1. DR.G.SASI KUMAR

2. INDICATIONS As a treatment for hypoxemia due to hypoventilation,decreased gas exchange, ventilation perfusionabnormalities. To improve O2 supply to tissues when the disease processcauses increased O2 demand. As specific treatment to certain conditions such as COpoisioning Survival of human at very low atm. pressure 3. OXYGEN DELIVERY DEVICES Classified depending on degree of dependancy.LowSupplemental oxygenNasal prongsdependancy alone is sufficientFace maskMedium Supplemental O2 andCPAP mask &dependancy respiratory assistance equipmentHigh supplemental O2 andNIPPVdependancy full respiratory support IPPVRequires intensivecare 4. LOW DEPENDANCY DEVICES CLASSIFIED further into Variable performance devicesFiO2 variable Fixed performance devicesFiO2 fixed 5. VARIABLE PERFORMANCE DEVICESMajor determinants of FiO2 are EQUIPMENT related:PATIENT related:1. Mask volume1. Peak insiratory flow2. O2 flow rate 2. Respiratory rate3. Quality of mask fit3. Tidal volume4. Areas of holes in mask 6. Variable performance devicesclassified depending on reservoir capacity: No capacity devices Low capacity devices -- 1500 ml 7. TYPE OF DEVICEEXAMPLES no capacity Nasal prongs Nasal sponge tipped catheterlow capacity Paediatric face mask Tracheastomy mask Swedish nosemedium capacityStandard adult face mask high capacity Face mask with reservoir bag T- bagvery high capacity Incubators Oxygen tents 8. NASAL CANNULA The nasal cannula can be rapidly and comfortably placed on most patients. Patients on long-term oxygen therapy most commonly use a nasal cannula. usually well tolerated, allows speech and eating/drinking, and is nonclaustrophobic. 9. The actual FIO2 delivered to adults with nasal cannulas is determined by oxygen flow nasopharyngeal volume the patients inspiratory flow 10. Cannulas can be expected to provide inspired oxygen concentrations up to 3035% with normal breathing and oxygen flows of 34 L/min. Usually flows greater than 5 L/min are poorly tolerated because of the discomfort of gas jetting into the nasal cavity and because of drying and crusting of the nasal mucosa. 11. FACE MASK WITH RESERVOIR BAG Two types of reservoir mask are commonly used: the partial rebreathing mask. the nonrebreathing mask. Mask reservoirs commonly hold approximately 600 mL or less. 12. THE PARTIAL REBREATHING MASK. "part" of the patients expired tidal volume refill thebag. Usually that gas is largely dead space that should notresult in significant rebreathing of carbon dioxide. 13. THE NONREBREATHING MASK incorporates flap-type valves between the bag and mask and on at least one of the masks exhalation ports. Reduces rebreathing of CO2. 14. Typical minimum flows of oxygen are 1015 L/min. FiO2 delivered with well fitting reservoir mask is 0.75 to 0.90 15. FIXED PERFORMANCE DEVICES Fixed FiO2 is delivered that does not vary with respiratory pattern. These devices make use of venturi principle. 16. VENTURI: An equipment which includes a constriction whereby its cross section gradually decreases & then increases. Fluid flowing through a venturi will have pressure drop at the constriction where the velocity is higher. 17. BERNAULLIS EFFECT: the lateral pressure of the fluid is least where the velocity is greatest Applications: Nebulizers Suction apparatus Venturi mask 18. FiO2 provided by O2 flow rate Amt. Of air Total flow rateventuri valve( L/min) entrained (L/min)(L/min)0.24251 530.2844145 0.31 641470.35837450.4010 32420.6015 1530 19. Low flow rate high air entrainment low FiO2 MORE RELABLE High flow rate less amount of air entrained high FiO2 Since total flow rate is low, it may be overcome bypatients peak inspiratory flow rate & rebreathing occurs. UNDERPERFORM by 5 to 10% 20. MEDIUM DEPENDANCY DEVICES Provides supplemental O2 and respiratory assistance Example : CPAP mask 21. CPAP MASK Tightly fitted on patients face with harness. Covers the nose and mouth with a good seal. Consist of 22 mm female taper inlet. T or Y shapedconnector allows O2 delivery through one limb &CPAP valve on other limb. Provides 2.5 to 20 cms H2O pressure. 22. HIGH DEPENDANCY DEVICES Supplemental O2 & full respiratory support is provided. Non Invasive Positive Pressure Ventilation Invasive Positive Pressure Ventilation NIPPV -- For patients with central apnoea syndrome, neuro muscular & chest wall diseases. Increasingly being used for weaning from mechanical ventilation & acute respiratory failure. 23. HYPERBARIC OXYGEN THERAPY Carbon monoxide poisioning Gas gangrene Congenital cardiac anomalies Peripheral vascular insufficiency Cancer therapy Decompression sickness 24. ONE-PERSON(MONOPLACE) HYPERBARIC CHAMBER 25. MULTIPLACE CHAMBERS 26. OXYGEN TOXICITY Pulmonary toxicity O2 is a lung irritant producing inflammation & congestion LORRAIN SMITH EFFECT. CNS toxicity PAUL BERT EFFECT localized muscle twitching of eyes, mouth & forehead rigid tonic phase of convulsion loss of conciousness vigorous clonic contraction of muscle group of head , neck , trunk & limbs 27. Hypo ventilation -- primarily seen in patients with COPD who have chronic CO2 retention. Retinopathy of prematurity -- The recommended PaO2 for premature infants receiving oxygen are 5080 mm Hg (6.610.6 kPa). 28. HELIOX THERAPY The most popular mixtures are the 80%/20% and70%/30% heliumoxygen. They have densities that are 1.805 and 1.586 times lessdense, respectively, compared with pure oxygen. 29. In anesthetic practice, pressures needed to ventilate patients with small-diameter tracheal tubes (TTs) can be substantially reduced (halved) when the 80%/20% mixture is used. Patients with acute distress from upper airway obstructing lesions may obtain relief until more definitive care can be delivered. The evidence is less convincing in treating lower airway obstruction in COPD and acute asthma. 30. thank you