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Oxygen therapy Dr.Anjolie Dr.Mandeep Dr.Chitra

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Hypoxia and Oxygen therapy Author: mr koholi Last modified by: Guest Created Date: 10/22/2004 12:19:53 PM Document presentation format: On-screen Show (4:3) – PowerPoint PPT presentation

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Title: Oxygen therapy Dr.Anjolie Dr.Mandeep Dr.Chitra


1
Oxygen therapyDr.AnjolieDr.MandeepDr.Chitra
  • www.anaesthesia.co.in anaesthesia.co.in_at_gmail.c
    om

2
Indications for oxygen therapy
  • To correct hypoxemia
  • V/Q mismatch
  • ? diffusion
  • hypoventilation
  • To ? dissolved oxygen
  • Anemia
  • Cyanide and CO poisoning
  • ? oxygen demand
  • high altitude
  • Shivering
  • Thyroid crisis
  • Hyperthermia
  • Anaesthesia- Preoxygenation
  • intestinal distension and ? PAH

3
  • Anoxia
  • No oxygen availability in tissues
  • Hypoxia
  • Lack of oxygen availability in tissues
  • Hypoxaemia
  • Lack of oxygen in the blood

4
Signs of hypoxia
Mild to moderate
Severe
  • Tachypnea
  • Paleness
  • Tachycardia
  • Mild hypertension
  • Restlessness
  • Headache
  • Lassitude
  • Tachypnea
  • Cyanosis
  • Bradycardia
  • Arrythmias
  • Hypotension
  • Confusion
  • Impaired judgement

5
Classification
  • According to design
  • Low flow
  • Reservoir
  • High flow
  • Enclosure
  • According to performance
  • Fixed
  • variable

6
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7
According to design
  • Low flow
  • Gas flow of apparatus is insufficient to
  • meet all inspiratory requirements
  • High flow
  • Gas flow of the apparatus is sufficient
  • to meet all inspiratory requirements
  • Reservoir
  • Stores a reserve volume that equals or
  • exceeds the patient tidal volume

8
According to performance
  • Fixed FiO2
  • If the system provides all the patients
  • inspired gas
  • Variable FiO2
  • If the system provides only some of the
    inspired gas, the patient draws the remaining
    from surrounding air

9
According to performance
  • Variable performance devices
  • No capacity
  • Nasal catheters
  • Nasal cannulae
  • Small capacity
  • Face masks
  • Large capacity device
  • Mask with bag
  • Fixed performance devices
  • HAFOE systems
  • Anaesthesia circuits
  • Ventilators

10
According to design
  • Lowflow
  • Nasal cannula
  • Nasal catheter
  • Trans tracheal catheter
  • Reservoir
  • Reservoir cannula
  • Simple mask
  • Partial rebreathing mask
  • Nonrebreathing mask
  • Nonrebreathing circuit
  • High flow
  • Air entrainment mask
  • Air entrainment nebulizer
  • Blending system
  • Enclosure
  • Oxyhood
  • Isolette
  • Tent

11
Variable performance devices
  • Patient factors
  • Inspiratory flow rate
  • Duration of inspiration
  • Duration of expiratory pause
  • Minute ventilation
  • Device factors
  • Oxygen flow rate
  • Physical volume
  • Resistance

12
How to select
  • Purpose
  • Patient
  • Age
  • Level of Consciousness
  • Pattern of breathing
  • Performance of the device

13
Nasal cannula
FiO2 range 0.22 -0.45
  • Advantages
  • No rebreathing
  • Better tolerated
  • Easy to use
  • Disposable
  • Low cost
  • Disadvantages
  • Flow gt 3 L / min not tolerated
  • Gastric distension
  • Drying of mucosa
  • O2 wastage
  • Jet lesion if vents are blocked
  • Unstable

14
Nasal cannula- Uses
  • Home care patients needing long term therapy
  • Low moderate FiO2 during eating

15
Nasal catheterFiO2 0.22-0.45
  • Advantages
  • Good stability
  • Disposable
  • Low cost
  • Disadvantages
  • Difficult to insert
  • Change every 8 hrs
  • High flow increases back pressure
  • DNS or polyp may block insertion
  • May provoke swallowing or gagging -aspiration

