OXYGEN THERAPYOXYGEN THERAPY

-Dr. Raghavendra Babu S

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Definition:Definition:

*Oxygen therapy is the administration of oxygen at concentrations greater than room air ( 21%)

*With goal of treating or preventing the symptoms and manifestations of hypoxia(a state of oxygen deficiency reaching the tissues)

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DEVICESDEVICES

The oxygen delivery devices can be categorized as

Low flow systemsReservoir systemsHigh flow systemsEnclosure systems

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Oxygen TherapyOxygen TherapyDesign & PerformanceDesign & Performance

Low flow Devices Flow does not meet inspiratory

demand O2 is diluted with air on inspiration Devices deliver Fio2 ranging from

22-60%E.g Nasal cannula Transtracheal catheter

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Nasal CannulaNasal Cannula

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NASAL CANNULANASAL CANNULA low oxygen devicelow oxygen device

This device delivers an unpredictable amount of oxygen ranging from 25-45 % at 1 - 6 L/min depending on how much the patient inhales through the mouth

Higher flow rates are uncomfortable for the patient

A high flow rate can quickly dry out the nasal mucosa and become rapidly uncomfortable

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Method Amount Delivered

F1o2 (Fraction Inspired Oxygen)

Priority Nursing

Interventions

Advantages Disadvantages

Nasal Cannula Low flow

24-44%

1 L\min=24%

2 L\min=28%

3 L\min=32%

4 L\min=36%

5 L\min=40%

6 L\min=44%

Check frequently that both prongs are in clients nares

Never deliver more than 2-3 L\min to client with chronic lung disease

Client able to talk and eat with oxygen in place

Easily used in home setting

may cause irritation to the nasal and pharyngeal mucosa if oxygen flow rates are above 6 liters/minute Variable FIO2

Reservoir SystemReservoir System Simple oxygen face mask Partial rebreathing mask Nonrebreathing mask

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SIMPLE FACEMASKSIMPLE FACEMASK low oxygen devicelow oxygen device

The simple facemask at an oxygen flow of 6 L/min delivers approximately 35-60 % oxygen

Increasing the flow to 10 L/min may increase oxygen concentration to about 50 %

If the flow rate is less than 6 L/min (as cylinder nears empty), the patient may re-breathe much of his own exhalation and thus, the concentration of oxygen delivered will be low, possibly severely hypoxic

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Partial Rebreathing Mask with reservoirPartial Rebreathing Mask with reservoir

Moderate oxygen deviceModerate oxygen device

Delivers 35-60% Oxygen at 6-10 L/min flow rate Ω First third of exhaled gases mix with

reservoir Ω Exhaled gases from upper airway are

oxygen rich

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Reservoir

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High Flow systemHigh Flow system

It provide oxygen at flow rates high enough to satisfy patient’s inspiratory demands.

Such high flows( i.e. 35-40 lit approx) are possible by

1.Entrainment of room air2.High flow rates and reservoirsE.g Venturi masks High flow aerosol nebuliser04/11/23 24

Oxygen TherapyOxygen TherapyHigh Flow Devices - High Flow Devices - EntrainmentEntrainmentAE Devices

AEM (Venti-Mask)

AE Nebulizer (Large Volume Nebulizer) cool/heated Aerosol

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Oxygen TherapyOxygen TherapyHigh Flow DevicesHigh Flow Devices

Air Entrainment systemWhat is Entrainment?

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VENTURI EFFECTVENTURI EFFECT

Oxygen is forced through a jet orifice entering the mask. As there is pressure drop across jet orifice, room air entrainment occurs through side ports

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Air Entrainment Mask

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Copyright ©1998 BMJ Publishing Group Ltd.

Bateman, N T et al. BMJ 1998;317:798-801

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T-pieceT-piece

Used on end of ET tube when weaning from ventilator

Provides accurate FIO2

Provides good humidity

Enclosure systemsEnclosure systems

Tents Hoods

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Oxygen HoodOxygen Hood High oxygen deviceHigh oxygen device

Clear plastic shell encompasses the baby's head Well tolerated by infants Size of hood limits use to younger than age 1

year Allows easy access to chest, trunk, and

extremities Allows control of Oxygen Delivery:

o Oxygen concentration o Inspired oxygen temperature and humidity

Delivers 80-90% oxygen at 10-15 liter per minute

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CPAPCPAP

Administering oxygen by

CPAP(continuous positive airway pressure):

1-Nasal CPAP.2-Endotracheal CPAP.

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Nasal CPAPNasal CPAP::

Nasal CPAP: It consists of a single nasopharyngeal tube that deliveries 2-8 cm of positive pressure with or without o2.

Nursing care : - Frequent suction .- Tube care.- Change the nasal tube.

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Endotracheal CPAPEndotracheal CPAP

Endotracheal CPAP: Positive pressure delivering via an ETT.

Nursing care : - Use sterile suctioning

techniques- Mouth care - Change the ETT every seven

days .

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Oxygen is a drug and should be administered keeping following things in mind: mode of administration, flow rate, FiO2 (venturi), treatment goal, monitoring, when to stop.

Oxygen toxicityOxygen toxicity

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What is free radical?What is free radical?A free radical is an atom or group

of atoms possing one or more unpaired electrons.

Radical + radical reactions typically very fast

Radical + Non-radical reactions twide range of reaction rates.

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What is an Antioxidant?What is an Antioxidant?A substance that, when present

at a low concentration compared with that of an oxidizable substrate, inhibits or prevents oxidation of the substrate.

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