OXYGEN THERAPY INDICATION-DELIVERING DEVICES.

1. OXYGEN THERAPY
DR.MEERA
DEPARTMENT OF ANAESTHESIOLOGY
KG HOSPITAL AND POST GRADUATE INSTITUTE

2. • INDICATION
• GOALS
• FACTORS DETERMINING SYSTEM TO BE USED
• OXYGEN DELIVERY METHODS
• OXYGEN TOXICITY

3. INDICATION
• HYPOXEMIA - PAO2 < 60mmHg , SaO2 <90%
• HYPOTENSION
• INCREASED METABOLIC DEMANDS
• SEVERE TRAUMA
• SHORT TERM THERAPY

4. GOALS
• TREAT HYPOXEMIA
• DECREASE WORK OF BREATHING
• DECREASE MYOCARDIAL WORK

5. OXYGEN THERAPY DEVICES- CLASSIFICATIONS
• PERFORMANCE OF THE DEVICE- Fixed , variable performance
• FLOW DELIVERED BY THE DEVICE- Low flow, high flow.
• PATIENT DEPENDENCY - Dependent, patient independent.
• DEGREE OF DEPENDENCY- low(nasal prongs), high (NIPPV, IPPV)

6. OXYGEN DELIVERY METHODS
• LOW FLOW / VARIABLE PERFORMANCE
Stable breathing patterns, depend on the ventilatory demands of
the patient.
• HIGH FLOW / FIXED PERFORMANCE
Inspired gas at a preset FiO2 is supplied continuously at high flow,
independent of patients breathing pattern.

7. LOW FLOW/ VARIABLE PERFORMANCE HIGH FLOW/ FIXED PERFORMANCE
NASAL CANNULA BAG-MASK VALVE SYSTEM
NASAL CATHETER BREATHING CIRCUITS
NASAL MASK VENTURI MASK
SIMPLE FACE MASK NEBULISERS
RESERVOIR MASK - PARTIAL REBREATHING
NON REBREATHING
MASK
OXYGEN HOODS/ TENTS

8. NASAL CANNULA
• Plastic tubing with prongs
• Maximum flow rate
4L /min , FiO2 upto 35%
• FiO2 increases approx
1-2% with every increase in
oxygen flow per litre.

9. ADVANTAGES DISADVANTAGES
WELL TOLERATED, COMFORTABLE PRESSURE SORE
LONG TERM THERAPY - COPD >5L / MIN - POORLY TOLERATED BECAUSE OF
GAS JETTING INTO THE NASAL CAVITY
HUMIDITY CONTROL DRYING/ CRUSTING OF NASAL MUCOSA

10. NASAL MASK
• HYBRID OF NASAL CANNULA
AND A FACE MASK
• SUPPLEMENTS OXYGEN EQUAL
TO THE NASAL CANNULA
• USES- OBSTRUCTIVE SLEEP
APNEA(CPAP/Bi-PAP)

11. SIMPLE FACE MASK / NON RESERVOIR OXYGEN
MASK
• DISPOSABLE PLASTIC DEVICE THAT COVERS BOTH NOSE AND
MOUTH.
• MINIMUM OXYGEN FLOW - 5L/MIN, FiO2 OF 0.3 - TO AVOID
REBREATHING AND EXCESSIVE RESPIRATORY WORK.
• MAXIMUM OXYGEN FLOW 10L/MIN, FiO2 OF 0.6
• INDICATION: SHORT TERM THERAPY IN PACU
TRANSPORT OF PATIENTS.

13. RESERVOIR MASK
• SIMPLE MASK WITH GAS RESERVOIR
PARTIAL REBREATHING MASK
NON REBREATHING MASK
DIFFERENCE- PRESENCE OF A VALVE BETWEEN
MASK AND BAG AND VALVE OVER MASK

14. PARTIAL REBREATHING MASK
• SIMPLE MASK WITH RESERVOIR BAG
• PART OF THE PATIENTS EXPIRED TIDAL VOLUME REFILLING THE BAG
COMBINED WITH SUPPLY OF FRESH OXYGEN.
• 6-10L/MIN PROVIDES 40-70% OF OXYGEN.

15. NON REBREATHING MASK
• SAME AS PARTIAL REBREATHER, INCORPORATES FLAP TYPE VALVES
BETWEEN THE BAG AND MASK AND MASKS EXHALATION PORTS.
• MINIMUM FLOW 10-15L/MIN, FiO2 60-100%
• ADVANTAGES- FiO2 DELIVERED > 0.60 IN MODERATE TO SEVERE
HYPOXIA
• DISADVANTAGE - LACK OF GOOD FACIAL SEAL SYSTEM,
INSUFFICIENT FLOW RATE MAY LEAD TO REBREATHING OF CO2.

