1) Oxygen therapy equipment can be classified as either low-flow/variable-performance equipment or high-flow/fixed-performance equipment. Low-flow equipment includes nasal cannulas and masks, while high-flow includes anesthesia bags and venturi masks. 2) Key oxygen therapy devices include nasal cannulas, nasal masks, simple face masks, reservoir masks, venturi masks, nebulizers, oxygen hoods, and hyperbaric oxygen chambers. Each device has advantages and disadvantages for delivering different concentrations of oxygen under varying conditions. 3) Proper use and settings of oxygen therapy equipment, including sufficient gas flow, addressing leaks, and patient fit are important to ensure patients receive the targeted concentration of oxygen

1. OXYGEN THERAPY EQUIPMENT
Dr. Mohammed Khairt Newigy
Lecturer In Anesthesia
UMM Al-Qurra University

2. Classifying Oxygen Therapy Equipment
Oxygen is given either:
1- Alone or
2-In a gas (mixed with air, helium, or nitric oxide)
Oxygen can be administered:
1- As a partial supplement to patients' tidal or
minute volume.
2- As the only source of the inspired volume.

3. Classification of oxygen therapy equipment
1- LOW-FLOW OR VARIABLE-PERFORMANCE EQUIPMENT
a) Oxygen (usually 100%) is supplied at a fixed
flow that is only a portion of inspired gas.
b) Such devices are usually intended for
patients with stable breathing patterns.
c) As ventilatory demands change, variable
amounts of room air will dilute the oxygen
flow.

4. 2- HIGH-FLOW OR FIXED-PERFORMANCE EQUIPMENT
a) Inspired gas at a preset FIO2 is supplied
continuously at high flow or by providing a
sufficiently large reservoir of premixed gas.
b) Ideally, the delivered FIO2 is not affected by
variations in ventilatory level or breathing
pattern.

5. 1-Variable-Performance Equipment
1-Nasal Cannulas
A) The nasal cannula is available as either:
a) a blind-ended soft plastic tube with an over-the-
ear head-elastic
b) or dual-flow with under-the-chin lariat
adjustment.
B) Sizing is available for adults, children, and infants.
C) Cannulas are connected to flowmeters with
small-bore tubing and may be used with a bubble
humidifier.

6. D) Advantages:
1- The nasal cannula can be rapidly and comfortably
placed on most patients.
2- Patients on long-term oxygen therapy most
commonly use a nasal cannula.
3- The appliance is usually well tolerated.
4- It allows speech and eating/drinking

7. Factors affecting the actual FIO2 delivered to
adults by nasal cannula:
E) The actual FIO2 delivered to adults with nasal
cannulas is determined by:
1- Oxygen flow
2- Nasopharyngeal volume
3- The patient's inspiratory flow (which depends
both on VT and inspiratory time).

8. Nasal cannula flow and FIO2
F) Nasal cannulas can be expected to provide
FIO2 up to 30–35% with normal breathing and
oxygen flows of 3–4 L/min.
G) FIO2 levels of 40–50% can be attained with
oxygen flows of greater than 10 L/min for short
periods.

9. Why nasal cannula flow > 5L/min is
poorly tolerated?
H) Usually flows greater than 5 L/min are poorly
tolerated because of:
1- The discomfort of gas jetting into the nasal
cavity.
2- Drying and crusting of the nasal mucosa.

12. Flowmeter

13. Flowmeter humidifier

14. 2- Nasal Mask
A) The nasal mask is a hybrid of the nasal
cannula and a face mask.
B) Nasal masks have been shown to provide
supplemental oxygen equivalent to the nasal
cannula under low-flow conditions for adult
patients.

15. Advantage
1- Patient comfort and compliance
2- Home use for obstructive sleep apnea (C-PAP and
Bi-PAP).
Disadvantages
2- Sores can develop around the external nares of
long-term nasal cannula use

16. Nasal Mask

17. 3- Nonreservoir Oxygen Mask
The "simple," or nonreservoir mask is a disposable
lightweight plastic device that covers both nose
and mouth.
The face seal is rarely free of "inboard" leaking;
therefore, patients receive a mixture of pure
oxygen and secondarily entrained room air.

