OXYGEN THERAPY

LT COL UMESH KUMARANAESTHESIOLOGIST

LEVEL III HOSPITAL CONGO DRC

70 yrs man K/C/O COPD

Respiratory Distress

Diaphoretic and Agitated

H/O : Progressive dysponea With worsening productive cough Fever and chills

SCENARIO

BP -150/90mmHg HR-130/min Temp-38.5 C RR-33/min SPO2-80%

Does pt need O2 ?How much need ?How to deliver O2 ?

EXAMINATION

IT IS THE ADMINISTRATION OF O2 CONCENTRATION GREATER THAN THAT IN ROOM AIR TO TREAT OR PREVENT HYPOXEMIA

DEFINITION

History

Indication

O2 requirement

O2 delivery system

Complication

OBJECTIVE

Joseph Priestley discovered element of oxygenin 1774

In 1783 French physician Dr Caillens first time used oxygen therapy as a remedial measure in disease

Paul Bert Oxygen toxicityin 1878

OXYGEN CASCADE 160mmHg (PiO2) 110mmHg(PAO2) 90-100mmHg( PaO2)

20-40mmHg(PtO2 ) 5-20mmHg(PO2 at mitocondria)

TRANSPORT OF OXYGEN

TRANSPORT OF CO2

Principally Hypoxemia

Poor ventilatory effort – post operative

Sedation Confusion

Poor oxygen delivery- shock

INDICATIONS

Severe anaemia

Heart failure

Severe trauma

Acute illness

Poisoning

INDICATIONS

Clinical Assessment

Noninvasive -Pulse oxymeter -Capnograph

Invasive -ABG analysis

OXYGEN REQUIREMENT

Tachypnoea

Dyspnoea

Tachycardia

Severe anaemia

Cyanosis

Disorientation, Agitation,Lethargy

Restlessness

CLINICAL ASSESSMENT

PULSE OXYMETER

SPO2 <90 Percent

EtCO2>45mmHg

CAPNOGRAPH

PaO2<60mmHg

SaO2<90percent PaCO2>45mmHg

INVASIVE -ABG ANALYSIS

O2 conc required by pt

O2 conc achieved by the delivery device

Importance of accuracy of device

Client comfort and client mobility

DELIVERY SYSTEM- SELECTION

All system require

Source of oxygen Flow meterOxygen tubingHumidifier Delivery device

OXYGEN DELIVERY METHODS

Central pipe line

Oxygen Cylinder

Oxygen concentration

OXYGEN SUPPLY SYSTEM

Device which extract O2 from the environmental air

Deliver up to 90-95 % O2 at the flow rate 3-5L/min

OXYGEN CONCENTRATOR

Recommended when oxygen flow 4 L/min

Prevent in drying of mucous membrane

Prevent the formation of tenacious sputum

Decrease loss of heat

HUMIDIFICATION

Variable performance deviceNasal cannulaFace mask

Fixed performance device Partial rebreathing mask

Non rebreathing mask Venturi mask

Noninvasive ventilation-CPAP/BiPAP

OXYGEN DELIVERY SYSTEM

NASAL CANNULA

Deliver O2 concentration 25-45% at a rate of 1-6 L/min

Flow rate in L/min % FIO2

1 252 293 334 375 416 45

Easy to use

Well tolerated

Comfortable for long period

Patient can eat and talk easily.

ADVANTAGES

Dryness of mucosa

Crusting over secretion

Epistaxis

DISADVANTAGES

Is prescribing O2 through face mask @ 4L/min correct??

Deliver O2 concentration 40-60 % depend on flow rate 6 -8 L/min

Easy to use

Requires good fit.

Improve humidification

Dryness is less

FACE MASK

It is simple mask with reservoir bag

It delivers 50-75 %of oxygen when flow 8 -11L/min

PARTIAL REBREATHING MASK

PARTIAL

REBREATHING

MASK

Delivery Oxygen concentration :upto 100% at 15 L/min Reservoir bag to entrain oxygen

One way valve : prevent oxygen dilution

Tight seal is essential

Reservoir bag must expand freely

NON REBREATHING MASK

NON REBREATHING MASK

Mixes - Air and oxygen

Accurate - Oxygen conc delivery

Colour coded valves

Oxygen conc - 24-40 %

VENTURI MASK

VENTURI MASK

COLOUR OF ADAPTER

% FIO2

Blue 24

Yellow 26

White 28

Green 30

Pink 35

Orange 40

O2 DELIVERY –TRACHEOSTOMY

Deliver 80-90% O2 at 10-15 L/min Used in <1 year of age

-

OXYGEN HOOD

DEVICE FLOW RATE L/min

% OXYGEN

Nasal cannula

1-6 25-45

Simple face mask

6-8 40-60

Partial Rebreather

8-11 50-75

Non Rebreather

10-15 90 -100

Venturi Mask 4-8 24-40

Emergency method of life saving

Preparing the equipment required forintubation

AIRWAY MASK BREATHING UNIT

Hypoventilation and CO2 narcosis

Absorption atelectasis

Retinopathy of Prematurity

COMPLICATIONS

Informed verbal consent Support and reassurance Oxygen is prescription drug

CONCLUSION

Prescription should include

Flow rate

Delivery device

Duration

Instruction for monitoring

70 yrs man K/C/O COPD

Respiratory Distress

Diaphoretic and Agitated

H/O : Progressive dysponea With worsening productive cough Fever and chills

SCENARIO

Bp 150/90mmHg HR-130/min Temp-38.5 RR-33/min SPO2-80%

1.Does pt need O2 ?2.How much need ?3.How to deliver O2?

EXAMINATION

Pt needs O2 O2 therapy :Emperically FIO2-40% Ventury mask and titrate : improvement

and monitor ABG-PaO2 40mmHg

Pt PaO2 Desired PaO2----------- = ------------------Pt FIO2 Desired FIO2

Pt PaO2(40) Desired PaO2(90)----------- = ------------------Pt FIO2(.21) Desired FIO2(X)

.21x90 X = ---------- = .47 40

FIO2=.47

Consider two patient on nasal cannula with 100 % O2 at 2 L/min

Normal pt-PIFR-15L/minInspired O2=2L/min(100%)+13L/min(21%)% of O2 received through device 2/13=15.4%

Sick pt-PIFR-30L/min

Inspired O2 =2L/min(100%)+28ltr/mint(21%)% of O2 received by sick pt=2/28 =7.1%

THANKS