This document discusses oxygen therapy, including its goals of correcting hypoxemia, reducing symptoms, and minimizing workload on the cardiopulmonary system. It describes various oxygen delivery devices like nasal cannulas, masks, and high flow devices. Special considerations are given for COPD patients to avoid depressing ventilation. The key is to carefully assess each patient's needs and monitor their response to oxygen therapy.

1. Oxygen Therapy Presented By: Brian Cayko, M.B.A., RRT, RCP

2. Objectives Indications, Objectives, & Hazards of O2 Therapy Medical Oxygen Oxygen Transport Oxygen Delivery COPD Hypoxic Drive

3. 3 Oxygen TherapyGeneral Goals/objectives Correcting Hypoxemia By raising Alveolar & Blood levels of Oxygen Easiest objective to attain & measure Decreasing symptoms of Hypoxemia Supplemental O2 can help relieve symptoms of hypoxia Less dyspnea/WOB Improve mental function

4. Oxygen TherapyGoals/objectives -cont’d Minimizing CP workload CP system will compensate for Hypoxemia by: Increasing ventilation to get more O2 in the lungs & to the Blood Increased WOB Increasing Cardiac Output to get more oxygenated blood to tissues Hard on the heart, especially if diseased Hypoxia causes Pulmonary vasoconstriction & Pulmonary Hypertension These cause an increased workload on the right side of heart Over time the right heart will become more muscular & then eventually fail (Cor Pulmonale) Supplemental o2 can relieve hypoxemia & relieve pulmonary vasoconstriction & Hypertension, reducing right ventricular workload 4

5. Oxygen Therapy The difference between O2 % delivered v. Inspired Patient Dependant! 5

6. Oxygen Therapy Assessing the need for oxygen therapy 3 basic ways Laboratory measures invasive or noninvasive Clinical Problem or condition COPD, Surgery, etc. Symptoms of hypoxemia Dyspnea, Neuro, HR, etc. 6

7. Oxygen Therapy Assessing the need for oxygen therapy Laboratory measures – invasive or noninvasive PO2 – partial pressure of oxygen PAO2 – Partial Pressure of Oxygen in Alveoli PaO2 – Partial pressure of Oxygen in arterial blood Hgb Saturation SpO2 – Pulse Oximetry of Oxyhemaglobin Saturax 7

8. Pulse Oximetry (SpO2) Non-invasive Detects the saturation levels of Oxyhemaglobin How much of the Hgb that is capable of carrying O2 actually is carrying O2 Technical Considerations / Problems Inaccurate if Non-Pulsatile Must always palpate the patients pulse while performing Pulse Oximetry Pulse & Pulse Ox’s heart rate monitor must correlate Other Inaccuracy causes Poor perfusion/circulation Trauma CO Poisoning Some Nail Polish / Thickened & discolored nails

9. Medical Gases All Medical Gases Are Drugs Require Prescription Quality of each gas is mandated by FDA Medical O2 must be 99% Pure Anhydrous Medical gas must be dry & free of oil/contaminants Cooled to dry Filter to clean

10. Composition of Room Air Nitrogen 78.08% ~78% Oxygen 20.946% ~21% Trace gases ~1%

11. O2 Supply

12. Oxygen TherapyAssessing the need for Requires expert in-depth knowledge RT is always available for consultation RT & Nurse will combine objective & subjective measures to confirm inadequate oxygenation Objective Test results Subjective Pt assessment Often recommend administration based solely on subjective measures 12

13. Oxygen TherapyDesign & Performance Low flow Devices Flow does not meet inspiratory demand O2 is diluted with air on inspiration Nasal Cannula transtracheal Catheter Reservoir Cannulas Mustache Pendant 13

14. 14 Nasal Cannula

15. Oxygen TherapyLow Flow Devices Nasal Cannula Adult 0-6 l/m >4L requires Humidity Can cause irritax, dryness, bleeding, etc. 24-44% Pediatrics (> 1mo) Low flows if possible Always humidified Neo 0-2 l/m Always humidified 15

16. Oxygen TherapyLow Flow Devices Reservoir Cannula Frequent replacement No humidification Requires nasal exhalation Nasal Stores ~20ml Aesthetically displeasing Pendant Better aesthetically Extra weight can irritate ears/face 16

