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Oxygen Therapy

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Title: Oxygen Therapy & O2 Delivery Systems Author: Prabhmeet Singh Last modified by: Guest Created Date: 10/22/2005 12:23:05 PM Document presentation format – PowerPoint PPT presentation

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Title: Oxygen Therapy


1
Oxygen Therapy O2 Delivery Systems
  • Dr. J. S Dali
  • MAMC

www.anaesthesia.co.in anaesthesia.co.in_at_gmail.c
om
2
Oxygen Therapy
  • ?

3
Oxygen Therapy
Partial Pr of O2 in insp. gas (Pi o2)
4
Oxygen Therapy
Partial Pr of O2 in insp. gas (Pi o2)
Conc. of O2 (Fi o2) (Orthobaric)
Total Pressure (Hyperbaric)
5
Father of modern O2 Therapy
  • ?

6
Father of modern O2 Therapy
O2 lack not only stops the machine, but totally
ruins the supposed machinery
  • J.S Haldane-1917

7
Aim of O2 Therapy
  • ?

8
Aim of O2 Therapy
  • To restore tissue O2 towards normal

9
O2 Cascade
Air
mitochondria
10
O2 Cascade
159mm Hg (20.95 of 760)
Atm. Air (dry)
?
Lower Resp. Tract (moist 37oc)
149mm Hg (20.95 of 713)
11
O2 Cascade
159mm Hg (20.95 of 760)
Atm. Air (dry)
Humidification 6 Vol (47mm Hg)
Lower Resp. Tract (moist 37oc)
149mm Hg 20.95 of 713 (760-47)
12
O2 Cascade
Lower Resp. Tract (moist 37oc)
149mm Hg (20.95 of 713)
?
?
101mm Hg (14 of 713) or (15 of 673) 673 760
47 40
Alveolar air
PA O2 FI O2 (Pb 47) PaCo2 x F
PI O2 PaCo2 PI O2 PaCo2 if breathing
100 O2
R.Q
13
O2 Cascade
Lower Resp. Tract (moist 37oc)
149mm Hg (20.95 of 713)
O2 consumption
Alv. ventilation
101mm Hg (14 of 713) or (15 of 673) 673 760
47 40
Alveolar air
PA O2 FI O2 (Pb 47) PaCo2 x F
PI O2 PaCo2 PI O2 PaCo2 if breathing
100 O2
R.Q
14
O2 Cascade
101mm Hg (14 of 713) or (15 of 673) 673 760
47 40
Alveolar air
?
Arterial blood
97mm Hg
Pa O2 100 0.3 x age (years) mm Hg A a
4 25 mmHg
15
O2 Cascade
101mm Hg (14 of 713) or (15 of 673) 673 760
47 40
Alveolar air
Venous admixture
Arterial blood
97mm Hg
Pa O2 100 0.3 x age (years) mm Hg A a
4 25 mmHg
16
Venous admixture(physiological shunt)
O2 Cascade
Low VA/Q
Normal True shunt (normal anatomical shunt)
17
Venous admixture(physiological shunt)
O2 Cascade
Low VA/Q
Normal True shunt (normal anatomical shunt)
Pulmonary (Bronchial veins)
Extra Pulm. (Thebesian veins)
18
Venous admixture(physiological shunt)
O2 Cascade
Low VA/Q
Normal True shunt (normal anatomical shunt)
Pulmonary (Bronchial veins)
Extra Pulm. (Thebesian veins)
Normal upto 5 of cardiac output
19
O2 Cascade
PA O2 101mm Hg (14 of 713) or (15 of
673) 673 760 47 40
Alveolar air
?
Venous admixture
?
Arterial blood
Pa O2 97mm Hg
Pa O2 100 0.3 x age (years) mm Hg A
a 4 25 mmHg
20
O2 Cascade
PA O2 101mm Hg (14 of 713) or (15 of
673) 673 760 47 40
Alveolar air
PI O2
Venous admixture
PV O2
Arterial blood
Pa O2 97mm Hg
Pa O2 100 0.3 x age (years) mm Hg A a
4 25 mmHg
21
O2 Cascade
Pa O2 97mm Hg (Sat. gt 95 )
Arterial blood
Utilization by tissue
Cell Mitochondria PO2 7 37 mmHg
Mixed Venous blood
PV O2 40mm Hg Sat. 75
The critical level for aerobic
metab. to continue
22
O2 Cascade
Pa O2 97mm Hg (Sat. gt 95 )
Arterial blood
Utilization by tissue
Cell Mitochondria PO2 7 37 mmHg
Mixed Venous blood
PV O2 40mm Hg Sat. 75
Pasteur point The critical level for aerobic
metab. to continue (1 2 mmHg PO2 in
mitochondria)
23
Which patient is better placed ?
  • A B
  • Hb 14gm (normal) 7gm (Anaemic)
  • C.O. 5 L (normal) 4 L (Low)
  • PaO2 23 mm 60 mm
  • O2 Flux 375ml 350ml