18. Factors affecting oxygen/entrained air ratio during
face mask ventilation
This ratio varies depending on:
1- Size of leak
2- Oxygen flow
3- Breathing pattern

19. A minimum oxygen flow of approximately 5 L/min
is applied to the mask to avoid rebreathing and
excessive respiratory work.
Disadvantages:
1- Wearing the mask for long periods of time is
uncomfortable.
2- Speech is muffled.
3- Drinking and eating are difficult.

20. FIO2 and flow of non rebreathing
simple face masks
It is difficult to predict delivered FIO2 at specific
flows.
During normal breathing, it is reasonable to expect:
1- FIO2 of 0.3 with flows of 5 L/min
2- FIO2 of 0.6 with flows of 10 L/min

21. Indications
1- The non-reservoir mask is used for patients who
require higher levels of oxygen than nasal cannulas
but need oxygen therapy for short periods of time.
Examples include
1- Therapy in the post anesthesia care unit(PACU).
2- Emergency department.

22. Contraindications
It is not the device of choice for patients with
severe respiratory disease who are;
1- Profoundly hypoxemic.
2- Profoundly tachypneic.
3- Unable to protect their airway from aspiration.

23. Non Rebreathing Simple Face Mask

24. Non Rebreathing Simple Face Mask

25. 4- Reservoir Masks
Incorporating a gas reservoir is a logical
development to the simple mask.
Two types of reservoir mask are commonly used:
A) The partial rebreathing mask.
B) The nonrebreathing mask.
Mask reservoirs commonly hold approximately 600
mL or less.

26. The partial rebreathing mask
The term "partial rebreather" refers to "part" of
the patient's expired VT refilling the bag.
Usually that gas is largely dead space that should
not result in significant rebreathing of carbon
dioxide.

27. The nonrebreathing mask.
The nonrebreather uses the same basic system as
the partial rebreather but incorporates flap-type
valves between the bag and mask and on at least
one of the mask's exhalation ports.
Inboard leaking is common, and room air will enter
during brisk(high) inspiratory flows, even when the
bag contains gas.

28. Disadvantages of reservoir masks:
1- The lack of a good facial seal system.
2- A relatively small reservoir.
Which can affect (decrease)delivered oxygen
concentration.
The key factor to successful application of the
masks is to use sufficient flow of oxygen, so the
reservoir bag is at least partially full during
inspiration.

29. Partial rebreathing masks FIO2 and flow
Typical minimum flows of oxygen are 10–15 L/min.
Well-fitting partial rebreathing masks provide:
1- FIO2 from 0.35 to 0.60 with oxygen flows up to
10 L/min
2- FIO2 may approach 1.0 with inlet flows of 15
L/min or more and ideal breathing conditions.

30. Indications of reservoir masks:
Patients suspected of significant hypoxemia, with
relatively normal spontaneous minute ventilation.
Such as patients with;
1- Trauma.
2- Myocardial infarction.
3- Carbon monoxide poisoning.

31. Partial Rebreathing Mask

32. Non- Rebreathing Mask

33. Partial Rebreathing VS Non-Rebreathing Mask

35. 2- Fixed-Performance (High-Flow)
Equipment
1- Anesthesia Bag or Bag-Mask-Valve Systems
The basic design follows that of the nonrebreathing
reservoir mask.
A- Self-inflating bags (AMBU) consist of a football-
sized bladder, usually with an oxygen inlet reservoir.
B- Anesthesia bags are 1, 2, or 3L non–self-inflating
reservoirs with a tailpiece gas inlet.

36. • Masks are designed to provide a comfortable
leak-free seal for manual ventilation.
• The inspiratory/expiratory valve systems may
vary.
• The flow to the reservoir should be kept high so
that the bags do not deflate substantially.

37. • When using an anesthesia bag, operators may
frequently have to adjust the oxygen flow and
exhaust valve spring tension to respond to
changing breathing patterns or demands

38. • The most common system for disposable and
permanent self-inflating resuscitation bags
(AMBU bags) uses a unidirectional gas flow.
• There are limits to the ability of each system to
maintain its fixed-performance characteristics.
• Delivered FIO2 can equal or approach 1.0 with
either anesthesia or self-inflating bags.

39. • Spontaneously breathing patients are allowed
to breathe only the contents of the system if
the mask seal is tight and the reservoir is
adequately maintained.
• Operators must adjust gas flow to the bag to
accommodate for any changes in ventilation
demand; observation of patient and reservoir
provides that information.