17. Oxygen TherapyLow Flow Devices Reservoir masks Simple Mask Non-Rebreather 17

18. Low Flow DevicesReservoir Masks Simple Mask Gas gathers in mask Exhalation ports Air entrained thru ports & around mask 5-10 L/M <5 = CO2 rebreathing >10 = use more invasive mask 18

20. b/w reservoir & mask

21. on one exhalation port

22. leak free will provide 100%

23. >~70% FiO2 is rare

24. Hard to provide leak free system

26. Oxygen TherapyHigh Flow Devices High Flow Supplies given FiO2 @ flows higher than inspiratory demand Uses Entrainment 21

27. Oxygen TherapyHigh Flow Devices Air Entrainment system What is Entrainment? 22

28. Oxygen TherapyHigh Flow Devices - Entrainment AE Devices AEM (Venti-Mask) AE Nebulizer (Large Volume Nebulizer) cool/heated Aerosol 23

29. Air Entrainment Mask 24

30. Oxygen TherapyHigh Flow Devices – Entrainment 25

31. Oxygen TherapyOther devices Enclosures Tents Hoods Incubators Others BVM Pulse Dose Cannula Concentrators 26

32. Oxygen TherapySelecting Delivery Approach Not one best method every time RT & their expert knowledge needs to be available for: Consult Assessment/reassessment Alteration of therapy Discontinuation of therapy 27

33. Oxygen TherapySelecting Delivery Approach Purpose (Objective) Increase FiO2 to correct hypoxemia minimize symptoms of hypoxemia Minimize CP workload Patient Cause & severity of hypoxemia Age Neuro status/orientation Airway in place/protected Regular rate & rhythm (minute Ventilation) 28

34. Oxygen TherapySelecting Delivery Approach Equipment Performance The more critical, the greater need for high stable FiO2 Becomes more difficult the more critical due to the patients varying respiratory pattern 29

35. Oxygen TherapySelecting Delivery Approach Pt Categories Emergency Highest FiO2 possible NRB mask, BVM Critical Adult >60% O2 NRB, Dual Entrainment systems Stable adult, acute illness, mild hypoxemia Low to mod FiO2 Simple Mask, Nasal Cannula 30

36. COPD Chronic Obstructive Pulmonary Disease Broad term used to describe non-reversible generalized airway obstruction. Obstructive Airway Diseases C OPD B ronchitis A sthma B ronchiectesis E mphysema

37. CO2 Retainer All COPD patients are NOT CO2 RETAINERS!! Some may be, But each patient needs to be assessed CO2 Retainer In Obstructive airway diseases it is often for the obstruction to trap air in the distal lungs CO2 is not eliminated from the body efficiently Over time, their body no longer reacts to High levels of CO2 normally, i.e. increased ventilation The result is CO2 retention

38. Oxygen TherapyPrecautions & Hazards Deprex of Ventilation 2 dominant stimulants to breathe in Blood stream CO2 O2 Hypercarbic drive is blunted High PCO2 no longer stimulates pt to increase Ventilax Hypoxic drive is the only stimulus left suppression of Hypoxic Drive Due to applying to much O2 33

39. Oxygen TherapySelecting Delivery Approach CO2 Retainer Chronic disease adult (COPD w/ CO2 retainment) acute on chronic illness Ensure adequate oxygenation without depresseing Ventilation SpO2 85-90% PaO2 50-60mmHg Use venti mask to control FiO2 precision Assess response to therapy!! If not maintainable on Cannula, use masks Pt may remove mask frequently due to Discomfort Convenience Change in mental status Encourage Cannula use b/w mask use if mask must come off for periods 34

40. Summary Call RT if in doubt, we are there to help you serve the patient Adult Delivery Nasal Cannula 1-6 L/m, 24-44%, humidify if >4 L/m, Stable Simple Mask 5-10 L/m, 35-55%, <5 l/m causes CO2 retention, Distress Non-Rebreather Mask >10 L/m, ~60-100%, Dependant on mask fit, Failure COPD does NOT equal CO2 retainment