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Oxygen Therapy

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Oxygen Therapy Par Geoff Wond Definition Oxygen Therapy is the administration of oxygen at concentrations greater than that of ambient air with the intent of treating ... – PowerPoint PPT presentation

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Title: Oxygen Therapy


1
Oxygen Therapy
Par Geoff Wond
2
Definition
  • Oxygen Therapy is the administration of oxygen at
    concentrations greater than that of ambient air
    with the intent of treating (or preventing) the
    symptoms and manifestations of hypoxia.
  • AARC

3
Oxygen supply sources
  • Piped oxygen system

4
Oxygen supply sources
  • Oxygen Concentrator

5
Oxygen supply sources
  • Portable oxygen cylinder

6
Oxygen flowmeter
7
Oxygen flowmeter connectors
BOC Adapter
Spigot Nipple
Sure-Loc Adapter
8
Oxygen supply tubing
Wide connector
Oxygen tube
Sure-Loc
Bubble tubing
5mm
9
Definitions
  • FDO2 Concentration of oxygen
  • delivered to the airway
  • FiO2 Fraction of inspired oxygen
  • e.g. an FiO2 of 0.4 40
    oxygen

10
Classification
  • Variable performance (Low flow)

Oxygen therapy devices are typically classified
in two groups
  • Fixed performance (High flow)

11
Variable Performance Systems (Low flow)
  • Deliver oxygen which is diluted with room air
    by the patient because the oxygen flow rate is lt
    patients inspiratory flow rate

12
Variable Performance Systems
  • FiO2 may be low or high depending on
  • oxygen flow rate
  • specific device, particularly the size of oxygen
    reservoir
  • patients ventilatory pattern

13
Variable Performance Systems
Nasal Cannulae
Medium Concentration Masks
High concentration Masks
14
Fixed Performance Systems
  • Deliver oxygen which is diluted by a venturi
    valve to deliver a total gas (air/oxygen) flow
    rate which is gt patients inspiratory flow rate
  • At a precise FiO2
  • Independent of patients ventilatory pattern
  • Independent of oxygen flow rate

15
Fixed Performance Systems
Venturi Masks
Humidifier Nebulisers
Oxygen Recovery T-Kits
16
Variable Performance SystemsNasal Cannulae

17
Variable Performance SystemsNasal
CannulaeIndications for use
  • Long term therapy
  • Stable post op patients
  • Minimal supplemental oxygen requirements
  • Patients who find a mask claustrophobic

18
Variable Performance SystemsNasal CannulaeMain
Users
  • Wards
  • Domiciliary

19
Variable Performance SystemsNasal
CannulaeAdvantages
  • Patient can speak, eat and drink and therefore
    well tolerated
  • Inexpensive

20
Variable Performance SystemsNasal
CannulaeDisadvantages
  • Prongs and dry gas flow cause trauma and
    irritation to the nasal mucosa
  • Oxygen flow rates above 4 l/min are uncomfortable
  • Use with caution on infants

21
Variable Performance SystemsNasal
CannulaeFeatures Benefits
  • Eight designs To suit all patients
  • Soft prongs Minimises irritation
  • Clear material Improves patient
    observation
  • Location saddle Assists in optimum
    positioning

22
Variable Performance SystemsNasal
CannulaeFeatures Benefits
  • Latex free Suitable for allergy patients
  • Over ear design Secure positioning
  • Non-Slip toggle Adjustment for best fit
  • Multi-Channel tube Oxygen flows even if tube is
    kinked

23
Variable Performance SystemsNasal CannulaeProng
shapes
Flared
Straight
Curved flared
Curved
24
Variable Performance SystemsNasal CannulaeProng
shapes
25
Variable Performance SystemsNasal CannulaeFlow
rate approximate FiO2
1 l/min 24 oxygen 2 l/min 28
oxygen 3 l/min 32 oxygen 4 l/min 36
oxygen Clinical Applications of Respiratory
Physiology - Egan
26
Variable Performance SystemsMedium Concentration
Masks
27
Variable Performance SystemsMedium Concentration
MasksMain users
  • Wards
  • Domiciliary
  • Theatre/Recovery

28
Variable Performance SystemsMedium Concentration
MasksIndications for use
  • Medium term therapy
  • Stable post op patients
  • FiO2 of 0.4 to 0.6 required

29
Variable Performance SystemsMedium Concentration
Masks
  • Exhalation ports permit entrainment of room air
    if peak inspiratory flow exceeds oxygen flow

30
Variable Performance SystemsMedium Concentration
MasksAdvantages
  • FiO2 is increased (over nasal cannulae) by
    extending the anatomic reservoir to include the
    volume within the mask
  • Relatively inexpensive

