This document discusses oxygen delivery devices and their indications. It describes: 1. Oxygen delivery devices are classified based on the level of dependency needed - low, medium, and high. Low dependency devices include nasal cannulas and masks, which can provide 30-35% oxygen. 2. Medium dependency devices provide supplemental oxygen and respiratory assistance using CPAP masks. High dependency devices provide full respiratory support through NIPPV or IPPV and require intensive care. 3. Variable and fixed performance low dependency devices are further described. Variable devices' oxygen concentration depends on equipment and patient factors, while fixed devices use a venturi to provide consistent concentrations from 24-40%.

1. DR.G.SASI KUMAR

2. INDICATIONS
 As a treatment for hypoxemia due to hypoventilation,
decreased gas exchange, ventilation perfusion
abnormalities.
 To improve O2 supply to tissues when the disease process
causes increased O2 demand.
 As specific treatment to certain conditions such as CO
poisioning
 Survival of human at very low atm. pressure

3. OXYGEN DELIVERY DEVICES
 Classified depending on degree of dependancy.
Low Supplemental oxygen •Nasal prongs
dependancy alone is sufficient •Face mask
Medium Supplemental O2 and •CPAP mask &
dependancy respiratory assistance equipment
High supplemental O2 and •NIPPV
dependancy full respiratory support •IPPV
Requires intensive
care

4. LOW DEPENDANCY DEVICES
 CLASSIFIED further into
 Variable performance devices—FiO2 variable
 Fixed performance devices—FiO2 fixed

5. VARIABLE PERFORMANCE DEVICES
Major determinants of FiO2 are—
 EQUIPMENT related:  PATIENT related:
1. Mask volume 1. Peak insiratory flow
2. O2 flow rate 2. Respiratory rate
3. Quality of mask fit 3. Tidal volume
4. Areas of holes in mask

6.  Variable performance devices—classified depending
on reservoir capacity:
 No capacity devices
 Low capacity devices -- <100 ml
 Medium capacity devices – 100 – 250 ml
 High capacity devices – 250- 1500 ml
 Very high capacity devices -- >1500 ml

7. TYPE OF DEVICE EXAMPLES
no capacity •Nasal prongs
•Nasal sponge tipped catheter
low capacity •Paediatric face mask
•Tracheastomy mask
•Swedish nose
medium capacity •Standard adult face mask
high capacity •Face mask with reservoir bag
•T- bag
very high capacity •Incubators
•Oxygen tents

8. NASAL CANNULA
 The nasal cannula can be rapidly and comfortably
placed on most patients.
 Patients on long-term oxygen therapy most commonly
use a nasal cannula.
 usually well tolerated, allows speech and
eating/drinking, and is nonclaustrophobic.

9.  The actual FIO2 delivered to adults with nasal
cannulas is determined by
 oxygen flow
 nasopharyngeal volume
 the patient's inspiratory flow

10.  Cannulas can be expected to provide inspired oxygen
concentrations up to 30–35% with normal breathing
and oxygen flows of 3–4 L/min.
 Usually flows greater than 5 L/min are poorly tolerated
because of the discomfort of gas jetting into the nasal
cavity and because of drying and crusting of the nasal
mucosa.

11. FACE MASK WITH RESERVOIR BAG
 Two types of reservoir mask are commonly used:
 the partial rebreathing mask.
 the nonrebreathing mask.
 Mask reservoirs commonly hold approximately 600
mL or less.

13. THE PARTIAL REBREATHING MASK.
 "part" of the patient's expired tidal volume refill the
bag.
 Usually that gas is largely dead space that should not
result in significant rebreathing of carbon dioxide.

14. THE NONREBREATHING MASK
 incorporates flap-type valves between the bag and
mask and on at least one of the mask's exhalation
ports.
 Reduces rebreathing of CO2.

15.  Typical minimum flows of oxygen are 10–15 L/min.
 FiO2 delivered with well fitting reservoir mask is 0.75
to 0.90

16. FIXED PERFORMANCE DEVICES
 Fixed FiO2 is delivered that does not vary with
respiratory pattern.
 These devices make use of venturi principle.

17. VENTURI:
 An equipment which includes
a constriction whereby its
cross section gradually
decreases & then increases.
 Fluid flowing through a
venturi will have pressure drop
at the constriction where the
velocity is higher.

18. BERNAULLI’S EFFECT:
 the lateral pressure of the fluid is least where
the velocity is greatest
 Applications:
 Nebulizers
 Suction apparatus
 Venturi mask

19. FiO2 provided by O2 flow rate Amt. Of air Total flow rate
venturi valve ( L/min) entrained (L/min)
(L/min)
0.24 2 51 53
0.28 4 41 45
0.31 6 41 47
0.35 8 37 45
0.40 10 32 42
0.60 15 15 30

21.  Low flow rate high air entrainment low FiO2
 MORE RELABLE
 High flow rate less amount of air entrained high
FiO2
 Since total flow rate is low, it may be overcome by
patients peak inspiratory flow rate & rebreathing occurs.
 UNDERPERFORM by 5 to 10%

22. MEDIUM DEPENDANCY DEVICES
 Provides supplemental O2 and respiratory assistance
 Example : CPAP mask

23. CPAP MASK
 Tightly fitted on patients face with harness.
 Covers the nose and mouth with a good seal.
 Consist of 22 mm female taper inlet. “T” or “Y” shaped
connector allows O2 delivery through one limb &
CPAP valve on other limb.
 Provides 2.5 to 20 cms H2O pressure.

24. HIGH DEPENDANCY DEVICES
 Supplemental O2 & full respiratory support is
provided.
 Non Invasive Positive Pressure Ventilation
 Invasive Positive Pressure Ventilation
 NIPPV -- For patients with central apnoea syndrome,
neuro muscular & chest wall diseases.
Increasingly being used for weaning from
mechanical ventilation & acute respiratory failure.

25. HYPERBARIC OXYGEN THERAPY
 Carbon monoxide poisioning
 Gas gangrene
 Congenital cardiac anomalies
 Peripheral vascular insufficiency
 Cancer therapy
 Decompression sickness

26. ONE-PERSON
(MONOPLACE)
HYPERBARIC CHAMBER

27. MULTIPLACE CHAMBERS

28. OXYGEN TOXICITY
 Pulmonary toxicity – O2 is a lung irritant producing
inflammation & congestion – LORRAIN SMITH
EFFECT.
 CNS toxicity – PAUL BERT EFFECT – localized muscle
twitching of eyes, mouth & forehead  rigid tonic
phase of convulsion  loss of conciousness 
vigorous clonic contraction of muscle group of head ,
neck , trunk & limbs

29.  Hypo ventilation -- primarily seen in patients with
COPD who have chronic CO2 retention.
 Retinopathy of prematurity -- The recommended
PaO2 for premature infants receiving oxygen are 50–80
mm Hg (6.6–10.6 kPa).

30. HELIOX THERAPY
 The most popular mixtures are the 80%/20% and
70%/30% helium–oxygen.
 They have densities that are 1.805 and 1.586 times less
dense, respectively, compared with pure oxygen.

31.  In anesthetic practice, pressures needed to ventilate
patients with small-diameter tracheal tubes (TTs) can
be substantially reduced (halved) when the 80%/20%
mixture is used.
 Patients with acute distress from upper airway–
obstructing lesions may obtain relief until more
definitive care can be delivered.
 The evidence is less convincing in treating lower
airway obstruction in COPD and acute asthma.

32. thank you