Oxygen therapy..

(neonate –pedia –adult) Done by :
Miss ; saja A. Almarshad.. th      RT 4 level student.

Enjoy my presentation that I guarantee it will be full of oxygen .. & interesting things to know , SO BE READY ^_^ SAJO ..

Info.
• 1774 – J . Priestly produced O2 – “Dephlogisticated Air” • 1776 – A . L . Lavoisier OXYGEN termed this vital air –

• Late 1800 – Bonnaire gave O2 to preterm “ Blue Baby ”

with success .

• 1907 – A . Lane invented NASAL CATHETER • 1919 – L . Hill developed O2 TENT. • 1920 - O2 therapy became routine for “ SICK NEW BORN ”

Impotency of o2..
• Living cells must be fuelled with oxygen in order to survive! • The respiratory system functions to supply oxygen to the cells and remove carbon dioxide from the tissues. • Illness and injury increase tissue oxygen demand

Definition

• Oxygen therapy is the administration of oxygen at concentrations greater than that in ambient air (21%) with the intent of treating or preventing the symptoms and manifestations of hypoxia

Indications for oxygen therapy
• Hypoxemia (Actual or suspected) • PaO2 < 60 mm Hg • SaO2 < 90% • Adult, children and infants > 28 days on room air PaO2 and/or SaO2 below desirable range for specific clinical situation (e.g.. • patients with intra-cardiac shunting). • Neonates PaO2 < 50 mm Hg, SaO2 < 88%, or capillary PO2 < 40 mm Hg • Severe trauma • Short term therapy • Post anesthesia recovery

CONT..
• Respiratory compromise – Cyanosis – Tachypnoea – Hypoxemia – Partially obstructed airway

• Cardiac compromise
– – – –

Chest pain Shock Tachycardia Arrhythmias


• Neurological deficits
– CVA – Spinal injuries – Coma

Aim of o2 therapy: therap • to increase PaO2 to acceptable level with concentration of oxygen.


• to decrease respiratory rate and work of breathing


• Dec. The effect of Hypoxemia & high

THERAPUTIC GOAL,, USE the lowest FIO2 possible for shortest time possible to achieve satisfactory Pao2(50-70 mmhg , newborns 60-80, infant 80-100, childadult) Carful monitoring especially in neonate is required.
 

Precautions/ Complications
• Ventilatory depression • PaO2 > 60 mm Hg may depress ventilation in some patients with chronic Hypercapnia. FiO2 > 50% • O2 toxicity • Absorption atelectasis • Decreased ciliary function, leukocyte function • Fire hazard • Retinopathy of prematurity (PaO2 > 80 mm Hg) • Bacterial contamination • Humidification system

Oxygen Delivery and Devices
• The therapeutic application of supplemental oxygen is integral part in the treatment of a wide range of disease states and may be accomplished utilizing a variety of oxygen administration devices.
• Appropriate application of supplemental oxygen requires: requires – An understanding of the proper application of the available oxygen delivery devices and – Knowledge of the indications and potential hazards of oxygen therapy

Classification of o2 delivery devices
1 - Low flow system ;; • Nasal Cannula • Simple oxygen mask • Partial rebreathing oxygen mask • Non-rebreathing oxygen mask

Cont. of the classification;
2 - High - flow oxygen delivery devices . • Venturi Mask • Aerosol Mask • Trach collar • Face tent • Briggs Adapter (T-piece)

other oxygen delivery devices;
Oxygen-Conserving Devices: • Reservoir Cannula


• Demand Oxygen Delivery Systems or Pulse Dose Oxygen Devices


• Transtracheal Oxygen Catheters

Additional Delivery Devices:
• O2 Tents/Croup Tents • Oxygen Hoods • Incubators or isolettes

LFS VS HFS
• LFS- uses only partial patient’s need • HFOS – the flow rate and reservoir capacity adequate to provide the total inspired flow needed. • HFOS must be capable of meeting the patient’s PIF to ensure consistent FIO2. • Device delivers at least 3xMV • Advantage 1.consistent FIO2

Criteria for use of LFS

When the patient is breathing ØVT 300700 ØRR  25 ØVentilatory pattern regular and

• In LFOS the larger the TV or the faster the RR the lower the FIO2 • The smaller the VT or the slower the RR the higher the FIO2 •  MV  FIO2

Nasal Cannula
• Most used oxygen therapy device.


