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Module 2.2 Oxygen Therapy
This document provides an overview of oxygen therapy, including the causes and presentation of hypoxia and how it is evaluated. It describes various devices that can be used to deliver oxygen therapy, separating them into low-flow devices like nasal cannulas, masks, tents, and hoods, and high-flow devices like Venturi masks and high flow nasal cannulas. The advantages and disadvantages of each device are discussed to help practitioners determine the best option for increasing a patient's oxygen levels.
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Module 2.2 Oxygen Therapy
- 1. OXYGEN THERAPY Gradian HealthSystems Basic Principles of Critical Care RESPIRATORY SYSTEM
- 2. Disclaimer Basic Principles ofCritical Care Training I Oxygen Therapy Disclaimer: Gradian Health Systems cannot provide formal recommendations or indications regarding medical care and clinical service delivery. The tables, checklists, and other clinical documents referenced in this training have not been validated in all settings. These documents are intended to serve as examples only. We recognize that all clinical training content and activities must be customized to meet the needs of each facility and its clinical staff, factoring in available resources, practitioner skill level, and other environmental considerations. For any questions regarding the contents or applications of this training, please contact Gradian Health Systems: 40 W 25th St, 6th Floor New York, NY 10010 USA +1 212-537-0340 training@gradianhealth.org
- 3. Module 2 Gradian HealthSystems Basics Principles of Critical Care Respiratory System
- 4. Module 2: RespiratorySystem MODULE OVERVIEW Lesson 1 I Respiratory System Anatomy and Physiology Lesson 2 I Oxygen Therapy Lesson 3 I Evaluation of the Respiratory System Lesson 4 I Airway Equipment and Management Lesson 5 I Invasive and Non-invasive Ventilation Lesson 6 I Basics of Mechanical Ventilation Lesson 7 I Ventilator Modes and Settings Lesson 8 I Ventilation Complications Basic Principles of Critical Care Training I Oxygen Therapy
- 5. Components of theGradian CCV SystemLesson 2: Oxygen Therapy Lesson Objectives • Differentiate between anoxia, hypoxia and hypoxemia • Explain the major causes of hypoxia • Describe the indications for oxygen therapy • Distinguish the devices that are used in oxygen therapy Basic Principles of Critical Care Training I Oxygen Therapy
- 6. Components of theGradian CCV SystemLesson 2: Oxygen Therapy Key Concepts • Hypoxia • Hypoxemia • Oxygen therapy Basic Principles of Critical Care Training I Oxygen Therapy
- 7. Oxygen Therapy Hypoxia • Statein which there is insufficient oxygen at the tissue level • Can result from: • Inadequate oxygen reaching the tissues (oxygen delivery) • Reduced amount of oxygen in the blood (hypoxemia) Hypoxemia • Low partial pressure of oxygen in the blood Anoxia • Total deprivation of oxygen supply Basic Principles of Critical Care Training I Oxygen Therapy
- 8. Oxygen Therapy Causes ofhypoxia Reduced oxygen tension Occurs in areas of altitude Hypoventilation Can be due to reduced respiratory rate or depth of breathing (reduced tidal volume). Common causes include sedation, coma (low GCS), airway obstruction, neuromuscular disease, etc. Ventilation Perfusion mismatch – areas of the lungs are not being ventilated (collapse, airway obstruction) or being adequately perfused (e.g. pulmonary embolism) Basic Principles of Critical Care Training I Oxygen Therapy
- 9. Oxygen Therapy Causes ofhypoxia Right to left shunt Blood passing from the right side of the heart to the left without being oxygenated. Examples include anatomical (VSD, ASD, PDA) or physiologic (atelectasis, pneumonia, ARDS) Impaired diffusion Diffusion id dependent on the distance and the surface area. If the area is decreased and the distance is increased, gaseous exchange in the alveolar will be impaired (e.g. interstitial disease, fibrosis, edema). Basic Principles of Critical Care Training I Oxygen Therapy
- 10. Oxygen Therapy Presentation ofhypoxia Acute symptoms include: • Tachycardia • Tachypnea • Sweating • Hypotension • Cyanosis • Restlessness • Dyspnea on exertion A physical examination will point to the cause of hypoxia Basic Principles of Critical Care Training I Oxygen Therapy
- 11. Oxygen Therapy Evaluation ofhypoxia Hypoxia is indicated by: • SpO2 ≤ 95% • ABGA PaO2≤ 80mmHg • PaO2:FIO2 ratio < 300 (normal 300-500) PaO2:FIO2 ratio is important in defining ARDS Basic Principles of Critical Care Training I Oxygen Therapy
