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Oxygen therapy
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- 2. What isoxygen? Why do we need oxygen? What is oxygen therapy? When do we need oxygen therapy? How to give oxygen therapy?
- 3. WHAT IS OXYGEN? In 1775 by joseph priestley an english scientist. Oxygen is a chemical element with symbol O and atomic number 8. Highly reactive nonmetallic element and oxidizing agent that readily forms compounds. 3rd most abundant element in the universe. Colorless, odorless, and tasteless
- 4. WHY DO WENEED OXYGEN? Cellular respiration. Biochemical energy from nutrients to ATP. Aerobic respiration. Anaerobic respiration.
- 5. AEROBIC RESPIRATION Pyruvate fromglycolysis. Kreb’s cycle Electron transport chain
- 6. WHAT IS OXYGENTHERAPY? Oxygen therapy is administration of oxygen in concentration more than in ambient air as a medical intervention. Thus providing adequate oxygen in the blood, while decreasing the work of breathing and reducing the stress on the myocardium.
- 7. 7 INDICATIONS FOR OXYGENTHERAPY Hypoxemia Inadequate amount of oxygen in the blood SPO2 < 90% PaO2 < 60 mmHg Excessive work of breathing Excessive myocardial workload
- 8. FACTORS INFLUENCING OXYGEN TRANSPORT Cardiac output Arterial oxygen content Concentration of Hb Metabolic requirements
- 9. Hypoxemia decreasein the arterial oxygen content in the blood Hypoxia decreased oxygen supply to the tissues.
- 10. 10 CAUSES OF HYPOXEMIA Shunt Hypoventilation As carbon dioxide increases oxygen falls V/Q mismatching (ventilation/perfusion) Pneumonia Pulmonary edema ARDS Increased diffusion gradient asbestosis Early pulmonary edema
- 11. CLINICAL MANIFESTATIONS OF HYPOXIA Impaired judgment, agitation (restlessness), disorientation, confusion, lethargy, coma Dyspnea Tachypnea Tachycardia, dysrhythmias Elevated BP Diaphoresis Central cyanosis
- 12. CAUSES OF HYPOXIA Hypoxic hypoxia Anemic hypoxia Ischemic or stagnant hypoxia Histotoxic hypoxia
- 13. NEED FOR OXYGENIS ASSESSED BY Clinical evaluation Pulse oximetry ABG
- 14. 14 OXYGEN THERAPY Goalof therapy is an SPO2 of >90% or for documented COPD patients(Spo2 88–92%)-(Pao2=55-60) As SPO2 normalizes the patients vital signs should improve” Heart rate should return to normal for patient Respiratory rate should decrease to normal for patient Blood pressure should normalize for patient
- 15. CAUTIONS FOR OXYGENTHERAPY Oxygen toxicity – can occur with Fio2 > 60% longer than 36 hrs Fio2>80%longer than 24 hrs Fio2>100%longer than 12hrs Suppression of ventilation – will lead to increased CO2 and carbon dioxide narcosis Danger of fire Absorbtion Atelectasia Premature retrolental fibroplasia
- 16. OXYGEN DELIVERY DEVICES 1. High flow (fixed performance) delivery systems. 2. Low flow (variable performance) delivery systems.
- 17. Low flowsystems contribute partially to inspired gas client breathes do not provide constant FIO2 Ex: nasal cannula, simple mask High flow systems deliver specific and constant percent of oxygen independent of client’s breathing Ex: Venturi mask, non-rebreather mask, trach collar, T- piece
- 18. Low FlowOxygen Delivery Devices : These include: i. Nasal cannula. ii. Simple mask / Mary Carterall mask. iii. Oxygen tents. iv. Non rebreathing mask. v. Rebreathing mask. vi. Polymask.
- 19. High flowoxygen delivery devices: i. Venturi mask ii. Air entertainment nebulizers. iii. High flow air-oxygen blenders. iv. Bag & mask ventilation
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- 21. NASAL CANNULA MERITS DEMERITS Easy to fix Keeps hands free Not much interference with further airway care Low cost Compliant Unstable Easily dislodged High flow uncomfortable Nasal trauma – drying and crusting Mucosal irritation FiO2 can be inaccurate and inconsistent
- 22. NASAL CANNULA Oxygen flowrate(l/min) Fio2 range 1 0.21-0.24 2 0.23-0.28 3 0.27-0.34 4 0.31-0.38 5 0.32-0.44
- 23. The Inspiredpercent oxygen increases by approx. 1-2%(above 21%) per litre of oxygen flow.
