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Oxygen Therapy

Oxygen Therapy

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Oxygen Therapy

Faisal Malmstrom, Critical Care Department SKMC

Carl Wilhelm Scheele
Priestly and Lavoisier

Airway obstruction needs to be addressed immediately .ABC  Air goes in and out. Any variation on this is a bad thing. blood goes round and round.

PaO2 <60 mm Hg  Type 2 (hypercapnic) PCO2>50 mmHg. pH<7.35 .Respiratory failure  Type 1 (hypoxemic) Saturation < 90%.

Definitions  Hypoxemia  Hypoxia .

Hypoxemia  Low alveolar oxygen tension (ambient. hypoventilation)  Ventilation-perfusion mismatch  Right to left shunt (venous admixture) intracardiac extracardiac  Impaired oxygen diffusion (uncommon) .

Alveolar gases .

minimal improvement with increased FiO2 .V/Q mismatch  Ventilated but not perfused: increased dead space ventilation. VT=VD+VA VD= VD equipment + VD anatomic + VD physiologic  Perfused but not ventilated: shunt >20% Shunt fraction.

34ml/gHb+ (PaO2 x 0.Hypoxia  Hypoxemic Hypoxia  Anaemic Hypoxia  Stagnant Hypoxia ( distributive or low CO)  Histotoxic Hypoxia VDO2= CO x Hb x SAT/100 x 1.003mlO2/100ml/mmHg) .

tachypnea. Hyperventilation +/.Cyanosis ( Hb.Symptoms of Hypoxemia and Hypoxia      Dyspnea. permanent brain injury Tachycardia/Hypertension – Hypotension/Bradycardia( 30 mmHg)  Lactic acidosis . perfusion) >15g/l Impaired mental performance----coma Seizures.

Sat<90%)  Hypotension ( Systolic BP < 100 mmHg)  Low Cardiac Output and Metabolic Acidosis ( bicarbonate <18 mmol/l)  Respiratory distress ( RR>24/minute) American College of Chest Physicians and NHLBI .5 mmHg.Indications for Oxygen therapy  Cardiac and respiratory arrest  Hypoxemia ( pO2 < 58.

Treatment I  Empiric oxygen treatment Cardiac/ respiratory arrest Hypotension Respiratory Distress Trauma GCS decrease from any cause Postoperative .

flow.  Treatment goal ( sat level)  Administration mode. when to stop .Treatment II  Verify hypoxemia Pulse oximetry ABG’s  Start Oxygen treatment.

The oxyhaemoglobin dissociation curve showing the relation between partial pressure of oxygen and haemoglobin saturation Currie. G. . BMJ 2006.333:34-36 Copyright ©2006 BMJ Publishing Group Ltd. P et al.

321:864-865 Copyright ©2000 BMJ Publishing Group Ltd. BMJ 2000. .Charting Oxygen treatment Dodd. M E et al.

Bad medicine To withhold Oxygen out of fear of hypercarbic ventilatory failure is poor practice Identify patients at risk (COPD) Use Venturi masks 0.24 -0. intubation) . ABG’s/ O2-sat to direct therapy Support ventilation (BiPAP.FiO2.28 ---.

Oxygen Hazards  Fire ( airway fires)  Tissue toxicity. pulmonary and retina  Decreased hypoxemic drive and increased VD in COPD.  Seizures (hyperbaric)  Mucosal damage due to lack of humidity .

Oxygen administration  Low flow systems  High Flow systems (HFOE) .

Nasal Prongs .

Bateman. BMJ 1998. .317:798-801 Copyright ©1998 BMJ Publishing Group Ltd. N T et al.

Face Mask (“Hudson”) .

Non-rebreather .

Venturi Mask .

Venturi valve .

.Bateman.317:798-801 Copyright ©1998 BMJ Publishing Group Ltd. N T et al. BMJ 1998.

P et al. (Results from the nocturnal oxygen therapy trial (NOTT) and the MRC trial) Currie. BMJ 2006. G.15 hours/day.Long term oxygen therapy prolongs survival in hypoxaemic patients with COPD when used for &ge. .333:34-36 Copyright ©2006 BMJ Publishing Group Ltd.

Adequate saturation for the patient. FiO2 (venturi).Take home message  Acute empiric oxygen treatment is ok but hypoxemia should be verified with pulse oximetry and /or ABG’s when situation more stable.  Oxygen is a drug and should be ordered as such: mode of administration. flow rate. monitoring. treatment goal. when to stop.  Never withhold oxygen out of fear of possible hypercarbia  Avoid overzealous treatment. COPD 88-90% .

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