24
Which patient is better placed ?
  • A B
  • Hb 14gm (normal) 7gm (Anaemic)
  • C.O. 5 L (normal) 4 L (Low)
  • SPO2 40 90
  • PaO2 23 mm 60 mm
  • O2 Flux 375ml 350ml

Min. gradient for O2 transfer from cap. to cell
(app. 20 mm Hg) sat. 20 30 200 300ml O2
flux Critical Level for O2 delivery / critical
O2 flux
25
O2 Cascade
Pa O2 97mm Hg (Sat. gt 95 )
Arterial blood
Utilization by tissue
Cell Mitochondria PO2 7 37 mmHg
Mixed Venous blood
PV O2 40mm Hg Sat. 75
Pasteur point The critical level for aerobic
metab. to continue (PO2 1-2 mmHg in
mitochondria, 22mmHg in capillary)
26
O2 Cascade
Pa O2 97mm Hg (Sat. gt 95 )
Arterial blood
?
Utilization by tissue
?
Cell Mitochondria PO2 7 37 mmHg
Mixed Venous blood
PV O2 40mm Hg Sat. 75
Pasteur point The critical level for aerobic
metab. to continue (PO2 1-2 mmHg in
mitochondria, 22mmHg in capillary)
27
O2 Cascade
Pa O2 97mm Hg (Sat. gt 95 )
Arterial blood
Perfusion
Utilization by tissue
O2 content (Hb Conc.)
Cell Mitochondria PO2 7 37 mmHg
Mixed Venous blood
PV O2 40mm Hg Sat. 75
Pasteur point The critical level for aerobic
metab. to continue (PO2 1-2 mmHg in
mitochondria, 22mmHg in capillary)
28
O2 content Per 100 ml Art. blood 14g x
1.39 x 100 20 ml Ven. blood 14g x 1.39 x
75 15ml Tissue extraction 25
5ml


29
O2 content Per 100 ml Art. blood 14g x
1.39 x 100 20 ml Ven. blood 14g x 1.39 x
75 15ml Tissue extraction 25
5ml
1 0.2ml
Art. blood
7g x 1.39 x 100 10 ml Ven. blood 7g x
1.39 x 50 5ml Tissue extraction 50
5ml 1 0.1ml
30
PO2 O2 content Per 100 ml 97mm Art.
blood 14g x 1.39 x 100 20 ml 40mm Ven.
blood 14g x 1.39 x 75 15ml Tissue
extraction 25 5ml
1 0.2ml

97mm Art. blood 7g x 1.39 x 100
10 ml ? Ven. blood 7g x 1.39 x 50
5ml Tissue extraction 50 5ml
1 0.1ml
31
PO2 O2 content Per 100 ml 97mm Art.
blood 14g x 1.39 x 100 20 ml 40mm Ven.
blood 14g x 1.39 x 75 15ml Tissue
extraction 25 5ml
1 0.2ml

97mm Art. blood 7g x 1.39 x 100
10 ml 27mm Ven. blood 7g x 1.39 x 50
5ml Tissue extraction 50 5ml
1 0.1ml
32
Oxygen Therapy
  • Indications