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- 29. NASAL CATHETER MERITS DEMERITS Good stability Disposable Low cost Difficult to insert High flow increases back pressure Needs regular changing May provoke gagging, air swallowing, aspiration Nasal polyps, deviated septum may block insertion
- 30. TRANSTRACHEAL CATHETER Athin polytetrafluoroethylene (Teflon) catheter Inserted surgically with a guidewire between 2nd and 3rd tracheal rings FiO2 – 22-35% Flow – ¼ - 4L/min Increased anatomic reservoir
- 31. TRANSTRACHEAL CATHETER MERITS DEMERITS Lower O2 use and cost Eliminates nasal and skin irritation Better compliance Increased exercise tolerance Increased mobility High cost Surgical complications Infection Mucus plugging Lost tract
- 32. NASAL MASK Hybridof nasal cannula and face mask. Supplemental oxygen equivalent to nasal cannula under low flow conditions for adult patients. Advantage – patient comfort. does not produce sores around nares Dry oxygen is not jetted into nasal cavity.
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- 38. SIMPLE OXYGEN MASK MERITSDEMERITS Disposable Light weight Covers both nose and mouth Elastic headband No reservoir bag Maleable metal nose bridge Incomplete seal Inboard leaking Mixture of oxygen and entrained room air Uncomfortable Speech is muffles Drinking and eating are difficult
- 39. Oxygen flow rate(L/min) Fio2 range 5-6 0.30-0.45 7-8 0.40-0.60
- 40. Masks lackingoxygen reservoirs best for Patients who require concentrations of oxygen greater than cannulas provide Need oxygen therapy for fairly short periods of time Example: medical transport or therapy, PACU, ER not for patients with severe respiratory disease who are hypoxemic, tachypneic or unable to protect their airway from aspiration.
- 41. MASK WITH RESERVOIRS Partial rebreathing mask Non rebreathing mask
- 42. PARTIAL REBREATHING MASK Consists of mask with exhalation ports and reservoir bag Reservoir bag must remain inflated O2 flow rate - 6 to 10L FIO2=60%-80% Client can inhale gas from mask, bag, exhalation ports Poorly fitting; must remove to eat
- 43. PARTIAL REBREATHING MASK No valves Mechanics – Exp: O2 + first 1/3 of exhaled gas (anatomic dead space) enters the bag and last 2/3 of exhalation escapes out through ports Insp: the first exhaled gas and O2 are inhaled FiO2 - 60-80% FGF > 8L/min The bag should remain inflated to ensure the highest FiO2 and to prevent CO2 Exhalation ports O2 Reservoir +
- 45. NON-REBREATHING MASK Consistsof mask, reservoir bag, 2 one-way valves at exhalation ports and bag Client can only inhale from reservoir bag Bag must remain inflated at all times O2 flow rate- 10 to 15L Fio2= 95-100% Poorly fitting; must remove to eat
- 46. NON-REBREATHING MASK Has3 unidirectional valves Expiratory valves prevents air entrainment Inspiratory valve prevents exhaled gas flow into reservoir bag FiO2 - 0.80 – 0.90 FGF – 10 – 15L/min To deliver ~100% O2, bag should remain inflated Factors affecting FiO2 air leakage and pt’s breathing pattern O2 Reservoir One-way valves
- 49. Fixed performance (High –Flow) equipment
- 52. VENTURI MASK • Mostreliable and accurate method for delivering a precise O2 concentration • Consists of a mask with a jet • Excess gas leaves by exhalation ports • O2 flow rate 4 to 15L & Narrowed orifice • Fio2, 24%-60% • Can cause skin breakdown; must remove to eat
- 54. AIR ENTRAINMENT NEBULIZER Have a fixed orifice, thus, air-to-O2 ratio can be altered by varying entrainment port size. Fixed performance device Deliver FiO2 from 28-100% Max. gas flows – 14-16L/min Device of choice for delivering O2 to patients with artificial tracheal airways. Provides humidity and temperature control
- 55. AIR ENTRAINMENT NEBULIZER Aerosol mask Facetent Tracheostomy collar T tube
- 56. HOW TO INCREASETHE FIO2 CAPABILITIES OF AIR-ENTRAINMENT NEBULIZERS? 1. Adding open reservoir (50-150ml aerosol tube) 2. Provide inspiratory reservoir (a 3-5 L anaesthesia bag) with a one way expiratory valve 3. Connect two or more nebulizers in parallel 4. Set nebulizer to low conc (to generate high flow) and providing supplemental O2 into delivery tube
- 57. BAG AND MASKVENTILATION
- 58. TRACHEOSTOMY COLLAR/MASK O2flow rate 8 to 10L Provides accurate FIO2 Provides good humidity; comfortable
