquid oxygen. </li></ul><ul><li>It consists of two layers, where the outer carbon steel shell is separated by a vacuum from an inner stainless steel shell, which contains the oxygen </li></ul><ul><li>The oxygen temperature is -170 C at 10.5 atm. </li></ul><ul><li>The VIE system is used in large hospitals which have a pipeline system, and where liquid oxygen can be supplied by road tanker </li></ul>
  20. 22. <ul><li>O2 therapy is the delivery of any O2 conc. Greater then 21% </li></ul><ul><li>The need for O2 should be determined through the thorough evaluation </li></ul><ul><li>One must consider advantages and disadvantages when choosing the appropriate technique </li></ul><ul><li>No procedure without complication </li></ul>Conclusions
  21. 23. Thank you