33
Oxygen Therapy
Indications
FIO2
Barometric Pressure
PIO2
34
Oxygen Therapy
Indications
FIO2 - FIO2 during anaes. - Rebreathing
Barometric Pressure - High altitude
PIO2
35
Oxygen Therapy
Indications
FIO2 - FIO2 during anaes. - Rebreathing
Barometric Pressure - High altitude
PIO2
  • O2 Consumption

Alveolar Ventilation
PAO2
36
Oxygen Therapy
Indications
FIO2 - FIO2 during anaes. - Rebreathing
Barometric Pressure - High altitude
PIO2
  • O2 Consumption
  • convulsions
  • thyrotoxicosis
  • -shivering
  • -pyrexia
  • Alveolar Ventilation
  • resp. depression
  • Resp. muscle paresis
  • resp.effort (trauma)
  • airway obstruction

PAO2
37
Oxygen Therapy
Indications
FIO2 - FIO2 during anaes. - Rebreathing
Barometric Pressure - High altitude
PIO2
  • O2 Consumption
  • convulsions
  • thyrotoxicosis
  • -shivering
  • -pyrexia
  • (7 / o C)
  • Alveolar Ventilation
  • resp. depression
  • Resp. muscle paresis
  • resp.effort (trauma)
  • airway obstruction

PAO2
38
Oxygen Therapy
Indications
Low VA/Q
Normal Anat. shunt
PaO2
39
Oxygen Therapy
Indications
  • Low VA/Q
  • Abn. Pulmonary shunt
  • - pneumonia
  • lobar atelectasis
  • ARDS
  • Normal Anat. shunt
  • Abn.extra Pulm. Shunt
  • cong. heart disease
  • (R L )

PaO2
40
Oxygen Therapy
Indications
  • Low VA/Q
  • Abn. Pulmonary shunt
  • - pneumonia
  • lobar atelectasis
  • ARDS
  • Normal Anat. shunt
  • Abn.extra Pulm. Shunt
  • cong. heart disease
  • (R L )

PaO2
Hypoxic hypoxia
41
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42
Simple Rule
  • Hypoxia due to hypoventilation
  • Slight increase in O2 conc.
  • (Thus the importance of ventimask)
  • Higher O2 conc.

43
Simple Rule
  • Hypoxia due to hypoventilation
  • Slight increase in O2 conc.
  • (Thus the importance of ventimask)
  • Higher O2 conc.
  • hypercapnoea
  • absence of cynosis

44
(No Transcript)
45
Oxygen Therapy
Indications
  • Low VA/Q
  • Abn. Pulmonary shunt
  • - pneumonia
  • lobar atelectasis
  • ARDS
  • Normal Anat. shunt
  • Abn.extra Pulm. Shunt
  • cong. heart disease
  • (R L )

PaO2
Perfusion
Hb concentration
Cell PO2
46
Oxygen Therapy
Indications
  • Low VA/Q
  • Abn. Pulmonary shunt
  • - pneumonia
  • lobar atelectasis
  • ARDS
  • Normal Anat. shunt
  • Abn.extra Pulm. Shunt
  • cong. heart disease
  • (R L )

PaO2
Perfusion local - PVD, thrombosis gen
shock, Hypovol.,
card. Failure cardiac arrest
  • Hb concentration
  • Anaemia
  • CO poisoning

Cell PO2
47
Which patient is better placed ?
  • A B
  • Anaemic patient Patient with Hb 14gm
  • Hb 7gm Normal Hb 7gm
  • Hb Co 7gm

48
Which patient is better placed ?
  • A B
  • Anaemic patient Patient with Hb 14gm
  • Hb 7gm Normal Hb 7gm
  • Hb Co 7gm
  • 2,3 DPG
  • Shift to R Shift to L
  • unloading of O2 unloading of O2
  • (blood tissue) (blood tissue)
  • PVO2 ? PVO2 ?

49
Which patient is better placed ?
  • A B
  • Anaemic patient Patient with Hb 14gm
  • Hb 7gm Normal Hb 7gm
  • Hb Co 7gm
  • 2,3 DPG
  • Shift to R Shift to L
  • unloading of O2 unloading of O2
  • (blood tissue) (blood tissue)
  • PVO2 27 mm Hg PVO2 ?

