Management Strategy of

Oxygenation
Ns. Denissa Faradita Aryani, S.Kep., MSc.
Clinical Care Manager – ICU RS UI
Medical Surgical Nursing Departement – Faculty of Nursing
Universitas Indonesia
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Ns. Denissa Faradita Aryani, S.Kep., MSc

1. Riwayat Pendidikan
2015: MSc Advanced Nursing, University of Nottingham, UK
2006 – 2011: Sarjana Keperawatan dan Profesi Ners, FIK UI, Indonesia
2. Riwayat Pekerjaan
2011 – 2012: Perawat Pelaksana, RSUP Fatmawati, Jakarta
2012 – sekarang: Staf Pengajar, Departemen Keperawatan Medikal Bedah, FIK UI, Depok
2016 – 2017: Perawat Primer, RSUPN dr. Cipto Mangunkusumo, Jakarta
2019 – sekarang: ICU Clinical Care Manager, RSUI, Depok
3. Area penelitian
Critical Care Nursing, Chronic Care, Respiratory Care Nursing, Palliative Care, Infectious Disease,
Learning and Development
4. Publikasi
https://www.sciencedirect.com/science/article/abs/pii/S1130862118301797
https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.995.6912&rep=rep1&type=pdf
http://www.proceedings.ui.ac.id/index.php/uiphm/article/view/242
http://proceedings.ui.ac.id/index.php/uiphm/article/view/240
http://www.proceedings.ui.ac.id/index.php/uiphm/article/view/257
http://www.proceedings.ui.ac.id/index.php/uiphm/article/view/249/0
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Objectives

In order to delivering appropriate intervention, student

should:
• Have knowledge of the different delivery services and in
what situation they should be used
• Notice about specific indicators
• Describe the indications for and uses of different types of
airway equipment
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Oxygen Devices: Video

• https://youtu.be/4OUEPvcAyRM
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Aim of Oxygenation Management

• Adequate oxygenation by achieve O2 saturation >95%

(according to preference baseline)
• Anticipate the need for airway management or oxygen
delivery and ensure that all appropriate equipment
• Select and perform airway management in accordance with
the situation, the indication and the patient's condition
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Minute Volume

• Minute volume is the total lung ventilation per minute.

Which is the volume of gas inhaled (inhaled minute volume)
or exhaled (exhaled minute volume) from a person's lungs
per minute
• The product of tidal volume and respiration rate.
• MV = TV x RR
• TV (8-10 cc/KgBB) max 6-8 cc/KgBB for COPD, ARDS
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Gas Exchange
O2 & CO2 carried in the
blood
• Dissolved in plasma
• Binding to Haemoglobin
(Hb)
• O2 carried on Hb measured
by pulse oximeter (SpO2)
• Gas dissolved in the plasma
= partial pressure or P
(mmHg) measured by GBA
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Why measure PaO2 and PaCO2 ?

• O2 that crosses from the lungs to blood is measured as PaO2
• PaO2 is a good measure of gas exchange. It is the amount of gas dissolved in
the plasma and can be thought of as the loading force that drives the binding
of O2 to Hb
• Individuals who have a severe respiratory disorder will usually receive a high
concentration of supplemental O2 and this may keep the the O2 saturations
within normal level. Because pulse oximeter does not measure CO2 level
• Measure circulation (tissue) and metabolism ( use by cells in tissue)
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PaO2 and PaCO2 in the alveoli

PaO2 PaCO2
• The normal average PaO2 of • The normal average
100 mm Hg is determined PaCO2 of 40 mm Hg is
determined by:
by:
✓The amount of carbon
✓The amount of oxygen dioxide that diffuses into
entering the alveoli the alveoli from the
capillary blood
✓The removal of oxygen by ✓The removal of carbon
the capillary blood flow dioxide from the alveoli by
means of ventilation.