31
Variable Performance SystemsMedium Concentration
MasksDisadvantages
  • Claustrophobic for some patients
  • Irritation from headstrap
  • CO2 accumulation in mask if oxygen flow rate lt 5
    l/min

32
Variable Performance SystemsMedium concentration
masksFeatures Benefits
  • Welded elastic tips Prevent pull-through
  • Crystal clear PVC Good visualisation
  • Multi-Channel tube O2 flows when tube is
    kinked

33
Variable Performance SystemsMedium concentration
masksFeatures Benefits
  • Nose clip versions Prevents channelling to
    eyes
  • Nose clip attached Prevents swivelling both
    ends
  • Swivel versions Optimum O2 tube position

34
Variable Performance SystemsMedium concentration
masksFeatures Benefits
  • Three sizes Swivelling style Suits all patients

Small Adult
Adult
Paediatric
35
Variable Performance SystemsMedium concentration
masksFeatures Benefits
  • With ear loops Not necessary to lift head

36
Variable Performance SystemsMedium concentration
masksFeatures Benefits
  • With nose clips Prevents channelling to eyes

Adult
Paediatric
37
Variable Performance SystemsMedium Concentration
MasksFlow rates approximate FiO2
  • 5-6 l/min 40 oxygen
  • 6-7 l/min 50 oxygen
  • 7-8 l/min 60 oxygen

Clinical Applications of Respiratory Physiology -
Egan
38
Variable Performance SystemsHigh concentration
masks

39
Variable Performance SystemsHigh concentration
masksIndications for use
Initial resuscitation only of severely traumatised
patients
  • Shock
  • Burns
  • Carbon Monoxide poisoning

40
Variable Performance SystemsHigh concentration
masksMain Users
  • Ambulances
  • Accident Emergency

41
Variable Performance SystemsHigh concentration
masksAdvantages
  • Very high FiO2 possible... 0.6-0.8

The initial resuscitation of severely traumatised
patients dramatically improves survival rates
42
Variable Performance SystemsHigh concentration
masksDisadvantages
  • Oxygen flow rate must always be high enough to
    ensure the reservoir bag does not collapse
  • Relatively expensive

43
Variable Performance SystemsHigh concentration
masksFeatures Benefits
  • Low valve resistance Minimises W.O.B
  • Removable valves Conversion to rebreathing
  • Swivelling tube Optimises positioning
    connector
  • Textured bag Prevents sticking

44
Variable Performance SystemsHigh concentration
masksIntersurgical non rebreathing - 3 valves
Two exhalation valves
One way bag valve
45
Variable Performance SystemsHigh concentration
masksPartial rebreathing - 2 valves
Two exhalation valves
One way bag valve removed
When the patient exhales, the last gas breathed
in is the first portion exhaled, filling the
reservoir bag. Because the last gas in fills only
the anatomic deadspace, it is high in O2 low in
CO2
46
Variable Performance SystemsHigh concentration
masksPartial rebreathing - 2 valves
Two exhalation valves
One way bag valve removed
During exhalation the first 1/3 of the breath
(anatomical deadspace) flows back into the
bag. The last 2/3 flows out through the
exhalation valves. Consequently, when properly
used, this does not increase CO2 levels.
47
Variable Performance SystemsHigh concentration
masksPartial rebreathing - No valves
During exhalation the first 1/3 of the breath
flows back into the bag. The last 2/3 flows out
through the exhalation valves. Reduction in
FiO2 but risk of suffocation eliminated
48
Variable Performance SystemsHigh concentration
masksFlow rates approximate FiO2
  • 10 l/min 0.6
  • 15 l/min 0.8
  • 25 l/min 0.9

Clinical Practice in Respiratory Care. Fink Hunt
49
Fixed Performance Systems
Fixed venturi valves
Adjustable venturi valves
Recovery T-Piece
50
All work on the venturi principle
Fixed Performance Systems
Air
O2
O2 Air
Air
51
Fixed Performance Systems Total flow available
from Venturi devices
52
Fixed Performance Systems Total flow available
from Venturi devices
If maximum flow available from the flowmeter is
20 l/min and minimum total flow is 40 l/min
then the maximum oxygen percentage available is
60
NB Normal adult peak inspiratory flow
requirement is 40 l/min - in adults, in
respiratory distress syndrome, this may rise to
80 l/min
53
Fixed Performance Systems Total flow available
from Venturi devices
Maximum flow available from the flowmeter is 15
l/min and minimum total flow is 40 l/min then
the maximum oxygen percentage available is 40
NB Normal adult peak inspiratory flow
requirement is 40 l/min - in adults, in
respiratory distress syndrome, this may rise to
80 l/min
54
Fixed Performance SystemsDirect venturi masks
55
Fixed Performance SystemsDirect venturi
masksIndications for use
  • Patients with chronic lung disease and CO2
    retention whose ventilation is dependent on
    hypoxic drive BUT
  • Over oxygenation produces respiratory depression
    with increased CO2 retention
  • This is avoided by giving precise oxygen
    concentrations i.e. via a venturi mask

