oxygen therapy 2012

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    Kusman Ibrahim, Ph.DFakultas Keperawatan Universitas Padjadjaran

  • Out line presentation

    Introduction Conditions for oxygen therapy Administration Monitoring Monitoring Side effects Conclusion

  • Introduction

    Oxygen is a colourless, odourless and tasteless gas that is essential for the body to function properly and survive

    The air we breathe contains 21% oxygen (O2), 78% nitrogen (N2) and oxygen (O2), 78% nitrogen (N2) and 1% of other gases

    Oxygen therapy is the administration of oxygen as an intervention, which can be for a variety of purposes in both chronic and acute patient care

  • administration of oxygen at concentrations greater than that in room air to treat or prevent hypoxemia (not enough oxygen in the blood).

    Purpose: increase oxygen saturation in tissues where the


    increase oxygen saturation in tissues where the saturation levels are too low due to illness or injury

    increases the amount of oxygen in the blood reduces the extra work of the heart decreases shortness of breath

  • Delivery of oxygen to tissues depends on :- Inspired oxygen concentration- Alveolar ventilation- Ventilation-perfusion distribution within the



    lungs- Hb concentration- concentration of CO- Cardiac output- Distribution of capillary blood flow within the

    tissues Oxygen levels in the blood can be helpful or


  • Conditions for oxygen therapy

    Acute Conditions : in emergency care1. Resuscitation2. Documented hypoxia3. Severe respiratory distress (acute asthma or 3. Severe respiratory distress (acute asthma or

    pneumonia)4. Shock5. Cor pulmonale6. Acute myocardial infarction7. Severe trauma

  • 8. Pulmonary hypertension9. Major hemorrhage10. Convulsion11. Hypothermia

    Conditions for oxygen therapy

    11. Hypothermia12. As home therapy to abort cluster headache

    attacks,due to its vasoconstrictive effect13. Used as a drug delivery route as nebulizer

    mask for delivery of Salbutamol or Epinephrine

  • Three forms of oxygen therapy:

    1. Normobaric oxygen (NBO), also called surface or sea level oxygen, is the administration of supplemental oxygen (24 to 100%) at atmospheric pressure. Examples of medical conditions include asthmas, congestive heart failure, pulmonary oedema or as a first-aid treatment in search and rescue operations. It is also used for anaesthesia during surgeries.

    2. Hyperbaric oxygen (HBO): In this treatment, 100 % oxygen is breathed at elevated pressure. It is an essential treatment in many conditions, including decompression illness, carbon monoxide poisoning, burns and mountain sickness.

    3. Hypobaric or altitude oxygen: Because of the physiological limitation of humans when operating at altitude, they require an O2 concentration greater than that inspired at sea level to prevent hypoxia.

  • Chronic Conditions :1. COPD2. Lung fibrosis3. Sleep apnea

    Conditions for oxygen therapy

    3. Sleep apnea4. Kyphoscoliosis5. Myopaties/muscular dystrophy6. Brain stem lesion7. Right-to-left shunts

  • Administration Source Pressure regulator flow meter (L/min) Supplemental oxygen:

    1. Nasal cannula (nasal prongs):- The most common and inexpensive , easy to

    apply, does not interfere with the clients ability to

    apply, does not interfere with the clients ability to talk or eat, comfortable

    - Delivering 0 low concentration of 24-45% at 2-6LPM

    - > 6 LPM, tend to swallow air and the Fi 0 is not increased

    - Limitation: inability to deliver high concentrations of 0, and can be drying and irritating to mucous membranes

  • Administration

    2. Face Mask- Simple face mask delivering 0 concentration of 40-

    60% at liter flows of 5 8 LPM- Partial rebreathing mask delivering 0 concentration of

    60-90% at liter flows of 6 10 LPM- Nonrebreathing mask delivering 0 concentration of

    - Nonrebreathing mask delivering 0 concentration of 95-100% at liter flows of 10 15 LPM

    - Venturi mask delivering 0 concentration varying from 24% to 40%, or 50% at liter flows of 4 10 LPM. It has wide bore tubing and color-coded jet adapters that correspond to a precise oxygen concentration and liter flow

  • Administration

    2. Face Tent- Can replace oxygen masks when masks are

    poorly tolerated by clients- Provide varying concentration of oxygen, e.g

    30% - 50% at 4 8 LPM- Frequently inspect for dampness, dry, and

    treat as needed

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  • High concentration (40-60%) 0 via high flow mask are particularly useful in acute type I respiratory failure because respiratory drive is high, such as acute asthma, pneumonia, pulmonary edema, pulmonary embolus,


    pulmonary edema, pulmonary embolus, ARDS. when used for prolonged periods, it should be humidified by passing over warm water

  • Low concentration (Venturi masks 24-28%) are particularly useful in delivering controlled 0 therapy in type II respiratory failure.0delivery through a nasal cannula vary depending on minute ventilation, nasal


    depending on minute ventilation, nasal blockage, and tendency to mouth-breath. humidification is not necessary as a high proportion of atmospheric air is mixed with 0

  • In COPD, and type II respiratory failure, patient develop an abnormal tolerance to raised COand may become dependent on hypoxic drive to breath. In these patients, lower 0 concentration is needed to avoid precipitating worsening


    is needed to avoid precipitating worsening respiratory depression.

    Positive pressure delivery system is used in patient who are unable to breathe on their own. use of AMBU bag, Resuscitator used in surgery with anesthetic machines.

  • %

    In patient with acute respiratory failure, close monitoring is essential and arterial blood gases taken on presentation should be repeated within 20min to establish that it has achieved acceptable Pa0 levels 55mmHg or

    achieved acceptable Pa0 levels 55mmHg or 0 saturation of 88%

  • Side Effects

    Vasoconstrictive effect on the circulatory system May increase the effect of stroke Seizures In infants, may cause blindness (promoting In infants, may cause blindness (promoting

    overgrowth of blood vessels in the eye obstructing sight, this is retinopathy of prematurity.

    Also in infant, it may contribute to construction of a ductus arteriosus

  • In adult ,pulmonary 0 toxicity manifested by pulmonary edema and free radical damage leading to fibrosis.

    Administration of high levels of 0 in patient with type II respiratory failure which

    Side Effects

    patient with type II respiratory failure which reduces respiratory drive precipitating respiratory failure and can lead to death


  • Conclusion

    Oxygen is essential for cell metabolism, and in turn, tissue oxygenation is essential for all normal physiologic functions.

    Prompt recognition of life threatening situations Prompt recognition of life threatening situations and immediate administration of oxygen appropriately will benefit the patient in reducing morbidity and mortality*

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