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Review of Oxygen Therapy

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Colorless, odorless, tasteless, transparent. Non-flammable ... Post anesthesia (recovery room) Respiratory Care Theory 2. 8. AARC Clinical Practice Guidelines ... – PowerPoint PPT presentation

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Title: Review of Oxygen Therapy


1
Review of Oxygen Therapy
  • RsCr 224
  • Respiratory Care Theory 2
  • Fall 2003

2
Characteristics of Oxygen
  • Colorless, odorless, tasteless, transparent
  • Non-flammable supports combustion
  • 21 of atmosphere
  • FDA standards of 99 pure
  • Exerts 159 mmHg of pressure (of 760)
  • Slightly heavier then air
  • Critical temperature 119 degrees C

3
Signs Symptoms of Hypoxemia
  • Tachypnea
  • Increased accessory muscle use
  • Patient c/o dyspnea
  • Tachycardia
  • Cyanosis (in severe cases only)
  • Restlessness disorientation impaired
    judgement confusion somnolence loss of
    coordination coma

4
Long Term Consequences of Hypoxemia (persistent)
  • Clubbing

5
Mini Clini
  • A disoriented postoperative male patient
    breathing room air exhibits tachypnea,
    tachycardia and mild cyanosis of the mucus
    membranes. Using a pulse oximeter, you measure
    the patients oxyhemoglobin saturation as 93.
    What would you recommend?

6
Assessing the Need for Supplemental Oxygen
  • Initial assessment is generally based upon values
    of oxygen obtained by using a pulse oximeter
    (SpO2 values)
  • These values are not always accurate
  • Assessment of need should also be based on other
    observable symptoms (discussed previously)
  • The best method for determining need is through
    the analysis of an arterial blood sample (PaO2)

7
Indications for Oxygen Therapy
  • Suspected hypoxia
  • Documented hypoxia
  • Trauma
  • Myocardial Infarction (MI)
  • Heart attack
  • Post anesthesia (recovery room)

8
AARC Clinical Practice Guidelines
  • The oxygen in the arteries is low
  • PaO2 lt 60 mmHg
  • And / or
  • The oxygen saturation is low
  • SaO2 lt90

9
Levels of Hypoxemia in Adults
  • Mild
  • 60 - 80 mmHg
  • Moderate
  • 40 60 mmHg
  • Severe
  • Less then 40 mmHg

10
What is Accomplished by Giving Oxygen to
Hypoxemic Patients?
  • Workload on the heart is decreased
  • Tachycardia generally goes away
  • Blood pressure stabilizes resulting in a decrease
    in heart workload
  • Since hypoxemia actually causes pulmonary
    vasoconstriction - once hypoxemia is relieved,
    pulmonary vasoconstriction goes away.
  • Long term hypoxemia causes Right Heart Failure

11
What else is Accomplished by Giving Oxygen to
Hypoxemic Patients?
  • Mental capacity increases - patients become more
    alert and less sleepy confusion diminishes
  • Breathing workload diminishes - tachypnea
    decreases or vanishes accessory muscle use
    decreases
  • Color improves - patients become less pale or
    less cyanotic capillary refill improves

12
Precautions Hazards Associated with the Use of
Oxygen
  • Oxygen Toxicity

13
Development of Oxygen Toxicity is Dose Related
  • How much oxygen is the patient receiving? (What
    is the FIO2?)
  • Risk is present if FIO2 is gt.50
  • Risk increases as FIO2 increases above .50
  • How long has the patient been receiving it?
  • Lung damage begins to occur in as little as 12
    hours
  • Clinical symptoms begin to show up in 24 hours
    (worsening hypoxemia)
  • Severe damage will occur after 48-72 hours
    (Exudative phase)

14
Other Precautions Hazards of Oxygen Use
  • Oxygen Induced Hypoventilation
  • Commonly seen in patients with COPD who are
    considered Blue Bloaters