50
Which patient is better placed ?
  • A B
  • Anaemic patient Patient with Hb 14gm
  • Hb 7gm Normal Hb 7gm
  • Hb Co 7gm
  • 2,3 DPG
  • Shift to R Shift to L
  • unloading of O2 unloading of O2
  • (blood tissue) (blood tissue)
  • PVO2 27 mm Hg PVO2 14mmHg

51
Hypoxia in co poisoning is out of proportion
to degree of anemia
52
Which patient is better placed ?
  • A B
  • Anaemic patient Patient with Hb 14gm
  • Hb 7gm Normal Hb 7gm
  • Hb Co 7gm
  • 2,3 DPG
  • Shift to R Shift to L
  • unloading of O2 unloading of O2
  • (blood tissue) (blood tissue)
  • PVO2 27 mm Hg PVO2 14mmHg
  • Cardiac Output

53
Dissolved O2 in plasma
  • 0.003ml / 100ml of blood / mm PO2
  • Breathing Air (PaO2 100mm Hg)
  • 0.3ml / 100ml of blood

54
Dissolved O2 in plasma
  • 0.003ml / 100ml of blood / mm PO2
  • Breathing Air (PaO2 100mm Hg)
  • 0.3ml / 100ml of blood
  • Breathing 100 O2

55
Dissolved O2 in plasma
  • 0.003ml / 100ml of blood / mm PO2
  • Breathing Air (PaO2 100mm Hg)
  • 0.3ml / 100ml of blood
  • Breathing 100 O2 (PaO2 600mm Hg)
  • 1.8ml / 100ml of blood

56
Dissolved O2 in plasma
  • 0.003ml / 100ml of blood / mm PO2
  • Breathing Air (PaO2 100mm Hg)
  • 0.3ml / 100ml of blood
  • Breathing 100 O2 (PaO2 600mm Hg)
  • 1.8ml / 100ml of blood
  • Breathing 100 O2 at 3 Atm. Pressure

57
Dissolved O2 in plasma
  • 0.003ml / 100ml of blood / mm PO2
  • Breathing Air (PaO2 100mm Hg)
  • 0.3ml / 100ml of blood
  • Breathing 100 O2 (PaO2 600mm Hg)
  • 1.8ml / 100ml of blood
  • Breathing 100 O2 at 3 Atm. Pressure
  • 5.4ml / 100ml of blood

58
Dissolved O2 in plasma
  • 0.003ml / 100ml of blood / mm PO2
  • Breathing Air (PaO2 100mm Hg)
  • 0.3ml / 100ml of blood
  • Breathing 100 O2 (PaO2 600mm Hg)
  • 1.8ml / 100ml of blood
  • Breathing 100 O2 at 3 Atm. Pressure
  • 5.4ml / 100ml of blood
  • Basis of Hyperbaric O2 therapy

59
Benefit of O2 therapy in Hypoxia
  • Hypoxic hypoxia (gas phase)
  • Anaemic hypoxia (fluid phase const.)
  • Stagnant hypoxia (fluid phase flow)
  • Histotoxic hypoxia (tissue phase) -

60
Benefit of O2 therapy in Hypoxia
  • Hypoxic hypoxia (gas phase)
  • Anaemic hypoxia (fluid phase const.)
  • Stagnant hypoxia (fluid phase flow)
  • Histotoxic hypoxia (tissue phase) -
  • Normal Person (breathing 100 O2)
  • 14gm x 1.34ml 18.7ml 1.8ml 20.5ml (1.8 is
    9 20.5)

61
Benefit of O2 therapy in Hypoxia
  • Hypoxic hypoxia (gas phase)
  • Anaemic hypoxia (fluid phase const.)
  • Stagnant hypoxia (fluid phase flow)
  • Histotoxic hypoxia (tissue phase) -
  • Normal Person (breathing 100 O2)
  • 14gm x 1.34ml 18.7ml 1.8ml 20.5ml (1.8 is
    9 20.5)
  • Anaemic patient (breathing 100 O2)
  • 4gm x 1.34ml 5.4ml 1.8ml 7.2 ml (1.8 is 25
    of 7.2)