16
Nasal catheter- Uses
  • 250ml- 8L flow
  • During bronchoscopy
  • Longterm care of infants

17
Trans tracheal catheter
FiO2 0.22-0.35
  • Advantages
  • Lower oxygen cost
  • No skin, nasal irritation
  • Improved compliance
  • Improved exercise tolerance
  • Increased mobility
  • Enchanced image
  • Disadvantages
  • High cost
  • Surgical complication
  • Infection
  • Mucous plugging
  • Lost track

18
Trans tracheal catheter -Uses
  • 250ml- 4L
  • Ambulatory patients who need increased mobility
  • Patients who do not accept nasal O2

19
FiO2 in low flow system
  • Anatomical reservoir 50 ml
  • 6 L/min 100ml /sec
  • 500 ml tidal volume
  • 50 ml --100
  • 100 ml -100
  • 350 ml -20
  • Total oxygen-5010070220 ml
  • Fio2 220/5000.44
  • For every L changes by 0.04

20
Nasal cannula, catheter
O2 flow rate L/min FiO2
1 0.24
2 0.28
3 0.32
4 0.36
5 0.40
6 0.44
21

Mask with reservoir bags
Face mask
6 0.6
7 0.7
8 0.8
9 0.8
10 0.8
5-6 0.4
6-7 0.5
7-8 0.6
22
Reservoir cannula
  • 250ml- 4 L /min
  • FiO2- 0.22-0.35
  • Advantages
  • Lower O2 cost
  • Increased mobility
  • Less discomfort
  • Disadvantages
  • Unattractive
  • Cumbersome
  • Poor compliance
  • Regularly replace every 3 weeks

23
Oxymizer reservoir cannula
Pendant reservoir cannula
24
Reservoir cannula- Uses
  • Home care
  • Ambulatory patients

25
Low capacity devices(physical volume adds a dead
space)
  • Rebreathing possible
  • - Device volume is high
  • - O2 flow is low
  • - Expiratory pause is short
  • Better tolerated at high flows
  • At high flows O2 is lost through the vents

26
Simple face mask
  • 5-12 L/ min
  • FiO2 0.35-0.50
  • Advantages
  • Easy to apply
  • Disposable
  • Inexpensive
  • Disadvantages
  • Uncomfortable
  • Must be removed for eating
  • Prevent radiant heat loss
  • Block vomitus

27
Simple face mask
Tracheostomy mask
28
Capnoxygen mask
  • Conventional face mask with CO2 sampling port
  • Bevel tip sample tube in the mid dome of a medium
    concentration oxygen mask
  • Monitor respiration

29
  • Partial rebreathing mask
  • 6-10L /min
  • FiO2 0.35-0.60
  • Has no valves
  • Inspiration O2 flows to mask and patient
  • Expiration source O2 and expired gas enters the
    bag
  • Non rebreathing mask
  • 6-10L/min
  • FiO2 0.55-0.70
  • Has 2 one way valves
  • Insp- insp valve opens provides O2 to patient
  • Exp- exp valve opens divert exp gas to atmosphere
  • Large air leaks

30
Large capacity devices
  • A reservoir bag is attached to the mask
  • O2 can accumulate throughout the respiratory
    cycle
  • Rebreathing is possible
  • Tight fit
  • Flows which prevent collapse of bag during
    inspiration
  • FIO2 0.6 0.9 possible

31
Respi-check mask
  • Non rebreathing mask
  • Most useful in Emergency department
  • 12-15L/min
  • Adult , paeds size
  • Coloured float that rises and falls when pressure
    and flow changes
  • Housing is designed to rotate 3600 to allow
    monitoring in all positions

Breakell A et al Emerg Med J. 2001
Sep18(5)366-9
32
Non rebreathing circuits
  • Reservoir device
  • 3 times minute ventilation
  • FiO2 range 0.21-1
  • Fixed FiO2
  • Blending system to premix air O2
  • Warmed, humidified by servo controlled heated
    humidifier

