This document provides information on various oxygen delivery devices including their flow rates and fractional inspired oxygen (FiO2) levels. It discusses both high-flow and low-flow devices. High-flow devices discussed include venti-masks, mechanical aerosol systems, non-rebreathing masks, and high flow nasal cannula. Low-flow devices discussed include nasal cannula, simple masks, and partial rebreathing masks. The document provides details on appropriate flow rates and FiO2 levels for different devices. It also provides guidelines for weaning patients from high flow nasal cannula in both pediatric and adult patients. Case examples are presented and recommendations provided.

1. Julia Lawrence RRT-NPS

2.  By the end of this workshop, the learner will be
able to compare and contrast the various types
of oxygen delivery devices according to flow
requirements and fractional inspired oxygen
delivered
 By the end of this workshop, the learner will be
able to discuss and determine which oxygen
delivery device(s) would be most appropriate
given case-based examples

3.  High-flow
 Venti-masks (air entrainment masks)
 Mechanical aerosol systems
 Non-rebreathing masks
 High flow nasal cannula
 Low-flow
 Nasal cannula
 Simple masks
 Partial rebreathing masks

4. oxygen
room air
exhaled gas

5. O2 Flow rate FiO2 O2 Flow rate FiO2 O2 Flow rate FiO2
Nasal cannula Oxygen mask Mask with reservoir
1 0.24 5-6 0.4 6 0.6
2 0.28 6-7 0.5 7 0.7
3 0.32 7-8 0.6 8 0.8
4 0.36 9 0.80+
5 0.4 10 0.80+
6 0.44

6. • Nasal Cannula
• Heated high flow Nasal Cannula
• Simple Face mask
• Venturi mask
• Non rebreather mask

7.  Nasal Cannula
 up to 4 lpm (adults 6 lpm)
 Approximately 24-45% Fio2

8.  Uses Optimal heated humidified O2
 Higher flow which causes a “splinting” effect
to the airways
 Reduces WOB
 Flow rates exceed patients
inspiratory flow rates

9. Patient size Color of
Cannula
Flow rate Size of outer
diameter
cannula
< 1400 gm Red 6L/Min 2.4
>1400 gm Yellow 6 L/min 2.4
Infant Violet 7 L/min 2.7
Infant
Intermediate
Blue 7 L/min 2.7
Pediatric Green 8 L/min 3.7
Sizes of Nasal CannulaSizes of Nasal Cannula

10.  Infant/ Pediatric cannula
 up to 8 lpm
 Adult Cannula
 10 to 60 lpm

11.  The following criteria are for patients being
admitted to the acute care floors.
 < 4 CRS (Clinical Respiratory Score)
 < 40% FiO2
 > 4kg
 > 4 weeks

13.  Flow Rates 6-10 lpm
 Approximately 35%-55%

14.  Allow for a set O2 concentration
 Entrain Room Air
 Liter flow depends on
Set Fio2
 Can deliver up to 100%

16.  Has a one way valve
 Can deliver close to 100% Fio2
 Liter flow enough to keep the
bag inflated

19. Weaning Highflow Nasal Cannula on Acute Care
Is patient on
pediatric or
adult circuit?
Pediatric Adult
Wean FiO2 to keep saturation
> pre set saturation limit
Once FiO2 is decreased to 40%
begin to wean liter flow
(Note: In CVICU wean according to
MDs order to maintain saturation,
may be to 21%)
If CRS is <4 wean flow by at least 1
lpm every 4 hours to a minimum of
4LPM
When at a flow of 4 lpm then
transition to a bubble humidifier.
Wean FiO2 to keep saturation >
pre set saturation limit
Once FiO2 is decreased to 40%
begin to wean liter flow
(Note: In CVICU wean according to
MDs order to maintain saturation,
may be to 21%)
If CRS is < 4 wean flow by 5 lpm
until you reach an end point of 10
lpm (Circuit RT 202 has a low flow
limit of 10 lpm)
Once at 10 liters transition to
another Oxygen delivery device.
Pre-determined Sat limit
Asthma > 92%
Pneumonia > 90%
Bronchiolitis > 90%
Sickle Cell > 94%
All others > 92%

20. Weaning patients on HFNC in Special Care Areas
Patient started on High flow
(Document Clinical Respiratory
Score)
Has CRS
decreased by
1 within 60
mins of
initiation?
YES NO
Continue to support the patient.
Assess patient Q1-2 h and Document CRS
Increase Flow to decrease WOB
Notify Practioner if CRS increases by > 2 from
initiation of HFNC
Assess patient Q1-2 h and document CRS
Wean if patient meets criteria.
Wean Fio2 to 40%, Keeping Sats greater than pre-
determined level
Begin weaning flow every hour if CRS < 4
Once the patient is tolerating < 4 LPM change to
regular Nasal cannula
Criteria for weaning HFNC
Sats above pre-determine sat limit
CRS < 4

22.  Intervention
 Why
 Liter flow

23.  14 y/o male with end-stage CF and recent
sinus surgery is admitted to your service. His
blood gas is as followed pH 7.35 Pco2 60 Pao2
85, HCO3 26
Vital signs O2 sat 88%, RR 30 HR 95 BP 130/90
What would you do?

24.  16 year old soccer player is admitted to the
ICU, following an acute onset of SOB after a
coughing spell. His recent chest x-ray shows a
moderate right sided pneumothorax. Pt is
hemodynamically stable.
 What would you recommend?

25.  A 6 month old RSV+ is admitted to the ICU
with increase WOB. His vital signs are as
followed
HR 180 RR 80 Sat 90
What would you recommend?