62
Oxygen Therapy
Indications
  • Physical effects of O2

63
Oxygen Therapy
Indications
  • Physical effects of O2
  • Air in the body where it should not be

64
Oxygen Therapy
Indications
  • Physical effects of O2
  • Air in the body where it should not be
  • Surgical emphysema
  • Pneumothorax
  • Air embolism
  • Bowel decompression

65
Gas Tensions
mmHg mmHg
Art. blood Ven. blood
Breathing air Breathing air Breathing air
PO2 100 40
PCo2 40 46
PN2 570 570
Breathing 100 O2 Breathing 100 O2 Breathing 100 O2
PO2 600 ?
PCo2 40 46
PN2 0 0
66
Gas Tensions
mmHg mmHg
Art. blood Ven. blood
Breathing air Breathing air Breathing air
PO2 100 40
PCo2 40 46
PN2 570 570
Breathing 100 O2 Breathing 100 O2 Breathing 100 O2
PO2 600 50
PCo2 40 46
PN2 0 0
67
  • Tissue requirement per 100ml 5ml
  • Dissolved Fraction 1.8 ml
  • Balance 3.2 ml
  • 0.2ml x 16 3.2ml
  • 84 saturation PO2 50mm Hg

68
Oxygen Therapy
Indications
  • Pre oxygenation / ?

69
Oxygen Therapy
Indications
  • Pre oxygenation / denitrogenation
  • To the O2 reserve in the body ?

70
O2 stores in the body
Breathing air Breathing 100 O2
Lungs (FRC) 450 ml 3000 ml
Blood 1000 ml 1090 ml
Tissue fluids / myoglobin
71
O2 Delivery systems
72
O2 Delivery systems
  • Ambient pressure
  • Variable performance devices
  • Fixed performance devices

73
O2 Delivery systems
  • Ambient pressure
  • Variable performance devices
  • Fixed performance devices
  • Positive pressure ventilation
  • Non invasive (BIPAP, CPAP)
  • Invasive

74
O2 Delivery systems
  • Ambient pressure
  • Variable performance devices
  • Fixed performance devices
  • Positive pressure ventilation
  • Non invasive (BIPAP, CPAP)
  • Invasive
  • ECMO

75
O2 Delivery systems
  • Ambient pressure
  • Variable performance devices (Pt. dependent) low
    flow
  • No capacity system no rebreathing
  • nasal catheter / cannulae
  • Capacity system chance of rebreathing
  • Small (mass shell only)
  • Large (with reservoir bag)
  • Fixed performance devices (Pt. independent) high
    flow
  • HAFOE (ventimask)
  • Anaesthesia circuits

76
  • High flow system
  • The gas flow is sufficient to meet all
    inspiratory requirement
  • Low flow system
  • The gas flow is insufficient to meet all
    inspiratory requirement.
  • Part of tidal volume is provided by room air.

77
Variables
  • O2 flow rate
  • Patient factors
  • Device factors

78
Variables
  • O2 flow rate
  • Patient factors
  • Inspiratory flow rate
  • Expiratory time (active exp. flow exp. pause)
  • Device factors

79
Variables
  • O2 flow rate
  • Patient factors
  • Inspiratory flow rate
  • Expiratory time (active exp. flow exp. pause)
  • Device factors
  • Physical volume (capacity)
  • Vent resistance (tight fit)

