Hazards of Oxygen Therapy

First year Respiratory Therapy

MJC 220
Oxygen Therapy

 The RCP is the primary member of the

healthcare team responsible for oxygen
administration.
 RCP must be well-versed in its goals and
objectives

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Oxygen is a “DRUG”

 Must be considered as a drug

 TOO MUCH of a drug can cause overdosing
problems

 TOO LITTLE isn’t enough to treat the symptoms

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Goals of Oxygen Therapy

 Correct hypoxemia
 Decrease symptoms associated with
hypoxemia
 Decrease workload on cardiopulmonary
system

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Indications for Oxygen

 Documented hypoxemia
 PaO2 less than 60 torr or SaO2 less than 90% in
adults and infants older than 28 days while
breathing room air
 Acute care situation where hypoxemia is
suspected
 Severe trauma
 Acute myocardial infarction
 Short term therapy i.e. Post-op anesthesia
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Monitoring the Patient

 Clinical assessment including but not limited

to cardiac, pulmonary, and neurological
status
 Assessment of physiologic parameters:
measurement of oxygen tensions or
saturation in any patient treated with oxygen

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Clinical Signs of Hypoxia
 Respiratory
 Increased respiratory rate (Tachypnea), dyspnea, cyanosis,
acc muscle use
 Cardiac
 Increased heart rate (Tachycardia), hypertension
 Neurological
 Confusion or panic
 Cyanosis
 Diaphoresis
 Somnolence, confusion, blurred vision, loss of coordination,
impaired judgment

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Long Term Sign
 Clubbing

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Precautions of Supplemental
Oxygen
1. Oxygen toxicity
2. Depression of ventilation
3. Retinopathy of Prematurity
4. Absorption atelectasis
5. Bacterial infection with humidifiers
Oxygen Toxicity

 Patients exposed to high oxygen levels for a

prolonged period of time have lung damage.
 First damage is capillary epithelium, leading to
edema, thickened membranes and finally to
pulmonary fibrosis and hypertension.

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A Vicious Cycle

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Depression of Ventilation

 COPD patients with CO2 retention have

blunted stimuli to breathing
 Hypoxic drive theory
 They have a different stimulus to breathe then normal

 GOLDEN RULE: You should never stop

giving oxygen to a patient in need.

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Retinopathy of Prematurity

 Is an abnormal eye condition in some

premature infants who receive high FIO2s
 Retinal arteries hemorrhage and scaring cause
retinal detachment and blindness.

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Absorption Atelectasis

 The alveoli in the lungs collapse and cause

shunting in the capillary lung fields.
 Loss of nitrogen in the blood causes less total
venous pressure. This leads to the collapse of of
the alveolus.

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Pressure gradients that cause
absorption atelectasis

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Infection Control

 Therapist must use an aseptic technique

when handling supplemental oxygen and
humidity equipment
 Never drain water from the tubing back into the
heated humidifier
 Always date the opened container
 Only use sterile liquids in reservoirs

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Oxygen: a fire hazard

 NEVER smoke while using supplemental

oxygen
 Severe facial burns can and do happen

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Clinical Guidelines
 Consider Oxygen as a drug
 Use the lowest FIO2 ….
 Use it for the shortest possible time
 Keep oxygen below 50% if…
 If you have to - accept lower saturations than
normal in some situations
 Check equipment regularly for contaminants

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That’s all folks!
 Any questions?

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Typical Question

Administration of high oxygen concentrations to

a neonate for prolonged periods of time may
result in which of the following:
 Atelectasis

 CO2 retention

 Retinopathy of Prematurity

 Pneumothorax

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Another?

Typically, which are the precautions of

administering oxygen to patients in the
hospital EXCEPT:
 Retinopathy of Prematurity

 Oxygen narcosis

 Absorption atelectasis

 Depression of ventilation

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