Lecture by Dr.NAJAH yousef ICU physician.Madinah Munawarah ,KSA

1. Dr_ NAJAH YOUSUF
ICU doctor, MGH
Madinah Munawarah, KSA

2.  70 yrs man K/C/O COPD
 Respiratory Distress
 Diaphoretic and Agitated
H/O : Progressive dysponea
With worsening productive cough
Fever and chills

3.  BP -150/90mmHg
 HR-130/min
 Temp-38.5 C
 RR-33/min
 SPO2-80%
Does pt need O2 ?
How much need ?
How to deliver O2 ?

4. IT IS THE ADMINISTRATION OF O2
CONCENTRATION GREATER THAN
THAT IN ROOM AIR TO TREAT OR
PREVENT HYPOXEMIA

5.  History
 Indication
 O2 requirement
 O2 delivery system
 Complication

6. Joseph
Priestley
discovered
element of
oxygen
in 1774

8. In 1783 French physician Dr Caillens
first time used oxygen therapy as a
remedial measure in disease

10. 160mmHg (PiO2)
110mmHg(PAO2)
90-100mmHg( PaO2)
20-40mmHg(PtO2 )
5-20mmHg(PO2 at mitocondria)

11. TRANSPORT OF OXYGEN

12. TRANSPORT OF CO2

13.  Principally Hypoxemia
 Poor ventilatory effort – post operative
 Sedation
 Confusion
 Poor oxygen delivery- shock

14.  Severe anaemia
 Heart failure
 Severe trauma
 Acute illness
 Poisoning

15.  Clinical Assessment
 Noninvasive -Pulse oxymeter
-Capnograph
 Invasive -ABG analysis

16.  Tachypnoea
 Dyspnoea
 Tachycardia
 Severe anaemia
 Cyanosis
 Disorientation, Agitation,Lethargy
 Restlessness

17.  SPO2 <90 Percent

18.  EtCO2>45mmHg

19.  PaO2<60mmHg
 SaO2<90percent
 PaCO2>45mmHg

20.  O2 conc required by pt
 O2 conc achieved by the delivery device
 Importance of accuracy of device
 Client comfort and client mobility

21.  All system require
Source of oxygen
Flow meter
Oxygen tubing
Humidifier
Delivery device

22.  Central pipe line
 Oxygen Cylinder
 Oxygen concentration

23.  Device which extract O2 from the
environmental air
 Deliver up to 90-95 % O2 at the flow
rate 3-5L/min

24.  Recommended when oxygen flow 4 L/min
 Prevent in drying of mucous membrane
 Prevent the formation of tenacious sputum
 Decrease loss of heat

25.  Variable performance device
Nasal cannula
Face mask
 Fixed performance device
Partial rebreathing mask
Non rebreathing mask
Venturi mask
 Noninvasive ventilation-CPAP/BiPAP

26. Deliver O2 concentration 25-45%
at a rate of 1-6 L/min
Flow rate in L/min % FIO2
1 25
2 29
3 33
4 37
5 41

27.  Easy to use
 Well tolerated
 Comfortable for long period
 Patient can eat and talk easily.

28.  Dryness of mucosa
 Crusting over secretion
 Epistaxis

29. Is prescribing O2
through face mask @
4L/min correct??

30.  Deliver O2 concentration 40-60 % depend
on flow rate 6 -8 L/min
 Easy to use
 Requires good fit.
 Improve humidification
 Dryness is less

31.  It is simple mask with reservoir bag
 It delivers 50-75 %of oxygen when
flow 8 -11L/min

34.  Delivery Oxygen concentration :upto 100%
at 15 L/min
 Reservoir bag to entrain oxygen
 One way valve : prevent oxygen dilution
 Tight seal is essential
 Reservoir bag must expand freely

36.  Mixes - Air and oxygen
 Accurate - Oxygen conc delivery
 Colour coded valves
 Oxygen conc - 24-40 %

39. COLOUR OF ADAPTER % FIO2
Blue 24
Yellow 26
White 28
Green 30
Pink 35
Orange 40

41.  Deliver 80-90% O2 at 10-15 L/min
 Used in <1 year of age
-

42. DEVICE FLOW RATE
L/min
% OXYGEN
Nasal cannula 1-6 25-45
Simple face
mask
6-8 40-60
Partial
Rebreather
8-11 50-75
Non
Rebreather
10-15 90 -100
Venturi Mask 4-8 24-40

43.  Emergency method of life saving
 Preparing the equipment required for
intubation

44.  Hypoventilation and CO2 narcosis
 Absorption atelectasis
 Retinopathy of Prematurity

45.  Informed verbal consent
 Support and reassurance
 Oxygen is prescription drug

46.  Prescription should include
Flow rate
Delivery device
Duration
Instruction for monitoring

47.  70 yrs man K/C/O COPD
 Respiratory Distress
 Diaphoretic and Agitated
H/O : Progressive dysponea
With worsening productive cough
Fever and chills

48.  Bp 150/90mmHg
 HR-130/min
 Temp-38.5
 RR-33/min
 SPO2-80%
1.Does pt need O2 ?
2.How much need ?
3.How to deliver O2?

49.  Pt needs O2
 O2 therapy :Emperically FIO2-40%
 Ventury mask and titrate : improvement
and monitor
 ABG-PaO2 40mmHg
 Pt PaO2 Desired PaO2
----------- = ------------------
Pt FIO2 Desired FIO2

50.  Pt PaO2(40) Desired PaO2(90)
----------- = ------------------
Pt FIO2(.21) Desired FIO2(X)
.21x90
X = ---------- = .47
40
FIO2=.47

52. Consider two patient on nasal cannula with 100
% O2 at 2 L/min
Normal pt-PIFR-15L/min
Inspired O2=2L/min(100%)+13L/min(21%)
% of O2 received through device 2/13=15.4%
Sick pt-PIFR-30L/min
Inspired O2 =2L/min(100%)+28ltr/mint(21%)
% of O2 received by sick pt=2/28 =7.1%