80
Variable Variable No cap. Devices Capacity devices Capacity devices
Variable Variable FIO2 FIO2 FICO2
O2 flow rate O2 flow rate
O2 flow rate O2 flow rate
Patient Factors Insp. Flow rate
Patient Factors Insp. Flow rate
Patient Factors Exp. time
Patient Factors Exp. time
Device Factors Physical volume
Device Factors Physical volume
Device Factors Vent resistance
Device Factors Vent resistance
81
Variable Variable No cap. Devices Capacity devices Capacity devices
Variable Variable FIO2 FIO2 FICO2
O2 flow rate O2 flow rate
O2 flow rate O2 flow rate
Patient Factors Insp. Flow rate
Patient Factors Insp. Flow rate
Patient Factors Exp. time
Patient Factors Exp. time
Device Factors Physical volume
Device Factors Physical volume
Device Factors Vent resistance
Device Factors Vent resistance
82
Variable Variable No cap. Devices Capacity devices Capacity devices
Variable Variable FIO2 FIO2 FICO2
O2 flow rate O2 flow rate
O2 flow rate O2 flow rate
Patient Factors Insp. Flow rate
Patient Factors Insp. Flow rate
Patient Factors Exp. time
Patient Factors Exp. time
Device Factors Physical volume
Device Factors Physical volume
Device Factors Vent resistance
Device Factors Vent resistance
83
Variable Variable No cap. Devices Capacity devices Capacity devices
Variable Variable FIO2 FIO2 FICO2
O2 flow rate O2 flow rate
O2 flow rate O2 flow rate
Patient Factors Insp. Flow rate
Patient Factors Insp. Flow rate
Patient Factors Exp. time
Patient Factors Exp. time
Device Factors Physical volume
Device Factors Physical volume
Device Factors Vent resistance
Device Factors Vent resistance
84
Variable Variable No cap. Devices Capacity devices Capacity devices
Variable Variable FIO2 FIO2 FICO2
O2 flow rate O2 flow rate
O2 flow rate O2 flow rate
Patient Factors Insp. Flow rate
Patient Factors Insp. Flow rate
Patient Factors Exp. time
Patient Factors Exp. time
Device Factors Physical volume
Device Factors Physical volume
Device Factors Vent resistance
Device Factors Vent resistance
85
Variable Variable No cap. Devices Capacity devices Capacity devices
Variable Variable FIO2 FIO2 FICO2
O2 flow rate O2 flow rate
O2 flow rate O2 flow rate
Patient Factors Insp. Flow rate
Patient Factors Insp. Flow rate
Patient Factors Exp. time
Patient Factors Exp. time
Device Factors Physical volume
Device Factors Physical volume
Device Factors Vent resistance
Device Factors Vent resistance
86
Variable Variable No cap. Devices Capacity devices Capacity devices
Variable Variable FIO2 FIO2 FICO2
O2 flow rate O2 flow rate
O2 flow rate O2 flow rate
Patient Factors Insp. Flow rate
Patient Factors Insp. Flow rate
Patient Factors Exp. time
Patient Factors Exp. time
Device Factors Physical volume
Device Factors Physical volume
Device Factors Vent resistance
Device Factors Vent resistance
87
Variable Variable No cap. Devices Capacity devices Capacity devices
Variable Variable FIO2 FIO2 FICO2
O2 flow rate O2 flow rate
O2 flow rate O2 flow rate
Patient Factors Insp. Flow rate
Patient Factors Insp. Flow rate
Patient Factors Exp. time
Patient Factors Exp. time
Device Factors Physical volume
Device Factors Physical volume
Device Factors Vent resistance
Device Factors Vent resistance
88
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89
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90
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91
Nasal Catheter
  • O2 Flowrate (L/min)
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • Fi O2
  • 0.24
  • 0.28
  • 0.32
  • 0.36
  • 0.40
  • 0.44

92
Normal Anatomic Reservoir (50ml) 6
Ltr/min 100ml/sec
50ml/1/2 Sec
93
Nasal Catheter
  • Merits
  • Easy to fix
  • Keeps hands free
  • Not much interference with further airway care
  • Useful in both spont. breathing and apnoeic

94
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95
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96
10-15 Ltr/min flow rate ----------- 50-60 O2
conc.
97
Nasal Catheter
  • Merits
  • Easy to fix
  • Keeps hands free
  • Not much interference with further airway care
  • Useful in both spont. breathing and apnoeic
  • Small but definite rise in FiO2 (dose not
    critical)
  • Demerits
  • Mucosal irritation (uncomfortable)
  • Gastric dilatation (especially with high flows)

98
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99
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100
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101
  • For higher O2 Concentration
  • gadgets with storage capacity (reservoir)
  • problem of re-breathing
  • minimized / avoided by higher flows