GBA
If Blood is Acid
Result
Body temperature is high →
Hb already heavily loaded
with CO2
It will not picked up and carry
as much O2
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Compensation or activity
Affect tissue oxygenation and
should optimize the binding
of O2 to Hb 1. Reducing body
temperature will allows more
Oxygen to bind with Hb
2. Hot tissue burn more
energy and O2 so they may
cause an O2 debt in the
system, which failing lungs
may not meet
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GBA

If blood is alkaline
Result
Body temperature is low
The amount of CO2
Compensation or Activity
Although it carries more
bound to Hb is low, more O2, it will not releases in
O2 will be picked up and the tissues. But only stay PaCO2 falls, allowing the
carried in Hb and recirculate back PaO2 to move closer to
to the lungs and heart the partial pressure of
the atmospheric oxygen
(approx. 159 mm Hg)

Decreasing RR
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Management strategy

• Airway stabilization
• Oxygen delivery devices (non-invasive)
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Airway stabilization

Head-tilt Chin-lift
• Manually airway
stabilization
• Contraindication on
cervical injury
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Jaw thrust
• Airway stabilization
for suspect cervical
injury
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Nasopharingeal Airway (NPA)

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Oropharingeal Airway (OPA)

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Collar neck
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Oxygen Delivery Devices

• low flow-low concentration, low flow-high concentration,

high flow-high concentration
Nasal Cannula, Simple facemask, Rebreathing Mask, Non
Rebreathing Mask, C-PAP
• Oxygen in the atmosphere: 21%
• Oxygen with devices 1L = 3-4% (approx in low flow devices)
• FiO2 = 21% + (L amount of oxygen devices)
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Nasal cannula
• Low flow low
concentration
• 1-6 L/min, FiO2 24 -
44%
(+) Convenient,
comfortable, good low
flow
(-)may cause sinus
pain, >2 L/need
humidity or it will have
drying effect
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Rebreathing Mask (RM)

• Low flow high

concentration
• 5-8 L/min, FiO2 40-60%
• Use in low PaO2 and
PaCO2 at the same time
• Mixed gas of Insp and
Exp with 1/3 Insp fill in
the reservoir bag and 2/3
out by the valve or side
• Allow the mixture of O2
and CO2
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Non Rebreathing Mask

• Low flow high

concentration
• 8-12 L/m, FiO2 80-100%
• One way valve to prevent
rebreathing
• It prevent the room air
being entrained. No
mixture of Insp and Exp
• Use in low PaO2 with
normal or slightly high
PaCo2
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High flow high concentration

• Nasal cannula high concentration / HFNC

• Continous Positive Airway Pressure (C-PAP)
• Non Invasive Ventilation
--
• Mechanical Ventilation
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Nasal cannula high concentration

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MonEv on HFNC
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CPAP
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Non-Invasive Ventilation
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NIV / NPPV

• Noninvasive positive pressure Indication

ventilation (NPPV) ventilasi COPD with exacerbation with respiratoric acidosis

(pH < 7.35)
tekanan positif
Secondary Hypercapnia Respiratory Failure ec
thoracal malfunction
Neuromuscular disorder
Lung Oedema
Weaning Process from Endotracheal Intubation
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NIV / NPPV Contraindication

Contraindication
Trauma or burn injury in Facial
Upper airway obstruction
Hypoxemia with life treathening
Unstable hemodinamic
High severity of underlying diseases
Unconsciousness
Seizure, Agitation
Vomit
Hypersecretion mucous
Pneumothorax
Consolidation imaging in CXR
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Setting Up NIV/NPPV

• PEEP
• Pressure Support
• Trigger
• FiO2
----
• Machine with mode NIV
• Breathing Circuit (double limb)
• NIV mask and strap
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Respiratory Physical Assessment

• Focused interview
• Visual inspection of the chest
• Palpation of the chest and lungs
• Percussion of the chest and lungs
• Auscultation of the lungs
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References
• Basset, Chris (2003). Essentials of Nursing Care. London: Whurr
Publishers
• Becker, D. E., Rosenberg, M. B., & Phero, J. C. (2014). Essentials of
Airway Management, Oxygenation, and Ventilation: Part 1: Basic
Equipment and Devices. Anesthesia Progress, 61(2), 78–83.
http://doi.org/10.2344/0003-3006-61.2.78
• Crocker, C. (2002). Nurse led weaning from ventilatory and
respiratory support. Intensive and Critical Care Nursing, 18(5), 272-
279.
• http://www.anaesthesia.med.usyd.edu.au/resources/lectures/ven
tilation_clt/ventilation.html