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Oxygen Therapy

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... remove to eat Venturi Mask Most reliable and accurate method for delivering a precise O2 concentration Consists of a mask with a jet Excess gas leaves by ... – PowerPoint PPT presentation

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Title: Oxygen Therapy


1
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2
Oxygen Therapy
  • Dr jarahzadeh
  • MD.Intensivist

3
Oxygen Therapy
  • Administration of oxygen at an FIO2 gt
    21

4
Introduction
  • Oxygen is a drug
  • Has a Drug Identification Number (DIN)
  • Colorless, odorless, tasteless gas
  • Makes up 21 of room air
  • Is NOT flammable but does support combustion.

4
5
Indications for Oxygen Therapy
  • Hypoxemia
  • Inadequate amount of oxygen in the blood
  • SPO2 lt 90
  • PaO2 lt 60 mmHg
  • Excessive work of breathing
  • Excessive myocardial workload

5
6
Factors Influencing Oxygen Transport
  • Cardiac output
  • Arterial oxygen content
  • Concentration of Hgb
  • Metabolic requirements

7
  • Hypoxemia
  • decrease in the arterial oxygen content in the
    blood
  • Hypoxia
  • decreased oxygen supply to the tissues.

8
Causes of Hypoxemia
  • Shunt
  • Hypoventilation
  • As carbon dioxide increases oxygen falls
  • V/Q mismatching (ventilation/perfusion)
  • Pneumonia
  • Pulmonary edema
  • ARDS
  • Increased diffusion gradient
  • asbestosis
  • Early pulmonary edema

8
9
Clinical Manifestations of Hypoxia
  • Impaired judgment, agitation (restlessness),
    disorientation, confusion, lethargy, coma
  • Dyspnea
  • Tachypnea
  • Tachycardia, dysrhythmias
  • Elevated BP
  • Diaphoresis
  • Central cyanosis

10
Need For Oxygen Is Assessed By
  • Clinical evaluation
  • Pulse oximetry
  • ABG

11
Cautions For Oxygen Therapy
  • Oxygen toxicity can occur with Fio2 gt 60
    longer than 36 hrs
  • Fio2gt80longer than 24 hrs Fio2gt100longer than
    12hrs
  • Suppression of ventilation will lead to
    increased CO2 and carbon dioxide narcosis
  • Danger of fire
  • Absorbtion Atelectasia
  • Premature retrolental fibroplasia

12
Methods of Dispensing Oxygen
  • Piped in
  • Cylinder
  • Oxygen concentrator

13
Classification of Oxygen Delivery Systems
  • Low flow systems
  • contribute partially to inspired gas client
    breathes
  • do not provide constant FIO2
  • Ex nasal cannula, simple mask
  • High flow systems
  • deliver specific and constant percent of oxygen
    independent of clients breathing
  • Ex Venturi mask, non-rebreather mask, trach
    collar, T-piece

14
Nasal Cannula
  • Used for low-medium concentrations of O2
  • Simple
  • Can use continuously with meals and activity
  • Flow rates in excess of 4L cause drying and
    irritation
  • Depth and rate of breathing affect amount of O2
    reaching lungs
  • adults ? 6 LPM
  • infants/toddlers ? 2 LPM
  • children ? 3 LPM
  • FIO2 is not affected by mouth breathing
  • 1lit o2FIO2 4
  • 6 lito2Fio2 24
  • 2124Fio2 45

15
Simple Mask
  • Low to medium concentration of O2
  • Client exhales through ports on sides of mask
  • Should not be used for controlled O2 levels
  • O2 flow rate- 6 to 8L
  • Can cause skin breakdown must remove to eat.
  • 1 lit o2FIO2 6
  • 6 lito2Fio2 36
  • 21 36Fio2 57-60

16
Partial Rebreather Mask
  • Consists of mask with exhalation ports and
    reservoir bag
  • Reservoir bag must remain inflated
  • O2 flow rate - 6 to 10L
  • FIO260-80
  • Client can inhale gas from mask, bag, exhalation
    ports
  • Poorly fitting must remove to eat

17
Non-Rebreathing Mask
  • Consists of mask, reservoir bag, 2 one-way valves
    at exhalation ports and bag
  • Client can only inhale from reservoir bag
  • Bag must remain inflated at all times
  • O2 flow rate- 10 to 15L
  • Fio2 95-100
  • Poorly fitting must remove to eat

18
Venturi Mask
  • Most reliable and accurate method for delivering
    a precise O2 concentration
  • Consists of a mask with a jet
  • Excess gas leaves by exhalation ports
  • O2 flow rate 4 to 15L Narrowed orifice
  • Fio2, 24-60
  • Can cause skin breakdown must remove to eat

