Oxygen Therapy Transport Delivery Copd Hypoxic Drive

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  • Great presentation on how not all those with COPD are CO2 retainers. When I went to nursing school in the early 80's I was taught that those with COPD were CO2 retainers and fit either a profile of a 'pink puffer' or a 'blue bloater'. Now I teach med-surg and though the CO2 retainer myth still is around in textbooks it is all the more essential to embrace evidenced based practice to instill outcomes based on the latest research and not on traditional mentality. Thanks for sharing.
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Oxygen Therapy Transport Delivery Copd Hypoxic Drive

  1. 1. Oxygen Therapy<br />Presented By:<br />Brian Cayko, M.B.A., RRT, RCP<br />
  2. 2. Objectives<br />Indications, Objectives, & Hazards of O2 Therapy<br />Medical Oxygen<br />Oxygen Transport<br />Oxygen Delivery<br />COPD<br />Hypoxic Drive<br />
  3. 3. 3<br />Oxygen TherapyGeneral Goals/objectives<br />Correcting Hypoxemia<br />By raising Alveolar & Blood levels of Oxygen<br />Easiest objective to attain & measure<br />Decreasing symptoms of Hypoxemia<br />Supplemental O2 can help relieve symptoms of hypoxia<br />Less dyspnea/WOB<br />Improve mental function<br />
  4. 4. Oxygen TherapyGoals/objectives -cont’d<br />Minimizing CP workload<br />CP system will compensate for Hypoxemia by:<br />Increasing ventilation to get more O2 in the lungs & to the Blood<br />Increased WOB<br />Increasing Cardiac Output to get more oxygenated blood to tissues<br />Hard on the heart, especially if diseased<br />Hypoxia causes Pulmonary vasoconstriction & Pulmonary Hypertension<br />These cause an increased workload on the right side of heart<br />Over time the right heart will become more muscular & then eventually fail (Cor Pulmonale)<br />Supplemental o2 can relieve hypoxemia & relieve pulmonary vasoconstriction & Hypertension, reducing right ventricular workload<br />4<br />
  5. 5. Oxygen Therapy<br />The difference between<br />O2 % delivered v. Inspired<br />Patient Dependant!<br />5<br />
  6. 6. Oxygen Therapy<br />Assessing the need for oxygen therapy<br />3 basic ways<br />Laboratory measures <br />invasive or noninvasive<br />Clinical Problem or condition<br />COPD, Surgery, etc.<br />Symptoms of hypoxemia<br />Dyspnea, Neuro, HR, etc. <br />6<br />
  7. 7. Oxygen Therapy<br />Assessing the need for oxygen therapy<br />Laboratory measures – invasive or noninvasive<br />PO2 – partial pressure of oxygen<br />PAO2 – Partial Pressure of Oxygen in Alveoli<br />PaO2 – Partial pressure of Oxygen in arterial blood<br />Hgb Saturation<br />SpO2 – Pulse Oximetry of Oxyhemaglobin Saturax<br />7<br />
  8. 8. Pulse Oximetry (SpO2)<br />Non-invasive <br />Detects the saturation levels of Oxyhemaglobin<br />How much of the Hgb that is capable of carrying O2 actually is carrying O2<br />Technical Considerations / Problems<br />Inaccurate if Non-Pulsatile<br />Must always palpate the patients pulse while performing Pulse Oximetry<br />Pulse & Pulse Ox’s heart rate monitor must correlate<br />Other Inaccuracy causes<br />Poor perfusion/circulation<br />Trauma<br />CO Poisoning<br />Some Nail Polish / Thickened & discolored nails<br />
  9. 9. Medical Gases<br />All Medical Gases Are Drugs<br />Require Prescription<br />Quality of each gas is mandated by FDA<br />Medical O2 must be 99% Pure<br />Anhydrous<br />Medical gas must be dry & free of oil/contaminants<br />Cooled to dry<br />Filter to clean<br />
  10. 10. Composition of Room Air<br />Nitrogen 78.08% ~78%<br />Oxygen 20.946% ~21%<br />Trace gases ~1%<br />
  11. 11. O2 Supply<br />
  12. 12. Oxygen TherapyAssessing the need for<br />Requires expert in-depth knowledge <br />RT is always available for consultation<br />RT & Nurse will combine objective & subjective measures to confirm inadequate oxygenation<br />Objective<br />Test results<br />Subjective<br />Pt assessment <br />Often recommend administration based solely on subjective measures<br />12<br />
  13. 13. Oxygen TherapyDesign & Performance<br />Low flow Devices<br />Flow does not meet inspiratory demand<br />O2 is diluted with air on inspiration<br />Nasal Cannula<br />transtracheal Catheter<br />Reservoir Cannulas<br />Mustache<br />Pendant<br />13<br />
  14. 14. 14<br />Nasal Cannula<br />
  15. 15. Oxygen TherapyLow Flow Devices<br />Nasal Cannula <br />Adult<br />0-6 l/m<br />&gt;4L requires Humidity<br />Can cause irritax, dryness, bleeding, etc.<br />24-44% <br />Pediatrics (&gt; 1mo)<br />Low flows if possible<br />Always humidified<br />Neo<br /> 0-2 l/m<br />Always humidified<br />15<br />
  16. 16. Oxygen TherapyLow Flow Devices<br />Reservoir Cannula <br />Frequent replacement<br />No humidification<br />Requires nasal exhalation<br />Nasal<br />Stores ~20ml<br />Aesthetically displeasing<br />Pendant<br />Better aesthetically<br />Extra weight can irritate ears/face<br />16<br />
