This document summarizes oxygen therapy in pediatrics. It discusses the indications for oxygen therapy including conditions like pneumonia, asthma, and heart failure. Methods of oxygen delivery include low-flow devices like nasal cannulas and face masks, and high-flow devices like Venturi masks and CPAP/BiPAP. Detection of hypoxemia can be done through clinical evaluation, pulse oximetry, and blood gas analysis. The document also covers treatment considerations like flow rates, interfaces, and humidification needs. Potential complications of oxygen therapy include CO2 narcosis.

1. Oxygen Therapy in Pediatrics
Prepared By : MS.Sabah Salim
Under Supervision Of : Dr.Khalaf Hussein

2. • Introduction on O2
• Indications
• Detection
• Treatment & Methods

3. Introduction
*Colorless, odorless, tasteless gas,Makes up 21% of
room air ,It’s NOT flammable but does support
combustion.
*It’s Considered as a medical gas.
*Stored in bottles in liquified Form
*1L of liquified form = 860 L of Gaseous O2

4. • For Mammalian to maintain their live ,depend on a
continuous supply of O2 to sustain aerobic metabolism.
The main purpose from O2 is

5. • ENERGY is provided by a series of biochemical
oxidation/reduction reactions .
• energy is captured by certain molecules, such as (ATP),
that then become reservoirs of ENERGY .

6. • Tissues have no storage system for O2.
They rely on a continuous supply at a rate that
precisely matches changing metabolic requirements.
• If supply fails, tissue hypoxaemia may develop
resulting in anaerobic metabolism and production of
lactate.

7. Hypoxemia
decrease in the arterial O2 content in the blood
Hypoxia
decreased O2 supply to the tissues.
• Hypoxemia (low oxygen in your blood) can cause hypoxia (low oxygen in
your tissues) when your blood doesn't carry enough oxygen to your
tissues to meet your body's needs.
• The word hypoxia is sometimes used to describe both problems.

8. So….............Oxygen Therapy
• Refers to supplemental oxygen given to people who,
aren’t able to get enough naturally largely due to
breathing disorders.

9. Indications:
• Pneumonia
• Asthma
• BPD underdeveloped lungs in newborns
• Heart Failure
• CF
• SA
• Trauma to the respiratory system

11. Detection
Clinical evaluation
Pulse oximetry
ABG

12. Clinical Evaluation

13. Pulse Oximetry
Based on the Red and Infrared light absorption
• Oxygenated hemoglobin absorbs more Infrared light
and allows more Red light to pass through
• Deoxygenated (or reduced) hemoglobin absorbs more
Red light and allows more Infrared light to pass
through.
Normal SpO2 values vary between 95 and 100%

14. ABG
Blood gases are a measurement of how much O2 and
CO2 are in your blood + pH
Normal Values
-PaO2 : 75 to 100 mm Hg (10.5 to 13.5 kPa)
-PaCO2 : 38 to 42 mm Hg (5.1 to 5.6 kPa)
-PH : 7.38 to 7.42
-SaO2 : 94% to 100%
-HCO3 : 22 to 28 mEq/L

15. Treatment & Methods
Depends on:
• age of the patient
• oxygen requirements/therapeutic goals
• patient tolerance to selected interface
• humidification needs

16. Classification
1-Low-flow devices:
• Provide oxygen at flow rates that are lower than patients’ inspiratory demands
• When the total ventilation exceeds the capacity of the oxygen reservoir, room air is entrained
2-High-flow devices:
• Provide a constant FiO2 by delivering the gas at flow rates that exceed the patient’s peak
inspiratory flow rate and by using devices that entrain a fixed proportion of room air

17. 1-Low flow delivery Method
*Simple face mask (without air entrainment device)
*Non re-breather face mask (mask with oxygen reservoir
bag and one-way valves which aims to prevent/reduce
room air entrainment)
*Nasal prongs (low flow)
*Tracheostomy mask (without air entrainment device)
*Face tent

18. Simple Oxygen Face Mask:
A plastic oxygen mask that covers the nose and mouth and is utilized when
delivering oxygen concentrations ranging from 30% - 60%.
*Naturally occurring room air is 21% and a higher percentage is often essential for
medical treatments.
*Depending on the mask size, it offers a self-contained reservoir of 100 to 200 ml
of additional gas and requires a flow of oxygen of 5 - 6L/min to avoid CO2
accumulation within the face mask.
*The mask has exhalation ports to allow carbon dioxide to escape as well as
mixing delivered oxygen with room air.

