oxygen therapy

1. Dr Sushma Saroa
Dr Vani Bhageria

2. OXYGEN THERAPY IS “THE
ADMINISTRATION OF OXYGEN AT
CONCENTRATIONS GREATER THAN THAT IN
AMBIENT AIR , WITH THE INTENT OF
TREATING OR PREVENTING THE SYMPTOM &
MANIFESTATION OF HYPOXIA.”

3. PaO2
80 – 100 mm Hg : Normal
60 – 80 mm Hg : cold, clammy limbs
< 60 mm Hg : cyanosis
< 40 mm Hg : mental confusion
< 30 mm Hg : bradycardia leads to
cardiac arrest

4. To maintain adequate
tissue oxygenation

5. HYPOXIA

6. TYPE OF HYPOXIA DEFINITION TYPE OF CASES
1. HYPOXIC ↓ O2 TENSION HIGH ALTITUDE-
HYPOVENTILATION
2. ANAEMIC ↓ CARRYING CAPACITY ANAEMIA-BLOOD LOSS-
CO POISIONING
3. STAGNANT ↓ PERFUSION HEART FAILURE -SHOCK -
ISCHEMIA
4. HISTOTOXIC CELLULAR HYPOXIA CYANIDE

7. CLASSIFICATION PaO2
NORMAL 80-100 mm Hg
Mild Hypoxia 60-80 mm Hg
Moderate Hypoxia 40-60 mm Hg
Severe Hypoxia < 40 mm Hg Respiratory
failure

8.  OXYGEN SHOULD BE GIVEN VERY
METICULOUSLY TO MAINTAIN SATURATION
ABOVE 94 % OR PO2> 80mmHg .
 FLOW AND DEVICE SHOULD BE MENTIONED
BEFORE ADMINISTRATING.

9. Use lowest possible FiO2 compatible with
adequate oxygen
100% O2 - not more than 12hrs
80% - not more than 24hrs
60% - not more than 36hrs

10. 98% for most patients is normal and safe
If target range is 94-98%
• Choose mask and flow rate to meet target range
• No blood gases needed
If target range is 88-92%
• Start with 1-2 litres nasal oxygen or 28% Venturi mask
then titrate up to meet target range
• Check blood gases after 30-60 mins

11. Clinical Devices
 Symptoms of
hypoxemia
 Cyanosis
 Oxygen saturation by
Pulse Oximeter (Monitor
Sp02 for first 5 mins and
then monitor Sp02 on
chart minimum 4
hourly)
 ABG analysis
 pH
 pO2
 pCO2
 Mixed venous blood
oxygenation

13. NO CONTRAINDICATIONS TO OXYGEN
HIGH CONCENTRATION HAVE DELETIRIOUS
EFFECTS
.

14.  NON PRODUCTIVE COUGH
 NAUSEA & VOMITING
 SUBSTERNAL CHEST PAIN
 FATIGUE
 NASAL STUFFINESS
 HEADACHE
 SORE THROAT
 HYPOVENTILATION
 NASAL CONGESTION
 DYSPNEA
 INSPIRATION PAIN

15. 1. Fire hazard
2. Oxygen toxicity (Primarily affects lung and
CNS.)
3. Depression of ventilation
4. Retinopathy of Prematurity in new born
5. Absorption atelectasis

16. when the patient is clinically stable and has
maintained target SpO2 on low dose 02
therapy for 2 sets of observations

17. o Low flow (Variable performance devices )
 Nasal cannula
 Nasal catheter
 Transtracheal catheter
o Reservoir system (Variable performance device)
 Reservoir cannula
 Simple face mask
 Partial rebreathing mask
 Non rebreathing mask
 Tracheostomy mask
o High flow (Fixed performance devices)
 Ventimask (HAFOE)
 Aerosol mask and T-piece with nebulisers

18. Device Flow Rate (L/min) Delivered O2 %
Nasal cannula 1 21-24
2 25-28
3 29-32
4 33-36
5 37-40
6 40-44

19. Advantages Disadvantages
o Comfortable and
easily tolerated
o No re-breathing
o Patient can eat and
drink
o Preferred by patients
(Vs simple mask)
o Low cost product
o Variable oxygen
delivery
o Causes nasal scaring
and drying on high
flows

21. Transtracheal catheter

22. Reservoir cannula

23. Device Flow Rate (L/min) Delivered O2 %
Simple oxygen face
mask
6-10 35-60

24. Device Flow Rate (L/min) Delivered O2 %
Venturi Mask 4-8 24-40
10-12 40-50
Device Flow Rate (L/min) Delivered O2 %
Face Mask with oxygen
Reservoir(Non-
Rebreathing Mask)
10-15 95-100

25. Advantages Disadvantages
• Low cost product
• Flow 5-10 L/min
 Uncomfortable
 Variable
concentration of
oxygen delivered
 100% FiO2 can not be
delivered .
 Patient cannot eat

28. • Aims to deliver constant oxygen
concentration by fixed dose device
• Increasing flow does not increase oxygen
concentration
• Good device for patients with raised C02
(patients with a target of 88-92%)

29. 24% Venturi - 2 L/min - Use 3 l/min if RR >30
28% Venturi - 4 L/min - Use 6 l/min if RR >30
35% Venturi - 8 L/min - Use 12 l/min if RR >30
40% Venturi - 10 L/min - Use 15 l/min if RR >30
60% Venturi - 15 L/min - Change to RM if 60%
Venturi is not sufficient

30. Advantages Disadvantages
 Deliver precise
oxygen concentration
.
 Doesnt dry mucous
membrane .
 Nebulizer can be used
along
 Uncomfortable
 Risk of skin irritation
 Not good for long
term therapy .

31. o Patients breathing through tracheostomy tube
 Adjust oxygen flow to maintain target saturation
 Prolonged oxygen use requires humidification
 Patients may also need suction to remove airway mucus

33. The centre of the ball indicates the correct
flow rate

34. THANK YOU