19
Tracheostomy Collar/Mask
  • O2 flow rate 8 to 10L
  • Provides accurate FIO2
  • Provides good humidity comfortable

20
T-piece
  • Used on end of ET tube when weaning from
    ventilator
  • Provides accurate FIO2
  • Provides good humidity

21
Face Tent
  • Low flow
  • O2 wet
  • O2 flow, 4-8 lit
  • Fio240

22
Oxygen Tent
  • Infant

23
Oxygen by transetracheal catheter
  • Fio2-30-50

24
Pulse Oximetry
  • Non-invasive monitoring technique that estimates
    the oxygen saturation of Hgb (SaO2)
  • May be used continuously or intermittently
  • Must correlate values with physical assessment
    findings
  • Normal SaO2 values 95 to 100

25
Pulse Oximetry
26
Pulse Oximetry
27
Factors Affecting SaO2 Measurements
  • Low perfusion states
  • Motion artifact
  • Nail polish(Blue) when using a finger probe
  • Intravascular dyes(methylen blue,indocyanine
    green,indigocarmine)
  • Vasoconstrictor medications
  • Abnormal Hgb(met-CoHb)
  • Too much light exposure

28
Nursing Interventions Related to Pulse Oximetry
Monitoring
  • Determine if strength of signal is adequate
  • Notify physician if SaO2 lt 92 or outside
    specific ordered limits
  • If continuously monitored, evaluate sensor site
    every 8 hrs and move PRN
  • Document SaO2, O2 requirements, clients activity
    according to policy

29
Oxygen Therapy
  • Goal of therapy is an SPO2 of gt90 or for
    documented COPD patients(Spo2 8892)-(Pao255-60)
  • As SPO2 normalizes the patients vital signs
    should improve
  • Heart rate should return to normal for patient
  • Respiratory rate should decrease to normal for
    patient
  • Blood pressure should normalize for patient

29
30
Optimization
  • My SpO2 is lt 90, what next?
  • Is the pulse oximeter working/accurate
  • Do I have a good signal?
  • Heart rate plus/minus ?
  • Is there adequate perfusion at the probe site?
  • Can the probe be repositioned?
  • Do other vital signs or clinical manifestations
    give evidence of hypoxemia?

30
31
Optimization cont.
  • Check my source!
  • Ensure the O2 delivery device is attached to
    oxygen not medical air.
  • Follow tubing back to source and ensure patency
  • Are all connections tight?
  • Is the flow set high enough?
  • All nebs especially high flow large volume nebs
    need to be run at the highest rate.
  • Turn flow meter to maximum for large volume nebs.

31
32
Optimization cont.
  • Reposition patient.
  • Avoid laying patient flat on back.
  • Raise head of bed.
  • Encourage deep breathing/coughing
  • Listen to chest.
  • Wheezing?
  • Do they need a bronchodilator?
  • Crackles?
  • Encourage deep breathing/cough.
  • Are they fluid overloaded?

32
33
optimization cont.
  • Can I improve the mechanics of breathing?
  • Patient position
  • Pursed lip breathing
  • Abdominal breathing.
  • Anxiety relief?

33
34
Optimization cont.
  • Increase the flow
  • With nasal prongs, increase the flow rate by 1 -2
    lpm increments until target SpO2 is reached.
  • High flow nasal prongs can be maximally set at 15
    lpm.
  • Call for physician assessment Medical if high
    oxygen flows are required.

34
35
Optimization cont.
  • What do I do if my patient is really hypoxemic
    (on low flow oxygen)?
  • Assess patient to determine cause of increasing
    oxygen requirements.
  • Best short term solution is non-rebreathe mask at
    15 lpm. (reservoir stays inflated)
  • Goal saturation is still 88 92.
  • Increase flow as required until re-assessed by
    physician

35
36
Optimization cont.
  • What do I do if my patient is really hypoxemic
    (on high flow oxygen)?
  • Assess patient to determine cause of increasing
    oxygen requirements.
  • Adjust FIO2 upwards in 10 increments titrating
    for target SPO2.
  • Call physician for further assessment

36
37
H1N1 points of emphasis
  • H1N1 decompensation requiring ICU admission
    usually begins with a systemic inflammatory
    response and pulmonary edema
  • CXR may not correlate with degree of oxygenation
    impairment
  • Gradually increasing oxygen requirement is a
    sentinel sign of impending respiratory failure

37
38
H1N1 points of emphasis
  • H1N1 Patients with escalating O2 needs warrant
    frequent monitoring for signs of impending
    respiratory failure
  • If a critical care triage system is operative,
    know the patients classification and prepare
    equipment accordingly endotracheal intubation
    may not be an option

38
39

40
Questions? Thank you for attention !
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