19. Indications:
Medium flow oxygen desired, mild to moderate respiratory distress
• When increased oxygen delivery for short period (<12 hrs)
Advantage:
Less expensive (Rs 80/-)
Can be used in mouth breathers
Contraindications:
Poor respiratory efforts, apnea
, severe hypoxia
Disadvantage
Uncomfortable
Require tight seal
Donot deliver high FiO2
FiO2 varies with breathing efforts
Interfere with eating, drinking,
communication
Difficult to keep in position for long
Skin breakdown

20. Non rebreather mask
Has one way valve
Can deliver 100% Fio2

21. Contraindications:
Poor respiratory efforts, apnea, severe hypoxia
Disadvantage
Expensive (Rs 250/-)
Require tight seal, Uncomfortable
Interfere with eating and drinking
Not suitable for long term use
Malfunction can cause CO2 buildup, suffocation
Disadvantage
Expensive (Rs 250/-)
Require tight seal, Uncomfortable
Interfere with eating and drinking
Not suitable for long term use
Malfunction can cause CO2 buildup, suffocation
Indications:
High FiO2 requirement >40%
Advantage:
Highest possible FiO2 without intubation
Suitable for spontaneously breathing patients with
severe hypoxia

22. Nasal Cannula
two-pronged tube device that delivers a low flow rate of oxygen that distributes oxygen
concentrations of 24% to 44%,
*appropriate for individuals requiring long-term oxygen use, or for those with minimal
respiratory distress.
*The two prongs sit at the entrance of the nostrils with the long, thin oxygen delivering tube
anchoring over the ears to help hold the nasal cannula in place.
***better for feeding

23. Indications
Low to moderate oxygen requirement
No or mild respiratory distress
Long term oxygen therapy
Advantages
Less expensive (Rs 70/-)
Comfortable, well tolerated
Able to talk and eat
Contraindications
Poor efforts, apnea, severe hypoxia
Mouth breathing
Disadvantages
Doesnot deliver high FiO2
Irritation and nasal obstruction
Less FiO2 in nasal obstruction
FiO2 varies with breathing efforts

24. Tracheostomy Mask
A tracheostomy mask, sometimes referred to as a tracheostomy collar,
is a small mask that fits over the patient’s tracheostomy site.
An adjustable elastic strap that fits around the patient’s neck
holds it in place.
The mask has an exhalation port that remains patent at all times and a port that
connects to the oxygen source with large-bore tubing.
The flow rate is usually set at 10 L/min, with a nebulizer set at the appropriate
oxygen concentration.

25. Oxygen tent
Clear plastic sheet that cover child’s upper body
FiO2 50%
Not reliable
Limit access to patient
Not useful in emergency situations

26. Face tent/face shield
High flow soft plastic bucket
Well tolerated by children than face mask
10-15 L/min, 40% FiO2
Access for suctioning without need for interrupting
oxygen

27. 2-High flow delivery Method
*CPAP/BiPaP drivers
*Face mask or tracheostomy mask used in conjunction
with an entrainment device
*High flow nasal prongs (HFNP)

28. CPAP and BiPAp
Noninvasive ventilation, an alternative to mechanical ventilation, is used to maintain
positive airway pressure and to improve alveolar ventilation without the need for an
artificial airway. It is commonly used for patients who have congestive heart failure,
sleep disorders, and pulmonary diseases to improve oxygenation, reduce and reverse
atelectasis, reduce pulmonary edema, and improve cardiac function. The two types of
noninvasive ventilation are CPAP and BiPAP.
Continuous positive pressure ventilation (CPAP) provides a set positive airway pressure
throughout the patient’s breathing cycle. It is commonly used for patients who
experience sleep apnea because the continuous positive pressure keeps the airway
open and prevents the upper airway from collapsing. The usual CPAP pressure is
between 5 and 20 cm of water.
Bilevel positive airway pressure (BiPAP) provides assistance during inspiration and
keeps the airway from closing during expiration. The benefits of BiPAP include an
increase in the amount of air in the lungs at the end of expiration, reduced airway
closure, and improved oxygenation.

