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Oxygen Therapy

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Foundation for the rational use of oxygen is knowledge of its pharmacokinetics ... O2 toxicity respiratory insufficicency cyanosis frothy or bloody sputum asphyxia ... – PowerPoint PPT presentation

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Title: Oxygen Therapy


1
Oxygen Therapy
2
Introduction
  • The transport and delivery of oxygen to body
    tissues is the essence of resp. care
  • Foundation for the rational use of oxygen is
    knowledge of its pharmacokinetics and
    appreciation of the biomedical changes induced by
    too much tissue oxygen (hyperoxia) and too little
    (hypoxia). Need optimal level
  • PaO2 is arterial blood oxygen pressure

3
Indications for O2 Therapy
  • Primary indication is to prevent or relieve
    hypoxemia .
  • Hypoxemia can be caused by hypoventilation,
    right-to-left shunts, diffusion impairments, and
    ventilation-perfusion mismatch.
  • Alveolar-arterial oxygen gradient P(A-a)O2
    can help determine need for O2 therapy

4
Hypoxemia (contd)
  • A normal A-a O2 in hypoxemia usually indicates
    the hypoxia is caused by hypoventilation and that
    oxygen therapy alone will not help
  • Alveolar Air Equation PAO2
    (PB - 47) x FIO2 - PaCO2/.8
  • Normal PaO2 80 - 100 mmHg
  • P(A-a)O2 on room air 5-10 mmHg
  • P(A-a)O2 on 100 O2 30-60 mmHg

5
Indications for Acute O2 Therapy
  • Blood gas values PaO2 lt
    60 mmHg SaO2 lt 90
  • Clinical signs and symptoms of mild-moderate
    hypoxia tachycardia disorientation tachypne
    a dyspnea cyanosis hypertension restlessnes
    s

6
Indications (contd.)
  • Clinical signs and symptoms of moderate-severe
    hypoxia cardiac arrhythmias labored
    breathing slow bounding pulse lethargy
    coma

7
General Criteria for Long-Term O2 Therapy
  • PaO2 lt 55 mmHg at rest on room air
  • Evidence of tissue hypoxia pulmonary
    hypertension compensatory polycythemia cor
    pulmonale
  • Evidence of central cyanosis
  • Severe arterial hypoxemia on exercise
  • Improvement with low-flow O2 therapy

8
Indications (contd.)
  • High-risk patients myocardial
    infarction hemorrhagic shock anaphylactic
    shock burn patients

9
Contraindications for O2 Therapy
  • primarily a concern over too much O2 leading to
    oxygen toxicity
  • in an infant too much O2 can lead to retrolental
    fibroplasia
  • Early symptoms of O2 toxicity retrosternal
    discomfort restlessness lethargy vomiting
    cough dyspnea

10
Contraindications (contd.)
  • Late signs of O2 toxicity respiratory
    insufficicency cyanosis frothy or bloody
    sputum asphyxia
  • symptoms develop after 4-12 hours of breathing
    100 O2

11
Mechanism of O2 Toxicity
  • O2 is used at the cellular level to produce ATP.
    O2 molecule is reduced by cytochrome oxidase and
    forms OH. and H2O2 (free radicals)
  • increases in free radicals lead to cell damage,
    wherein leakage from these cells leads to an
    inflammation process
  • glutathione, peroxidase, Vitamins C E protect
    against free radicals
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