Oxygen therapy involves administering oxygen at concentrations greater than room air (21%) to treat or prevent hypoxia. There are various types of hypoxia depending on the underlying cause. Oxygen delivery devices range from low flow nasal cannulas to high flow non-rebreathing masks and tents. Proper device selection and settings are needed to achieve the desired fraction of inspired oxygen. While oxygen therapy can be life-saving, risks include tissue toxicity, decreased drive to breathe, and airway fires. Close monitoring is required to safely and effectively administer supplemental oxygen.

1. IntroductionIntroduction
07/06/13 1

2. OXYGEN THERAPYOXYGEN THERAPY
J.NaNdhakumar
mSc (N) I YEar
collEgE of NurSINg
mTPg & rIhS
07/06/13 2

3. 07/06/13 3

4. Oxygen
was
discovered
by JB
Priestley
in 1773

5. Composition of Room AirComposition of Room Air
Nitrogen 78.08% ~78%
Oxygen 20.946% ~21%
Trace gases ~1%

6. Definition:Definition:
*Oxygen therapy is the administration of oxygen
at concentrations greater than room air ( 21%)
 *With goal of treating or preventing the
symptoms and manifestations of hypoxia(a state
of oxygen deficiency reaching the tissues)
07/06/13 6

7. Topics of DiscussionTopics of Discussion
*Types of Hypoxia
*Signs and symptoms of Hypoxia
*Indications
*O2 delivery Systems
*Hazards o2 therapy
07/06/13 7

8. HYPOXIAHYPOXIA
Inadequate oxygen being
delivered to the cells
07/06/13 8

9. Types of HypoxiaTypes of Hypoxia
1-Hypoxic Hypoxia
2-Circulatory Hypoxia
3-Hemic Hypoxia
4-Demand Hypoxia
5-Histotoxic Hypoxia
07/06/13 9

10. Hypoxic HypoxiaHypoxic Hypoxia
*Low PaO2(arterial oxygen tension) which is
secondary to FiO2 < 21% or decreased
barometric pressure( high altitude )
*Impaired ventilation secondary to
neuromuscular weakness or narcotic
overdose
*Impaired oxygenation secondary to
Pulmonary Fibrosis, ARDS
07/06/13 10

11. Circulatory HypoxiaCirculatory Hypoxia
*Inadequate pumping of the blood from the
lungs to tissues , maybe secondary to
disorders causing decreased cardiac output
such as MI, low fluid volume, hypotension,
poor supply of arteries. If the patient has
myocardial ischemia supplemental O2 is
definitely indicated.
07/06/13 11

12. Hemic HypoxiaHemic Hypoxia
Decreased oxygen carrying capacity as in
anemia or carbon monoxide poisoning
07/06/13 12

13. Demand HypoxiaDemand Hypoxia
Increased tissue consumption of oxygen in
hypermetabolic states : like fever,
malignant hyperthermia
07/06/13 13

14. Histotoxic HypoxiaHistotoxic Hypoxia
Utilization of oxygen is abnormal
such as in cyanide poisoning
07/06/13 14

15. Signs and Symptoms of HypoxiaSigns and Symptoms of Hypoxia
Tachypnea, dyspnea
Tachycardia, dysrythmias, pulse change,
hypertension
Anemia,
Restlessness, disorientation, lethargy,
Cyanosis, clubbing
07/06/13 15

16. IndicationsIndications
 1)PaO2 <60mmHg or SaO2 <90% in subjects breathing room
air.
 PaO2=partial pressure of oxygen as measured in the arterial
blood, SaO2=hemoglobin’s saturation
 2)Acute situation where hypoxemia is suspected
 3)Severe trauma
 4)Acute myocardial infarction
 5)Short term, post operative
07/06/13 16

17. DefinitionsDefinitions
 FiO2= Fraction of inspired oxygen, or
the percent of oxygen in the inspired
gas
 Oxygen toxicity is cellular injury of the lung
parenchyma and airway epithelium due
to release of cytoxic free oxygen
radicals.
 There is no exact threshold at which O2
toxicity occurs, however signs of gas
exchange abnormalities occur within 24-
48 hours if on 100% oxygen. Atelectasis
leading to drop in PO2, decreased lung
compliance, infiltrates on x-ray.
 Breathing FiO2 up to 50 % for 2-7 days
usually does NOT result in toxicity.07/06/13 17

18. DEVICESDEVICES
The oxygen delivery devices can be
categorized as
Low flow systems
Reservoir systems
High flow systems
Enclosure systems
07/06/13 18

19. Oxygen TherapyOxygen Therapy
Design & PerformanceDesign & Performance
◦ Low flow Devices
 Flow does not meet inspiratory demand
 O2 is diluted with air on inspiration
 Devices deliver Fio2 ranging from 22-60%
E.g
 Nasal cannula
 Transtracheal catheter
19

20. Nasal CannulaNasal Cannula
20

21. 07/06/13 21

22. NASAL CANNULANASAL CANNULA
low oxygen devicelow oxygen device
This device delivers an unpredictable amount of
oxygen ranging from 25-45 % at 1 - 6 L/min
depending on how much the patient inhales through
the mouth
Higher flow rates are uncomfortable for the patient
A high flow rate can quickly dry out the nasal
mucosa and become rapidly uncomfortable
22

23. NASAL CANNULA Cont…NASAL CANNULA Cont…
low oxygen devicelow oxygen device
Delivers 25-45% FIO2 at 1-6 L/min flow
1. Flow 0 liters per minute: 21% (Room
Air)
2. Flow 1 liters per minute: 25%
3. Flow 2 liters per minute: 29%
4. Flow 3 liters per minute: 33%
5. Flow 4 liters per minute: 37%
6. Flow 5 liters per minute: 41%
7. Flow 6 liters per minute: 45%
23