29. Continuous positive airway pressure
By applying underwater expiratory resistance
Indicated
When oxygen requirement >60% with a PaO2 of <60
mmHg
CPAP reduce work of breathing, increases FRC and
helps maintain it, recruit alveoli, increase static
compliance, and improve ventilation perfusion ratio

30. Used in
Early ARDS, acute bronchiolitis, pneumonia
It should be tried in spontaneously breathing child who does not
require emergency intubation prior to conventional ventilation

31. Venturi Mask:
•Often used when a clinician has a concern about CO2 retention,

32. Contraindications
Poor respiratory efforts, apnea, severe
hypoxia
Disadvantage
Uncomfortable
Expensive (Rs 150/-)
Cannot deliver high FiO2
Interfere with eating and drinking
indications:
Desire to deliver exact amount of FiO2
Advantage:
Fine control of FiO2 at fixed flow
Fixed, reliable, and precise FiO2
Doesnot dry mucus membranes
High flow comes from the air, saving the oxygen cost
Can be used for low FiO2 also
Helps in deciding whether the oxygen requirement is increasing or
decreasing

33. Bi-Flow Nasal Mask: Designed for patients who suffer from nasal sores from a normal two-
pronged nasal cannula, this mask fits over the nose in a ‘cup fit’ style of mask.
Bi-Flow Oxygen Mask: Designed as a more comfortable solution for patients who cannot
tolerate a cannula or who have recurring necrosis, the design of the mask will provide Fi02
volume comparable to a cannula while eliminating the irritation of the cannula.

34. Humidification
The humidifier should always be placed at a level below the patient's head.
Why Humidification?
• Cold, dry air increases heat and fluid loss
• Medical gases including air and oxygen have a drying effect and mucous membranes become dry
resulting in airway damage.
• Secretions can become thick & difficult to clear or cause airway obstruction
• In asthma, the hyperventilation of dry gases can compound bronchoconstriction.
Indications:
• Patients with thick copious secretions
• Non-invasive and invasive ventilation
• Nasal prong flow rates of greater than 2 LPM (under 2 years of age) or 4 LPM (over 2 years of age)
• Facial mask flow rates of greater than 5 LPM
• Patients with tracheostomy

35. Potential complications
CO2 Narcosis - This occurs in patients who have chronic respiratory obstruction or respiratory insufficiency which
results in them developing hypercapnea (i.e. raised PaCO2). In these patients the respiratory centre relies on
hypoxaemia to maintain adequate ventilation. If these patients are given oxygen this can reduce their
respiratory drive, causing respiratory depression and a further rise in PaCO2 resulting in increased CO2 levels
in the blood and CO2 narcosis.
Pulmonary Atelectasis
Pulmonary oxygen toxicity - High concentrations of oxygen (>60%) may damage the alveolar membrane when
inhaled for more than 48 hours resulting in pathological lung changes.
Retrolental fibroplasia (also known as retinopathy of prematurity) An alteration of the normal retinal vascular
development, mainly affecting premature neonates (<32 weeks gestation or 1250g birthweight), which can
lead to visual impairment and blindness.
Substernal pain-due: characterised by difficulty in breathing and pain within the chest, occurring when
breathing elevated pressures of oxygen for extended periods.

36. Oxygen safety
Oxygen is not a flammable gas but it does support combustion (rapid burning).
Due to this the following rules should be followed:
• Do not smoke in the vicinity of oxygen equipment.
• Do not use aerosol sprays in the same room as the oxygen equipment.
• Turn off oxygen immediately when not in use. Oxygen is heavier than air and will
pool in fabric making the material more flammable. Therefore, never leave the nasal
prongs or mask under or on bed coverings or cushions whilst the oxygen is being
supplied.
• Oxygen cylinders should be secured safely to avoid injury.
• Do not store oxygen cylinders in hot places.
• Keep the oxygen equipment out of reach of children.
• Do not use any petroleum products or petroleum byproducts e.g. petroleum
jelly/Vaseline whilst using oxygen.

37. •THANK YOU