40. • A primary concern for clinicians using mask-
bag systems is aspiration.
• Failure to maintain an adequate oxygen supply
in the reservoir and inlet flow is another
concern.
• The spring-loaded valve of anesthesia bags
must be adjusted properly to prevent
overdistention of the bag.

41. • Self-inflating bags do not look different when
oxygen flow to the unit is inadequate, and
they will entrain room air into the bag, thus
lowering the delivered FIO2.

42. Anesthesia Bag

43. AMBU Bag

45. AMBU Bag Use

46. 2- Air-Entrainment Venturi Masks
• The gas delivery system with air-entrainment masks
is somewhat different than with an oxygen reservoir.
The goal in venturi mask design is to:
1- Create an open system.
2- With high flow about the nose and mouth.
3- With a fixed FIO2.
• Oxygen is directed by small-bore tubing to a mixing
jet; the final oxygen concentration depends on the
ratio of air drawn in through entrainment ports.

47. • Despite the high-flow concept, FIO2 can vary up
to 6% per setting.
Indications of venturi mask:
1- Patients whose hypoxemia cannot be controlled
on lower FIO2 devices such as the nasal cannula.

48. Causes of increased FIO2 than expected during use
of venturi masks:
FIO2 can increase if the entrainment ports are
obstructed by:
1- The patient's hands.
2- Bed sheets.
3- Water condensate.

49. Venturi Masks

50. Venturi Mask Principle

51. Venturi Mask In Use

53. Venturi Mask

56. 3- Air-Entrainment Nebulizers
• Large-volume, high-output or "all-purpose"
nebulizers have been used in respiratory care for
many years to provide bland mist therapy with
some control of the FIO2.
• These units are commonly placed on patients
following extubation for their aerosol-producing
properties.

57. • Like the entrainment masks, nebulizers use a
pneumatic jet and an adjustable orifice to vary
entrained air for various FIO2 levels at fixed
setting points or are continuously adjustable
from 0.24 to 1.0.

58. • Nebulizer systems can be applied to the patient
with many different devices, including
tracheostomy, face tent, and T-piece adapter.
These appliances can all be attached via large-
bore tubing to the nebulizer.

60. Nebulizer

61. Adjustable Nebulizer

62. 4- Oxygen Hoods
• Oxygen hoods cover only the head, allowing
access to the infant's lower body while still
permitting use of a standard incubator or
radiant warmer.
Indications
The hood is ideal for relatively short-term oxygen
therapy for newborns and inactive infants.

63. • Normally, oxygen and air are premixed by an
air–oxygen blending device and passed
through a heated humidifier.
• There is no attempt to completely seal the
system, as a constant flow of gas is needed to
remove carbon dioxide (minimum flow > 7
L/min).
• Hood inlet flows of 10–15 L/min are adequate
for a majority of patients.

64. Oxygen Hood

65. Helium–Oxygen Therapy
• Helium–oxygen (Heliox) mixtures have a
number of medical applications.
• Helium is premixed with oxygen in several
standard blends.

66. The most popular mixtures of Helium–Oxygen are:
1- 80%/20%
2- 70%/30%
• They are available in large-sized compressed gas
cylinders.
• The colour code for Heliox cylinder is white and
brown.
• In anesthetic practice, pressures needed to
ventilate patients with small-diameter tracheal
tubes (TTs) can be substantially reduced (Halved)
when the (Heliox) 80%/20% mixture is used.

67. Indications of Helium–Oxygen Therapy
Temporary relief in patients with acute distress from
upper airway–obstructing lesions such as:
1- Subglottic edema.
2- Foreign bodies.
3- Tracheal tumors.

68. Heliox Cylinders

69. • Patients' WOB(work of breathing) can be
reduced when Heliox is delivered via the
mechanical ventilator (noninvasive or via an
artificial airway).
• Non-intubated patients commonly receive
heliox therapy via mask with reservoir bag.

70. Hyperbaric Oxygen
• Hyperbaric oxygen therapy uses a pressurized
chamber to expose the patient to oxygen
tensions exceeding ambient barometric
pressure (usually > 760 mm Hg).
• Around 3 bars hyperbaric oxygen is commonly
used.

71. indications of hyperbaric oxygen include:
1- Decompression sickness.
2- Gas embolism.
3- Gas gangrene.
4- Carbon monoxide poisoning.
5- Treatment of certain wounds e.g diabetic foot.

72. Hyperbaric Oxygen Therapy

73. Hyperbaric Oxygen Therapy