102
Simple face mask
Simple Face Mask ?
103
Simple face mask
Simple Face Mask
NO YES
104
Simple face mask
  • O2 Flowrate (L/min)
  • 5-6
  • 6-7
  • 7-8
  • Fi O2
  • 0.40
  • 0.50
  • 0.60

105
Partial Rebreathing mask (polymask)
106
(No Transcript)
107
Partial Rebreathing mask(polymask)
  • O2 Flowrate (L/min)
  • 6
  • 7
  • 8

Fi O2 0.60 0.70 0.80
108
Poly mask
  • What type of circuit it is ?

109
Poly mask
  • What type of circuit it is ?
  • Modified T Piece

110
Non Rebreathing mask
Non Rebreathing Mask
111
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112
10 15 Ltr/min flow rate
50-100 O2 conc.
113
Face Masks
  • Merits
  • Higher Oxygen Conc.
  • Demerits
  • Rebreathing (if O2 flow is inadequate)
  • Interfere with further airway care
  • Proper fitting is required
  • Uncomfortable (sweating, spitting)

114
Bag Valve Mask assembly(Ambu Resuscitator)
Bag Valve Mask assembly(Ambu Resuscitator)
115
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116
Bag Valve Mask assembly(Ambu Resuscitator)
  • Delivers O2 during BOTH spont. artf. Vent
  • O2 concentration
  • 30 50 (without reservoir)
  • 80 100 (with reservoir)
  • To deliver 100 O2

117
Bag Valve Mask assembly(Ambu Resuscitator)
  • Delivers O2 during BOTH spont. artf. Vent
  • O2 concentration
  • 30 50 (without reservoir)
  • 80 100 (with reservoir)
  • To deliver 100 O2
  • Reservoir as large as bag vol
  • O2 flow rate gt minute volume (10 l/m)
  • Drawback keeps rescuers hands engaged

118
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119
Pocket Mask
  • Delivers O2 in BOTH spont. aponeic
  • Allows use of both hands for maintaining airway
  • Upto 4 ltr reserve vol. (rescuers vital
    capacity)

O2 Flowrate (L/min) 5 10 15
Fi O2 0.40 0.50 0.80 (Spont.) 0.54 (M -
mask)
120
Incubator
  • Small infants not on ventilator
  • Works on venturi principle
  • Complete air change 10 times / hour
  • Control of humidity temperature
  • O2 conc. falls rapidly when access ports are open

121
O2 tents
  • For children not tolerating mask / catheter
  • Large capacity system
  • Upto 50 O2 concentration
  • Large tent cap. and leak port limited CO2 build
    up.
  • Disadvantage
  • Limited access
  • Risk of fire
  • Conflict in O2 therapy / nursing care

122
Can You name the device ? Written over it 28
_at_ 4 L P M ? If flow is doubled (8 LPM) what
will the age of O2 delivered by the device ? If
flow is halved (_at_ 2 LPM) what will be the age
of O2 received by the patient ?
What is the likely entertainment ratio of this
device ? 1 2 4 8 16 What
precaution to be taken for humidification of
gases while using this device ?
123
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124
  • Works on principle of constant pressure jet
    mixture.
  • O2 jet entrains air as per entrain. ratio.
  • Total flow gt PIFR (30 35 L/min)
  • Eliminates the problem of dead space leak free
    connection.

125
Ventimask
126
Simple face mask
Simple Face Mask
NO YES
127
  • Works on principle of constant pressure jet
    mixture.
  • O2 jet entrains air as per entrain. ratio.
  • Total flow gt PIFR (30 35 L/min)
  • Eliminates the problem of dead space leak free
    connection.
  • Upper limit is 60 .
  • Humidification of O2 supply is not sensible.

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If conc. of O2 which a patient is getting is not
known then the situation is similar toa drug
being administered without knowing the dose
which can do harm if given more or provide
insufficient effect if given less
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100 - not more than 12hrs 80 - not more than
24hrs 60 - not more than 36hrs
O2 Toxicity
131
Rest (read it yourself)
132
Thank you Best of Luck
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