24. Reservoir SystemReservoir System
 Simple oxygen face mask
 Partial rebreathing mask
 Nonrebreathing mask
07/06/13 24

25. SIMPLE FACEMASKSIMPLE FACEMASK
low oxygen devicelow oxygen device
 The simple facemask at an oxygen flow of 6 L/min delivers
approximately 35-40 % oxygen
 Increasing the flow to 10 L/min may increase oxygen
concentration to about 50 %
 If the flow rate is less than 6 L/min (as cylinder nears
empty), the patient may re-breathe much of his own
exhalation and thus, the concentration of oxygen delivered
will be low, possibly severely hypoxic
25

26. 26

27. Partial Rebreathing Mask with reservoirPartial Rebreathing Mask with reservoir
Moderate oxygen deviceModerate oxygen device
Delivers 35-60% Oxygen at 6-10 L/min flow
rate
Ω First third of exhaled gases mix with reservoir
Ω Exhaled gases from upper airway are oxygen
rich
27
Reservoir

28. Non-Rebreathing Mask with reservoirNon-Rebreathing Mask with reservoir
High oxygen deviceHigh oxygen device
Delivers 95% Oxygen at 10-12 L/min
Two valves added to Rebreathing mask
prevents:
◦ Entrainment of room air during inspiration
◦ Retention of exhaled gases during expiration
28
Valves

29. High Flow systemHigh Flow system
 It provide oxygen at flow rates high
enough to satisfy patient’s inspiratory
demands.
 Such high flows( i.e. 35-40 lit approx) are
possible by
1. Entrainment of room air
2. High flow rates and reservoirs
E.g
 Venturi masks
 07/06/13 29

30. Oxygen TherapyOxygen Therapy
High Flow Devices - EntrainmentHigh Flow Devices - Entrainment
AE Devices
◦ AEM (Venti-Mask)
◦ AE Nebulizer (Large Volume Nebulizer)
 cool/heated Aerosol
30

31. Oxygen TherapyOxygen Therapy
High Flow DevicesHigh Flow Devices
Air Entrainment system
◦ What is Entrainment?
31

32. VENTURI EFFECTVENTURI EFFECT
Oxygen is forced through a jet
orifice entering the mask. As there
is pressure drop across jet orifice,
room air entrainment occurs
through side ports
07/06/13 32

33. Venturi MasksVenturi Masks
Venti-MasksVenti-Masks
Can provide 24%-50% oxygen by mixing
room air with a precise amount of oxygen
thereby delivering a precise FiO2. The size
of the port and the oxygen liter flow
determine the FiO2. The mask should be
fitted to the patient as best as possible to
prevent entrainment of room air around
the mask which would alter the FiO2.
07/06/13 33

34. Air Entrainment Mask
34

35. Copyright ©1998 BMJ Publishing Group Ltd.
Bateman, N T et al. BMJ 1998;317:798-801

36. Reference ChartReference Chart
07/06/13 36
Method FiO2
(Approximate)
Flowrate
(L/min)
Non rebreather Mask 60-80% 10-15
Venti Mask 24%
26%
28%
31%
35%
40%
50%
3
3
6
6
9
12
15
Simple Face Mask 35-55% 5-10lpm
Nasal Cannula 24%
28%
32%
36%
40%
44%
1
2
3
4
5
6

37. Enclosure systemsEnclosure systems
 Tents
 Hoods
07/06/13 37

38. Oxygen HoodOxygen Hood
High oxygen deviceHigh oxygen device
 Clear plastic shell encompasses the baby's head
 Well tolerated by infants
 Size of hood limits use to younger than age 1 year
 Allows easy access to chest, trunk, and extremities
 Allows control of Oxygen Delivery:
o Oxygen concentration
o Inspired oxygen temperature and humidity
 Delivers 80-90% oxygen at 10-15 liter per minute
38

39. CPAPCPAP
Administering oxygen by CPAP(continuous
positive airway pressure):
1-Nasal CPAP.
2-Endotracheal CPAP.
07/06/13 39

40. Nasal CPAPNasal CPAP::
Nasal CPAP: It consists of a single
nasopharyngeal tube that deliveries 2-8
cm of positive pressure with or without
o2.
Nursing care :
- Frequent suction .
- Tube care.
- Change the nasal tube.
07/06/13 40

41. Endotracheal CPAPEndotracheal CPAP
Endotracheal CPAP: Positive pressure
delivering via an ETT.
Nursing care :
- Use sterile suctioning techniques
- Mouth care
- Change the ETT every seven days .
07/06/13 41

42. Oxygen HazardsOxygen Hazards
Fire ( airway fires)
Tissue toxicity, pulmonary and retina
Decreased hypoxemic drive and
increased in COPD.
Seizures (hyperbaric)
Mucosal damage due to lack of humidity

43. Complications of oxygen adm…Complications of oxygen adm…
1- Air way obstruction(thickened
secretions, mechanical problems with
artificial airway or ventilator circutory.
2- Tracheal damage
3- pulmonary infection
4- Barotrauma (pneumothorax or tension
pneumothorax)
07/06/13 43

44. Cont….Cont….
5- Decrease cardiac output.
6- Atelectasis.
7- Alteration in GI(dilation,bleeding).
8- Alteration in renal function.
9- Alteration in cognitive perceptual
status
07/06/13 44

45. Take home messageTake home message
 Acute empiric oxygen treatment is ok but hypoxemia
should be verified with pulse oximetry and /or ABG’s
when situation more stable.
 Oxygen is a drug and should be administered keeping
following things in mind: mode of administration, flow
rate, FiO2 (venturi), treatment goal, monitoring, when
to stop.

46. Merci …..Merci …..
07/06/13 46