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Oxygen Gas AdministrationOxygen Gas Administration

وحيد. زيد م م عاجل

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Oxygen TherapyGeneral Goals/objectives– Correcting HypoxemiaCorrecting Hypoxemia

By raising Alveolar & Blood levels of OxygenBy raising Alveolar & Blood levels of Oxygen

Easiest objective to attain & measureEasiest objective to attain & measure

– Decreasing symptoms of HypoxemiaDecreasing symptoms of HypoxemiaSupplemental O2 can help relieve symptoms Supplemental O2 can help relieve symptoms of hypoxiaof hypoxia

– Less dyspnea/WOBLess dyspnea/WOB– Improve mental funxImprove mental funx

Oxygen TherapyOxygen TherapyDesign & Performance Design & Performance

Flow does not meet inspiratory demandFlow does not meet inspiratory demand

O2 is diluted with air on inspirationO2 is diluted with air on inspiration

Nasal CannulaNasal Cannula

Nasal CatheterNasal Catheter

Xtracheal CatheterXtracheal Catheter

Resevoir CannulasResevoir Cannulas

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44

Nasal CannulaNasal Cannula

Oxygen TherapyOxygen TherapyLow Flow DevicesLow Flow Devices

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Oxygen TherapyOxygen TherapyLow Flow DevicesLow Flow Devices

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Oxygen TherapyOxygen TherapyLow Flow DevicesLow Flow Devices

Xtracheal catheterXtracheal catheter– Surgically inserted in tracheaSurgically inserted in trachea– Uses trachea/upper airway as reservoirUses trachea/upper airway as reservoir

Requires very low flows to meet needsRequires very low flows to meet needs

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Oxygen TherapyOxygen TherapyLow Flow DevicesLow Flow Devices

– Reservoir CannulaReservoir Cannula

– Frequent replacementFrequent replacement– No humidificaxNo humidificax– Requires nasal exhalaxRequires nasal exhalax

NasalNasal– Stores ~20mlStores ~20ml– Aesthetically displeasingAesthetically displeasing

PendantPendant– Better aestheticallyBetter aesthetically– Extra weight can irritate Extra weight can irritate

ears/faceears/face88

Low Flow DevicesLow Flow DevicesReservoir MasksReservoir Masks

Simple MaskSimple MaskGas gathers in maskGas gathers in mask

Exhalax portsExhalax ports

Air entrained thru ports & around Air entrained thru ports & around maskmask

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1010

Partial rebreather Non-rebreatherPartial rebreather Non-rebreather

AEMAEM

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Oxygen TherapyOxygen TherapyMore ReservoirsMore Reservoirs

EnclosuresEnclosures– TentsTents– HoodsHoods– IncubatorsIncubators

OthersOthers– BVMBVM– Pulse Dose CannulaPulse Dose Cannula– ConcentratorsConcentrators

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Oxygen TherapyOxygen TherapyMore Reservoirs – EnclosuresMore Reservoirs – Enclosures

Oxygen TentsOxygen Tents– RareRare– Air conditioned to provide constant Air conditioned to provide constant

desired Tempdesired Temp– Frequent opening & constant leakage Frequent opening & constant leakage

Make FiO2 variableMake FiO2 variable

Analyze FiO2 @pt head level (layering)Analyze FiO2 @pt head level (layering)

– Primarily for pediatric aerosol therapy Primarily for pediatric aerosol therapy for Croup or CFfor Croup or CF

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Oxygen TherapyOxygen TherapyMore Reservoirs – EnclosuresMore Reservoirs – Enclosures

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Oxygen TherapyOxygen TherapyMore Reservoirs – EnclosuresMore Reservoirs – Enclosures

Incubator (isolette)Incubator (isolette)– Plexiglas enclosurePlexiglas enclosure– Servo controlled convex Servo controlled convex

heating with supplemental O2heating with supplemental O2– Freq opening & dilution Freq opening & dilution

makes it hared to deliver high makes it hared to deliver high O2O2

– Hoods are used in Incubators Hoods are used in Incubators to provide supplemental O2to provide supplemental O2

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Oxygen BlenderOxygen Blender

Oxygen TherapyOxygen TherapySelecting Delivery ApproachSelecting Delivery Approach– Purpose (Objective)Purpose (Objective)

Increase FiO2 to correct hypoxemiaIncrease FiO2 to correct hypoxemia

minimize symptoms of hypoxemiaminimize symptoms of hypoxemia

– PatientPatientCause & severity of hypoxemiaCause & severity of hypoxemia

AgeAge

Neuro status/orientaxNeuro status/orientax

Airway in place/protectedAirway in place/protected

Regular rate & rhythm Regular rate & rhythm 1717

Oxygen TherapyOxygen TherapyPrecautions & HazardsPrecautions & Hazards

– O2 ToxicityO2 ToxicityPrimarily affects Lungs & CNSPrimarily affects Lungs & CNS

2 determining factors of O2 tox2 determining factors of O2 tox– PO2PO2– Time of exposureTime of exposure– i.e., higher the PO2 & exposure time the greater i.e., higher the PO2 & exposure time the greater

the toxicity.the toxicity.

CNS effects occur with Hyperbaric PressuresCNS effects occur with Hyperbaric Pressures

Pulmonary effects can occur @ clinical PO2 Pulmonary effects can occur @ clinical PO2 levelslevels

– Patchy infiltrates on x-ray, prominent in lower Patchy infiltrates on x-ray, prominent in lower lung fieldslung fields

– Major alveolar injuryMajor alveolar injury1818

Oxygen TherapyOxygen TherapyPrecautions & HazardsPrecautions & Hazards

– Retinopathy of Prematurity (ROP) Retinopathy of Prematurity (ROP) retrolental fibroplasiaretrolental fibroplasia

Up to 1month of ageUp to 1month of age

excesive Blood oxygen level causes retinal excesive Blood oxygen level causes retinal vasoconstrixvasoconstrix

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Oxygen TherapyOxygen TherapyPrecautions & HazardsPrecautions & Hazards

– FireFire Newspaper!Newspaper!Fire TriangleFire Triangle

– O2, Heat, & FuelO2, Heat, & Fuel

increase risk of fire increase risk of fire – High Concentrax of O2High Concentrax of O2– High Pressures of O2High Pressures of O2

Reduce O2 buildup in enclosed Reduce O2 buildup in enclosed environmentsenvironments

– Under drapesUnder drapes– Operating rooms, etc.Operating rooms, etc.

Be cautious when using electronic Be cautious when using electronic equipmentequipment

– Scalpels, Cardioverx, Cardio ShockScalpels, Cardioverx, Cardio Shock2020