  17. 17. Oxygen TherapyLow Flow Devices<br />Reservoir masks<br />Simple Mask<br />Non-Rebreather<br />17<br />
  18. 18. Low Flow DevicesReservoir Masks<br />Simple Mask<br />Gas gathers in mask<br />Exhalation ports<br />Air entrained thru ports & around mask<br />5-10 L/M<br />&lt;5 = CO2 rebreathing<br />&gt;10 = use more invasive mask<br />18<br />
  19. 19. 19<br />Non-rebreather<br />Non-rebreather <br /><ul><li>Utilizes one way valves
  20. 20. b/w reservoir & mask
  21. 21. on one exhalation port
  22. 22. leak free will provide 100%
  23. 23. >~70% FiO2 is rare
  24. 24. Hard to provide leak free system
  25. 25. 1 L reservoir bag</li></li></ul><li>Oxygen TherapyLow Flow Devices<br />Performance Characteristics of Low Flow <br />FiO2 varies with amount of air dilution, pt dependant<br />Must assess response to therapy<br />Objective & Subjective<br />20<br />
  26. 26. Oxygen TherapyHigh Flow Devices<br />High Flow <br />Supplies given FiO2 @ flows higher than inspiratory demand<br />Uses Entrainment <br />21<br />
  27. 27. Oxygen TherapyHigh Flow Devices<br />Air Entrainment system<br />What is Entrainment?<br />22<br />
  28. 28. Oxygen TherapyHigh Flow Devices - Entrainment<br />AE Devices<br />AEM (Venti-Mask)<br />AE Nebulizer (Large Volume Nebulizer)<br />cool/heated Aerosol<br />23<br />
  29. 29. Air Entrainment Mask<br />24<br />
  30. 30. Oxygen TherapyHigh Flow Devices – Entrainment<br />25<br />
  31. 31. Oxygen TherapyOther devices<br />Enclosures<br />Tents<br />Hoods<br />Incubators<br />Others<br />BVM<br />Pulse Dose Cannula<br />Concentrators<br />26<br />
  32. 32. Oxygen TherapySelecting Delivery Approach<br />Not one best method every time<br />RT & their expert knowledge needs to be available for:<br /> Consult<br />Assessment/reassessment<br />Alteration of therapy<br />Discontinuation of therapy<br />27<br />
  33. 33. Oxygen TherapySelecting Delivery Approach<br />Purpose (Objective)<br />Increase FiO2 to correct hypoxemia<br />minimize symptoms of hypoxemia<br />Minimize CP workload<br />Patient <br />Cause & severity of hypoxemia<br />Age<br />Neuro status/orientation<br />Airway in place/protected<br />Regular rate & rhythm (minute Ventilation)<br />28<br />
  34. 34. Oxygen TherapySelecting Delivery Approach<br />Equipment Performance<br />The more critical, the greater need for high stable FiO2<br />Becomes more difficult the more critical due to the patients varying respiratory pattern<br />29<br />
  35. 35. Oxygen TherapySelecting Delivery Approach<br />Pt Categories<br />Emergency<br />Highest FiO2 possible<br />NRB mask, BVM<br />Critical Adult<br />&gt;60% O2<br />NRB, Dual Entrainment systems<br />Stable adult, acute illness, mild hypoxemia<br />Low to mod FiO2<br />Simple Mask, Nasal Cannula<br />30<br />
  36. 36. COPD<br />Chronic Obstructive Pulmonary Disease<br />Broad term used to describe non-reversible generalized airway obstruction.<br />Obstructive Airway Diseases<br />C OPD<br />B ronchitis<br />A sthma<br />B ronchiectesis<br />E mphysema<br />
  37. 37. CO2 Retainer<br />All COPD patients are NOT CO2 RETAINERS!!<br />Some may be, But each patient needs to be assessed<br />CO2 Retainer<br />In Obstructive airway diseases it is often for the obstruction to trap air in the distal lungs<br />CO2 is not eliminated from the body efficiently<br />Over time, their body no longer reacts to High levels of CO2 normally, i.e. increased ventilation<br />The result is CO2 retention<br />
  38. 38. Oxygen TherapyPrecautions & Hazards<br />Deprex of Ventilation<br />2 dominant stimulants to breathe in Blood stream<br />CO2<br />O2<br />Hypercarbic drive is blunted<br />High PCO2 no longer stimulates pt to increase Ventilax<br />Hypoxic drive is the only stimulus left<br />suppression of Hypoxic Drive <br />Due to applying to much O2<br />33<br />
  39. 39. Oxygen TherapySelecting Delivery Approach<br />CO2 Retainer<br />Chronic disease adult (COPD w/ CO2 retainment)<br />acute on chronic illness<br />Ensure adequate oxygenation without depresseing Ventilation<br />SpO2 85-90%<br />PaO2 50-60mmHg<br />Use venti mask to control FiO2 precision<br />Assess response to therapy!!<br />If not maintainable on Cannula, use masks<br />Pt may remove mask frequently due to <br />Discomfort<br />Convenience<br />Change in mental status<br />Encourage Cannula use b/w mask use if mask must come off for periods<br />34<br />
  40. 40. Summary<br />Call RT if in doubt, we are there to help you serve the patient<br />Adult Delivery<br />Nasal Cannula 1-6 L/m, 24-44%, humidify if &gt;4 L/m, Stable<br />Simple Mask 5-10 L/m, 35-55%, &lt;5 l/m causes CO2 retention, Distress<br />Non-Rebreather Mask &gt;10 L/m, ~60-100%, Dependant on mask fit, Failure<br />COPD does NOT equal CO2 retainment<br />

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