- 59. T-PIECE Used onend of ET tube when weaning from ventilator Provides accurate FIO2 Provides good humidity
- 60. FACE TENT Lowflow O2 wet O2 flow, 4-8 lit Fio2=40%
- 61. Oxygen tent Hood Incubator ENCLOSURES
- 62. OXYGEN TENT Consistsof a canopy placed over the head and shoulders or over the entire body of a patient FiO2 – 40-50% @12- 15L/minO2 Variable performance device Provides concurrent aerosol therapy Disadvantage Expensive Cumbersome Difficult to clean Constant leakage Limits patient mobility
- 63. OXYGEN HOOD Anoxygen hood covers only the head of the infant O2 is delivered to hood through either a heated entrainment nebulizer or a blending system Fixed performance device Fio2 – 21-100% Minimum Flow > 7/min to prevent CO2 accumulation
- 64. INCUBATOR Incubators arepolymethyl methacrylate enclosures that combine servo-controlled convection heating with supplemental O2 Provides temperature control FiO2 – 40-50% @ flow of 8- 15 L/min Variable performance device
- 65. HYPERBARIC O2 THERAPY(HBOT)
- 66. DEFINITION A modeof medical treatment wherein the patient breathes 100% oxygen at a pressure greater than one Atmosphere Absolute (1 ATA) 1 ATA is equal to 760 mm Hg at sea level
- 67. PHYSIOLOGICAL EFFECTS OFHBO Bubble reduction ( boyle’s law) Hyperoxia of blood Enhanced host immune function Neovascularization Vasoconstriction
- 68. INDICATIONS OF HBOT ACUTECONDITIONS CHRONIC CONDITIONS Decompression sickness Air embolism Carbon monoxide poisoning Severe crush injuries Thermal burns Acute arterial insufficiency Clostridial gangrene Necrotizing soft-tissue infection Radiation necrosis Diabetic wounds of lower limbs Refratory osteomyelitis Actinomycosis (chronic systemic abscesses)
- 69. METHODS OF ADMINISTRATIONOF HBOT
- 70. PROBLEMS WITH HBOT Barotrauma Ear/ sinus trauma Tympanic membrane rupture Pneumothorax Oxygen toxicity Fire hazards Clautrophobia Sudden decompression
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- 72. COMPLICATIONS OF OXYGENTHERAPY 1. Oxygen toxicity 2. Depression of ventilation 3. Retinopathy of Prematurity 4. Absorption atelectasis 5. Fire hazard
- 73. 1. O2 TOXICITY Primarily affects lung and CNS. 2 factors: PaO2 & exposure time CNS O2 toxicity (Paul Bert effect) occurs on breathing O2 at pressure > 1 atm tremors, twitching, convulsions
- 74. PULMONARY OXYGEN TOXICITY C/F acute tracheobronchitis Cough and substernal pain ARDS like state
- 75. PULMONARY O2 TOXICITY(LORRAIN-SMITH EFFECT) Mechanism: High pO2 for a prolonged period of time ↓ intracellular generation of free radicals e.g.: superoxide,H2O2 , singlet oxygen ↓ react with cellular DNA, sulphydryl proteins &lipids ↓ cytotoxicity ↓ damages capillary endothelium, ↓
- 76. Interstitial edema Thickened alveolarcapillary membrane. ↓ Pulmonary fibrosis and hypertension
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- 78. HOW MUCH O2IS SAFE? 100% - not more than 12hrs 80% - not more than 24hrs 60% - not more than 36hrs Goal should be to use lowest possible FiO2 compatible with adequate tissue oxygenation
- 79. INDICATIONS FOR 70%- 100% OXYGEN THERAPY 1. Resuscitation 2. Periods of acute cardiopulmonary instability 3. Patient transport
- 80. 2. DEPRESSION OFVENTILATION Seen in COPD patients with chronic hypercapnia Mechanism ↑PaO2 suppresses peripheral V/Q mismatch chemoreceptors depresses ventilatory drive ↑ dead space/tidal volume ratio ↑PaCO2
- 81. 3. RETINOPATHY OFPREMATURITY (ROP) Premature or low-birth-weight infants who receive supplemental O2 Mechanism ↑PaO2 ↓ retinal vasoconstriction ↓ necrosis of blood vessels ↓ new vessels formation ↓ Hemorrhage → retinal detachment and blindness To minimize the risk of ROP - PaO2 below 80 mmHg
- 82. 4. ABSORPTION ATELECTASIS 100%O2 oxygen nitrogen PO2 =673 PCO2 = 40 PH2O = 47 A B A – UNDERVENTILATED B – NORMAL VENTILATED
- 83. DENITROGENATION ABSORPTION ATELECTASIS The “denitrogenation”absorption atelectasis is because of collapse of underventilated alveoli (which depends on nitrogen volume to remain above critical volume ) ↓ Increased physiological shunt
- 84. 5. FIRE HAZARD High FiO2 increases the risk of fire Preventive measures Lowest effective FiO2 should be used Use of scavenging systems Avoid use of outdated equipment such as aluminium gas regulators Fire prevention protocols should be followed for hyperbaric O2 therapy