33
High air flow oxygen enrichment
  • Air entrainment by an oxygen venturi
  • Air entrainment nebulizer

34
  • Shearing effcet
  • Page 842
  • Air entrained by shear forces not by low lateral
    pressure

35
Streaming fluid regains the pressure, much higher
than that at the constriction, if the tube distal
to the constriction opens very gradually
Venturi
  • This function is lost if the angle of the cone is
    gt 15º

36
The ventimask
37
The ventimask
  • Air entrainment devices function as true high
    flow system only at low FiO2
  • If output flow decreases below the patients
    inspiratory flow, air dilution occurs and FiO2
    becomes variable

38
The ventimask
  • Operating principle- venturi !! ?
  • Shearing effect
  • Low to moderate FiO2 0.24-0.40
  • Depends on
  • -size of the nozzle
  • -Oxygen velocity
  • -Size of air entrainment port
  • -Downstream flow resistance

39
The ventimask
  • 24 blue
  • 28 white
  • 35 yellow
  • 40 red
  • 60 green

40
Air oxygen ratio
41
Magic box
42
Oxy arm
  • 2-10 L/min oxygen flow
  • Equalent or greater FiO2 than venturi mask

Headset
baffled cup diffuser
43
Oxyarm- Advantages
  • Patient can talk
  • Minimal contact-Routine nursing care
  • No clastrophobia
  • Lack of facial contact
  • Unhindered line of sight
  • Odorless and latex free
  • Capnography is possible

Ling E et al Can J Anaesth. 2002
Mar49(3)297-301.
44
Air entrainment nebulizer
  • 10-15L/min input
  • Output flow atleast 60L/min
  • Fixed FiO2 (0.28-1)
  • Advantages
  • Temperature control
  • Extra humidification
  • Disadvantages
  • FiO2 lt0.28 or gt0.4 not ensured
  • Varies with back pressure
  • High infection rate

45
Air entrainment nebulizer
  • Ways to assess whether air entrainment nebulizer
    meets patients needs
  • -Mist output at the expiratory side of
    the T tube through out inspiration
  • -Compare it with patients peak
    inspiratory flow

46
Air entrainment nebulizer
47
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48
Blending system
  • Should provide output flow of atleast 60L/min
  • Fixed FiO2 (0.21-1)
  • Advantage
  • Full range of FiO2
  • Disadvantage
  • Requires 50psi air O2
  • Blender failure
  • Inaccuracy is common

49
Face tent
  • 12-15L/min
  • FiO2 -0.40-0.50
  • Variable FiO2

50
Face tent
  • Advantage
  • Provides concurrent aerosol therapy
  • Disadvantages
  • Expensive
  • Cumbersome
  • Requires cooling
  • Difficult to clean, disinfect
  • Limits patient mobility
  • Fire hazard

51
Oxygen hood
  • Minimum flow 7 L / min to prevent rebreathing

52
Oxygen hood
  • gt 7 L/min
  • FiO2 0.21-1
  • Fixed FiO2
  • Advantage
  • Full range of FiO2
  • Disadvantage
  • Difficult to clean and disinfect

53
Oxygen therapy in incubator
  • A venturi is used to add oxygen to the chamber
  • Scavenging mechanism in built ? air changes
  • Humidification possible
  • Temperature maintained
  • Multiple access ports for nursing
  • Infant can be transported

54
Incubators (Isolette)
55
Evaluation of therapy
  • Blood pressure
  • Pulse rate
  • Perfusion
  • Level of consciousness
  • Respiratory rate
  • Work of breathing
  • PO2

56
Protocol for titration of
oxygen therapy
57
Toxicity of normobaric oxygen
  • Physiology Vasoconstriction
  • V/Q changes
  • ? buffering capacity of blood
  • CO2 narcosis
  • Eye - retrolental fibroplasia
  • Lungs - acute and chronic toxicity
  • www.anaesthesia.co.in anaesthesia.co.in_at_gmail.c
    om
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