17. HIGH FLOW OXYGEN DELIVERY SYSTEM
• INDICATION- PATIENT WITH VARIABLE BREATHING PATTERN.
• FOR THOSE WHO REQUIRE CONSISTENT HIGH FiO2.
• PROFOUND DYSPNEA AND HYPOXIMEA.
• TYPES- BAG MASK VALVE SYSTEM
Self inflating bags
breathing circuits.
AIR ENTRAINMENT VENTURI MASK
AIR ENTRAINMENT NEBULISERS.
OXYGEN HOODS
HELIUM OXYGEN THERAPY
HYPERBARIC OXYGEN THERAPY.

18. BAG MASK VALVE SYSTEM
• Self inflating bags(AMBU Bags) consists of football sized bladder,
oxyen inlet reservoir.
• Breathing circuits- non self inflating reservoirs with gas inlet and valve.
• Flow to the reservoir should be kept high to prevent deflation.
• Provides constant FiO2 of >90%
• Mask are designed to provide a comfortable leak free seal for manual
ventilation.
• Limitation - In spontaneously breathing person flow has to be adjusted
with the valve.
Risk of aspiration

20. AIR ENTRAINMENT VENTURI MASK
• BASED ON BERNOULLI PRICIPLE - AS THE VELOCITY OF THE FLUID
INCREASES, THE PRESSURE OF THE FLUID DECREASES.
• GOAL IS TO CREATE AN OPEN SYSTEM WITH HIGH FLOW ABOUT THE
NOSE AND MOUTH, WITH A FIXED FiO2.
• FINAL CONCENTRATION DEPENDS ON THE RATIO OF AIR DRAWN IN
THROUGH ENTRAINMENT PORTS.
• INDICATION- PATIENT WHOSE HYPOXEMIA CANNOT BE CONTROLLED
ON LOWER FiO2 DEVICES.

22. VENTURI PRINCIPLE

23. AIR ENTRAINMENT NEBULISERS.
• COMMONLY PLACED ON
PATIENTS FOLLOWING
EXTUBATION FOR THEIR
AEROSOL PRODUCING
PROPERTY.
• CAN BE APPLIED WITH
TRACHEOSTOMY COLLAR, FACE
TENT, T-PIECE ADAPTOR

24. OXYGEN HOODS - PEDIATRIC O2 DELIVERY SYSTEM
• COVERS ONLY HEAD ALLOWING ACCESS TO LOWER BODY
• OXYGEN AND AIR PREMIXED PASSED THROUGH HEATED
HUMIDIFIERS
• MINIMUM FLOW RATE >7L/MIN, WITH 80-90% O2 CONCENTRATION
• INDICATION - SHORT TERM O2 THERAPY FOR NEW BORN AND
INFANTS.

26. HELIUM OXYGEN THERAPY-HELIOX
• HELIUM IS PREMIXED WITH O2
(80+20% / 70+30%)
• INDICATION - RELIEF IN
PATIENTS WITH ACUTE
DISTRESS FROM UPPER
AIRWAY OBSTRUCTIONS -
Subglottic edema, tracheal tumors,
foreign bodies.

27. HYPERBARIC OXYGEN THERAPY
• USES A PRESSURISED CHAMBER TO EXSPOSE THE PATIENT TO
OXYGEN TENSIONS EXCEEDING AMBIENT BAROMETRIC PRESSURE
(>760mmHg)
• INDICATIONS
DECOMPRESSION SICKNESS
GAS GANGERENE
CARBON MONOXIDE POISONING.

29. OXYGEN TOXICITY
• PULMONARY COMPLICATION- INFLAMMATORY LUNG INJURY
• HIGH FiO2 CAUSES HYPOVENTILATION AND HYPERCARBIA IN COPD
PATIENTS.
• RESPIRATORY CENTRE INSENSITIVE TO HYPERCARBIC DRIVE
• ABSORPTION ATELECTASIS IN COPD PATIENTS WITHIN 6 MINUTES OF
100% OXYGEN
• PREVENTION - FiO2 24-30% IN COPD PATIENTS

30. CARDIOVASCULAR COMPLICATIONS
• HYPERBARIC OXYGEN HAS DIRECT MYOCARDIAL DEPRESSION.
• SUDDEN RELIEF OF HYPOXIA ABOLISHES SYMPATHETIC OVER
ACTIVITY CAUSING HYPOTENSION AND CIRCULATORY COLLAPSE.
• DEPRESSION OF HEMATOPOIESIS
• FREE RADICAL INJURY.

31. THANK YOU