- 12. Oxygen Therapy Management ofhypoxia 1. Maintaining a patent airway • Suctioning • Use of OPA (not tolerated in conscious patients) or NPS • Head-tilt and jaw thrust (only jaw thrust if cervical spine injury suspected) • Positive pressure ventilation using CPAP or BiPAP can be used to keep an open airway • Bronchoconstriction can be relieved using bronchodilators Basic Principles of Critical Care Training I Oxygen Therapy
- 13. Oxygen Therapy Management ofhypoxia 2. Increasing FiO2 • Can be achieved by using devices to deliver oxygen Basic Principles of Critical Care Training I Oxygen Therapy
- 14. Oxygen Therapy Oxygen DeliveryDevices I Low Flow Devices Nasal cannula • Flow rate 1-6 L/min • FiO2 24-45% • Estimation of FiO2 (20% + (4 x O2 L/min)) • Advantages: • Less claustrophobia • Convenient for patient (can eat / talk) • Disadvantages • Dry mucous membrane if giving >4 L/min • Limited value with mouth breathers Basic Principles of Critical Care Training I Oxygen Therapy
- 15. Oxygen Therapy Oxygen DeliveryDevices I Low Flow Devices Reservoir cannulas • Nasal cannula with a reservoir providing 10 mls • Reservoir can be pendant (on chest) or moustache (around nostril) shaped • Reservoir allows for increased FiO2 and flow rates • Flow rate 1-16 L/min; FiO2 up to 90% • Advantages • Higher FiO2 compared to simple nasal cannula • Disadvantages • Will entrain air if patient flow rate is high Basic Principles of Critical Care Training I Oxygen Therapy Image source: https://thoracickey.com/medical-gas-therapy/
- 16. Oxygen Therapy Oxygen DeliveryDevices I Low Flow Devices Simple face mask • Flow rate 6-10 L/min • FiO2 40-60% • Advantages: • Higher FiO2 • Disadvantages • Not convenient for patient • Claustrophobia • Dry mucous membrane if giving >4 L/min Basic Principles of Critical Care Training I Oxygen Therapy
- 17. Oxygen Therapy Basic Principlesof Critical Care Training I Oxygen Therapy Oxygen Delivery Devices I Low Flow Devices Face mask - partial rebreather • No one-way inhalational valve • Flow rate 10-12 L/min • Bag must always be partially inflated • FiO2 80-90% • Advantages: • Higher FiO2 • Disadvantages • Expired air mixed with inhaled air • Claustrophobia
- 18. Oxygen Therapy Basic Principlesof Critical Care Training I Oxygen Therapy Oxygen Delivery Devices I Low Flow Devices Face mask – non-rebreather • One-way inhalational valve between mask and reservoir; allows for oxygen to flow from tubing to reservoir and mask; one-way valve in exhalation ports • Flow rate 10-15 L/min (bag must always be partially inflated to avoid suffocation) • FiO2 80-90% • Advantages: • Higher FiO2 (used if >40% is needed) • Disadvantages • Claustrophobia (must be well-fitted to get high FiO2) • Humidification is difficult
- 19. Oxygen Therapy Basic Principlesof Critical Care Training I Oxygen Therapy Oxygen Delivery Devices I Low Flow Devices Face tent • Flow rate minimum 15 L/min • FiO2 28-100% • Advantages: • Higher FiO2 • Use in patient who can’t wear a mask (claustrophobia, facial trauma, etc.) • Disadvantages • No seal – difficult to achieve high FiO2
- 20. Oxygen Therapy Basic Principlesof Critical Care Training I Oxygen Therapy Oxygen Delivery Devices I Low Flow Devices Oxygen tent / hood • Covers patient’s head and/or upper body • Flow rate minimum 8-10 L/min • FiO2 25-70% • Advantages: • Patient not encumbered • Can be humidified • Disadvantages • FiO2 may vary and not higher than other devices
- 21. Oxygen Therapy Basic Principlesof Critical Care Training I Oxygen Therapy Oxygen Delivery Devices I High Flow Devices Venturi mask • Can be used on face mask, tracheostomy, t-piece, or face tent • Entrains room air to achieve FiO2 • Flow rate minimum 4-12 L/min • FiO2 24-60% using different sized and colored ports • Advantages: • More precise FiO2 despite respiratory rates and tidal volumes • Useful in COPD and CO2 retention is a problem • Humidification not required due to ambient patient air entrainment • Disadvantages • Claustrophobia • Interferes with talking and eating
- 22. Oxygen Therapy Basic Principlesof Critical Care Training I Oxygen Therapy Oxygen Delivery Devices I High Flow Devices High flow nasal cannula (HFNC) • Air / oxygen blender is used • Flow rate minimum 10-60 L/min • FiO2 up to 100% set on blender • Advantages: • Heated and humidified • Provide PEEP (1 cmH2O for every 10L of flow) • Reduces anatomical deep space • Disadvantages • May delay escalation to intubation for patients requiring intubation Nishimura, Masaji. (2015). High-flow nasal cannula oxygen therapy in adults. Journal of Intensive Care. 3. 10.1186/s40560- 015-0084-5.
Editor's Notes
- #23 Creative Commons CC0 1.0 Universal Public Domain Dedication Nishimura, Masaji. (2015). High-flow nasal cannula oxygen therapy in adults. Journal of Intensive Care. 3. 10.1186/s40560-015-0084-5.