• If used with flow larger than 4 lpm bubble humidifier indicated.. • Oxygen concentrations delivered by the nasal cannula according to flow.

• The use of NC for long term use led to discovery of limitation • During expiration there is waist of flow to the room .

NC. Cont..
 

Flow

Advantages
Use in adults, children, infants, Easy to apply, Disposable, Low cost, Well tolerated

• Up to 6 L/min. • Humidifier should be used when flow exceeds 4 L/min • < 2 L/min (infants)


Disadvantage
Unstable, Easily dislodged, High flows uncomfortable, Can cause dryness/bleeding, Deviated septum may block flow, mouth breathing may reduce FiO2

FiO2 range FiO2 stability

• 22 - 45%


• Variable

Best use
Stable patients needing low FiO2, Home care patients

Guide lines for estimating FIO2 with NC F IO 2
1 2 3 4 5 6 ? ? .24 .28 .32 .36 .40 .44

te

nt one liter O2 there is increase by 4 %

Simple mask
Flow rate must be at least 5l/min Exact concentration of oxygen depends on patient’s respiratory pattern Useful post-operatively

Flow • 5 - 12 L/minute FiO2 range • 35 - 50% FiO2 stability • Variable
 

‫ــــــــــــــــــــــــــــــــ‬ ‫ـــــــــ‬

Advantages • Use on adults, children and infants, Quick, easy to apply, • Disposable,

Disadvantages • Uncomfortable, Must be removed for eating, Blocks vomits in unconscious patients Best use • Emergencies, Shortterm therapy requiring moderate FiO2

REBREATHER MASK
• Reservoir bags’ WITH one way valve = non rebreather.. Without valve= partialrebreather.. • Flow rate must be set to 15l/min • Fill reservoir 2 thirds before applying • Useful in acute situation • Should not be worn

Partial rebreather
 

Flow • 6 - 10 L/minute (Prevent bag collapsing on Insp.) FiO2 range • 35 - 60% FiO2 stability • Variable

Advantages • Use on adults, children and infants, Quick, easy to apply, • Disposable, Inexpensive, Moderate to high FiO2 Disadvantages • Uncomfortable, Must be removed for eating, Blocks vomits in unconscious patients, • potential suffocation hazard Best use • Emergencies, Short-term therapy requiring moderate to high FiO2

Non rebreather..
Flow • 6 - 10 L/minute (Prevent bag collapsing on Insp.) FiO2 range • 55 - 70% FiO2 stability • Variable

Advantages • Same as partialRebreathing Mask, High FiO2 Disadvantages • Same as partialRebreathing Mask, potential suffocation hazard Best use • Emergencies, Short

depends on: 1. The size of entrainment port. 2. The velocity of oxygen at jet.

Air Entrainment >or= 3 years Total amount of air

•The smaller the orifice the greater is the

velocity of oxygen and the more air is entrained. The largest jet provides the lowest oxygen velocity and thus the least air entrainment and the higher FiO2

Flow • Varies, should provide output flow > 60 L/min FiO2 range • 24 - 50% FiO2 stability • Fixed

 

Advantages Disadvantages

• Easy to apply, Disposable, Inexpensive, Stable, Precise FiO2’s

• Limited to adult and pediatric use, Uncomfortable, Noisy, • Must be removed for eating, FiO2 > 40% not ensured, FiO2 • varies with back pressure

Best use

• Unstable patients requiring precise low FiO2

Oxygen hoods and tents
• Oxygen hoods used to deliver O2 to infants. • Receive oxygen from a high flow humidification system. • Flow is set at 10 – 15 liters / min. to provide a constant flow through the hood , maintain a constant FIO2 , and wash out of CO2. •

Tents
• Uses a frame and a large , soft plastic material

to enclose the patient. • Used in pediatrics especially with croup. • Tents receive O2 from a high flow aerosol system . • FIO2 is difficult to be controlled because of large volume. •

O2 DELIVERY IN pedia & infant ..

KEY POINTS with neonates….
• •
   

Use the lowest FIO2 to Keep PaO2 50 – 80 mm. Hg. , SpO2 88 - 95 %

n O2 is a DRUG only should be used Ø Documented hypoxia Ø Resp. Distress Ø Cynosis n When prescribing O2– specify Ø Device Ø Duration Ø Monitoring n Take care when the devices is used to prevent – NOS. INFECTION Ø Dose

• • • • • • •

‫‪Thanq ‬‬

‫الحمد لله على السلمه‬