56
Fixed Performance SystemsDirect venturi
masksMain users
  • ITU
  • Recovery
  • General Wards
  • Domiciliary

57
Fixed Performance SystemsDirect venturi masks
Flowmeter l/min
Venturi valve
58
Variable Performance Systems Direct venturi
masks Advantages
  • Precise oxygen concentrations from 24 to 60
  • Dont need to humidify the oxygen

59
Variable Performance Systems Direct venturi
masks Disadvantages
  • Widespread misconception that oxygen
    concentration varies with oxygen flow rate
  • If patient PIF gt oxygen flow rate then
    entrainment of room air occurs
  • Patients sometimes hold the mask by the venturi
    and block off air entrainment ports

60
Variable Performance Systems Direct venturi
masks Disadvantages
  • Noisy at higher flow rates
  • Oxygen tubing can pop off at higher
    concentrations/flow rates
  • Six different valves
  • Cannot rapidly change O2 concentration

61
Swiveling style mask
62
Noseclip mask
63
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64
Fixed Performance SystemsOxygen Recovery T-Kit

65
Fixed Performance Systems Oxygen Recovery T-Kit
Indications for use
  • Spontaneously breathing intubated patients
  • Connects to a 15mm e/t tube connector or a
    laryngeal mask
  • Flextube acts as an oxygen reservoir

66
Variable Performance SystemsOxygen Recovery
T-Kit Main Users
  • Recovery

67
Fixed Performance Systems Adjustable venturi
68
Fixed Performance Systems Adjustable venturi
Advantages over single valves
  • Oxygen concentration can be changed quickly
  • Reduction in stock levels

69
Fixed Performance Systems Adjustable venturi
Changing O2 concentrations
70

71
TWO CONFIGURATIONS IN BOTH ADULT PAEDIATRICS
72
Fixed Performance Systems Adjustable venturi
Total flow rates
73
Oxygen TherapyHumidificationCategories
  • Active
  • Add water (and some add heat) to the inspired
    gas
  • Passive
  • Use the heat moisture exhaled by the patient
    to humidify inspired gas HMEs

74
Oxygen TherapyHumidificationActive
  • Three categories
  • Bubble Humidifiers
  • Pass-over humidifiers
  • Nebuliser humidifiers

75
Oxygen TherapyHumidificationActive
Bubble Humidifiers
  • Commonly used unheated, with simple oxygen
    administration devices (eg Nasal cannulae, medium
    concentration masks venturi masks) to bring the
    gas to ambient levels of humidity

76
Oxygen TherapyHumidificationActive
Nebuliser humidifiers
77
Oxygen TherapyHumidification
Aquamist humidifier nebuliser
Bubble humidifier
78
Oxygen TherapyHumidification
  • Hydrates the bronchial tree
  • Breaks down viscous bronchial secretions
  • Assists in the production of secretions

79
Oxygen TherapyHumidification
  • Lining the trachea and bronchial tree are cells
    that secrete mucus, which traps pollutants and
    bacteria.
  • Also in the bronchi are cells containing tiny
    hairlike lashes, called cilia, that project into
    the blanket of mucus and with constant wavelike
    motions push the mucus up out of the airways.

Cilia
80
Oxygen TherapyHumidificationObjectives
  • Adds sufficient water to the inspired gas to
  • Make it comfortable
  • Prevent infection and airway obstruction

81
Oxygen TherapyHumidificationIndications for use
  • Prolonged oxygen administration
  • Tracheostomies

82
Consequences of prolonged dry gas
administration
  • Respiratory epithelial tissue dries out and
    crusting of the mucus present occurs
  • Movement of mucus out of the system is impaired
  • Infection Airway obstruction
  • Death

83
MAIN USERS
  • Hospital (all areas), but mainly ITU
  • Domicillary

84
HUMIDIFICATION DEVICES
85
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86
  • Large open ports in the
  • mask allow excess water
  • to escape
  • Large bore inlet (and tubing)
  • restricts condensation and blockage

87
Oxygen TherapyHumidificationHumidifier nebuliser
Allows the delivery of precise oxygen
concentrations (28-60) Provides humidification
andnebulisation therefore re-hydrationof mucosa
and dried secretions
88
1963
89
Oxygen TherapyHumidificationBubble humidifier
Oxygen is bubbled through the water
reservoirProvides humidification to prevent the
mucus membrane from drying out
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