15
What Makes These Patients Vulnerable?
  • They tend to be hypercapnic (CO2 values may be 20
    to 23 torr above normal)
  • They tend to ventilate less than normal
    individuals
  • They tend to breath based mainly upon peripheral
    chemoreceptor drive
  • Too much oxygen causes them to decrease their
    depth rate of breathing- leading to a further
    drop in pH and potentially serious cardiac
    problems

16
Other Precautions Hazards of Oxygen Use
  • Retinopathy of Prematurity (retrolental
    fibroplasia)
  • Only seen in neonates who are given enough oxygen
    sufficient to raise the PaO2 above 100 torr.
  • Only affects the arteries of the eyes and is only
    operative for about the first month of life.
  • Can cause blindness
  • Simple prevention by keeping PaO2 to lt80 torr

17
Other Precautions Hazards
  • Absorption Atelectasis
  • Occurs when airways are blocked after the patient
    has been receiving a high level of oxygen (gt.50)
  • Results in the collapse of the area distal to the
    obstruction as remaining oxygen is removed and
    cannot be replaced

18
Schematic of Development of Absorption
Atelectasis
19
Types of Oxygen Delivery System
  • High Flow Systems
  • Includes enclosures
  • Low Flow Systems
  • Includes reservoir systems

20
Low Flow Systems
  • Do not meet or exceed the patients peak flow
    demand
  • Examples - nasal cannulas simple masks
    nonrebreathing masks transtracheal catheters

21
Nasal Cannula
22
Nasal Catheter
23
Transtracheal Catheter
24
Reservoir Cannula
25
Pendant Cannula
26
Simple Oxygen Mask
27
Partial rebreathing and Non-Rebreathe
28
High Flow Systems
  • Generally must be able to deliver a total flow of
    gt 30 - 40 l/m
  • Air Entrainment Masks (Venti-masks) Large Volume
    Jet Nebulizers Blending Systems (rarely used)

29
Venturi Mask
30
Characteristics of Entrainment Systems
  • As FIO2 is increased - total flow decreases
  • Therefore source gas flow must be set higher on
    the flowmeter to compensate for this fact
  • Entrainment systems are sensitive to backpressure
    occurring downstream from the jet
  • Any resulting backpressure will decrease air
    entrainment which will lead to an increase in
    FIO2 and a decrease in total flow. Backpressure
    issues should be avoided!!

31
Aerosol Setup
32
Schematic of a Blender Type High Flow System
33
How Blenders Work
  • A Blender requires a source of 50 psi oxygen and
    a source of 50 psi air. Gas is blended to
    provide 50 psi blended gas at any FIO2 between 21
    100.
  • A flowmeter can be attached to the blenders 50
    psi DISS outlet connector OR
  • A ventilator requiring 50 psi can be attached
    directly to the 50 psi outlet on the blender

34
Picture of an Oxygen Blender
35
Other Less Common Oxygen Delivery Methods
  • Oxygen Tents (Croup Tents) Used for children
  • Infant Oxygen Hood
  • Infant Incubator

36
Croup Tent
37
Head Hood
38
Infant Incubator
39
Hyperbaric Oxygen
  • Used for
  • Tx of air embolism
  • Carbon Monoxide poisoning
  • To enhance wound healing
  • Necrotizing soft tissue infections
  • Exceptional blood loss
  • Tx of refractory osteomyelitis
  • Radiation Necrosis

40
A Monoplace Hyperbaric Chamber
41
Other Therapeutic Gases
  • Nitric Oxide - used to enhance blood flow through
    the lungs by selectively dilating pulmonary
    vessels.
  • Helium- Heliox - used in mixtures of 80 oxygen -
    20 helium or 90 oxygen - 10 helium
  • Used in conjunction with small volume nebulizer
    therapy to enhance drug deposition in cases of
    severe asthma
  • Correction factor when using 80/20 is 1.8.
    Multiply this value times flowrate setting on the
    flowmeter to determine actual flow.
  • Carbon Dioxide and Oxygen (Carbogen)
  • Act as a respiratory stimulant, treat singulation

42
End of Review
  • Thats all folks
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