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Techniques of Oxygen

Delivery
Contents
Requirement of supplemental oxygen
Different types of flow systems
Devices used for oxygen delivery
Technique to delivery oxygen
Adjuncts to Oxygen Delivery
Summary
References
Patient conditions that warrant administration of
Supplemental oxygen:
Difficulty breathing
Respiratory compromise due to any cause
Circulatory compromise
Shock
Decreased level of consciousness
SpO2 of less then 96%
Oxygen delivery system can be
divided into
Low flow systems
High flow systems
Low Flow System
In this the room air is entrained
because the gas flow is insufficient to
meet all inspiratory flow requirements.
Provide an oxygen concentration of
23% to 90 %
Not so reliable
High Flow Systems
The flow rate and reservoir capacity
provide adequate gas flow to meet
the total inspired flow requirements
of the patient.
Entrainedment of the room air does
not occur.
Provide low or high inspired oxygen
concentration.
Reliable
Low Flow Systems
Oxygen mask
Simple oxygen mask-
low flow device
Deliver 35% to 60% oxygen with flow rate of 6 to 10
L/ min
Minimum oxygen flow of 6L/min should be used
Indications: Medium flow O2 desired- mild to mod.
Resp distress
Contra indication: Poor resp. effort, Severe
hypoxia, Apnea
Advantage: less expensive
Disadvantage : does not deliver high conc. O2 ,
Interferes with eating and talking.
Partial rebreathing mask
Simple face mask + reservoir bag
Reliable to provide oxygen concentration of 50%
to 60 %
Oxygen flow of 10 to 12 L/min is generally
required
Indications: relatively high O2 requirement .
Contra indication: Poor resp. effort, Severe hypoxia,
Apnea
Advantage: inspired gas not mixed with room air
Disadvantage : more O2 flow does not increase O2 conc,
Interferes with eating and talking.
Non breathing mask
Face mask + reservoir bag+
A valve incorporated into the exhalation port
A valve placed between reservoir bag and mask
Oxygen flow into the mask is adjusted to prevent collapse of
bag
Inspired concentration of oxygen of 95% can be achieved by
10 to 12L/min of oxygen
Well sealed face mask is used
Indications: delivery of high conc. Of O2
Contra indication: Poor resp. effort, Apnea
Advantage: high conc. O2 without intubation
Disadvantage : expensive, more O2 required. Interferes with
eating and talking. Requires a tight seal.
Venturi- type mask
Reliable
Provide controlled low to moderate (25% to 60%)
of inspired oxygen concentration
Indications: desire to deliver exact amount of O 2
Contra indication: Poor resp. effort, Severe
hypoxia, Apnea
Advantage: fine control of FIO2 at a constant
flow
Disadvantage : expensive, can not deliver high
O2 conc. Interferes with eating and talking
Face tent
Also known as face shield
High flow soft plastic bucket
Well tolerated by children then face
mask
Up to 40% of oxygen can be
delivered with 10 to 15 L/min of
oxygen flow
Access for suctioning is achieved
without interrupting the oxygen flow.
Oxygen tent
Clear plastic shell that encloses the
childs upper body
Provide more then 50% of O2
Not reliable
Limits access to patient
Cannot be used in emergency
situation.
Nasal Cannula
Low flow oxygen device
Consist of 2 short soft plastic prongs which are
inserted in to the ant. Nares and O2 is delivered into
the nasopharynx
Upto 4 L/min of O2 can be used
Does not provide humidified oxygen
Indications: low to mod O2 required, mild or no distress,
long term O2 therapy requirement.
Contra indication: Poor resp. effort, Apnea, severe
hypoxia, mouth breathing.
Advantage: comfortable, well tolerated.
Disadvantage : does not deliver high O2 conc.
Nasal catheter
Flexible, lubricated oxygen catheter
with multiple holes in distal 2 cm
Advanced posteriorly into the
pharynx through nostril
No advantage over nasal cannula
Hemorrhage and gastric distension
can occur
High Flow Systems
Oxygen hood
Clear plastic shell with covers the patients
head
Well tolerated by infants
Allows access to chest, trunk and extremities
Permits control of inspired oxygen
concentration, temp. and humidity
Flow of oxygen- 10-15 L/min
80 to 90 % of oxygen conc. can be achieved
Can be used in neonates and infants only.
Bag Valve Mask Ventilation
Two hands must be used
One hand- head tilt- chin lift maneuver
Other hand- compress ventilation bag
In infants and toddlers, the jaw is supported
with base of middle and ring finger. Pressure
in submental area should be avoided
In older children finger tips of 3 rd, 4th, 5th
fingers are placed on the ramus of mandible
to hold the jaw forward and extend head.
A neutral sniffing position is maintained.
Hyperextension of head is avoided to maintain
the optimum position for airway patency.
This can be achieved by placing folded towel
under the neck and head.
Distention of stomach frequently occurs. It
should be avoided or treated promptly to
prevent aspiration. It can be minimized in
unconscious patient by applying cricoid
pressure (Sellick maneuver)
Self inflating Bag-Valve Ventilation
Devices
At oxygen inflow of 10L/min, pediatric self
inflating bag provides 30-80% of oxygen
without oxygen reservoir and 60-95% with
reservoir.
10-15L/min of oxygen is required to keep the
adequate amount of oxygen in reservoir.
Before initiating ventilation oxygen flowing into
the bag should be confirmed.
Many bags have a pop off valve set as 35 to 45
cm of H2O to prevent barotrauma.
During CPR a high pressure is required so pop
off valve should be closed.
Administered tidal volume should be approx.
10-15 ml/kg.
About 450ml of bag should be used for
ventilating full term neonate or infant.
When larger bags are used , only the force and
tidal volume necessary to produce effective
chest expansion should be used.
Bag with fish mouth or leaf flap operated valve
should not be used to provide supplemental
oxygen during spontaneous respiration.
Anesthesia Ventilation
System
Consist of reservoir bag, an overflow port, fresh gas port
and standard connector for mask or ET tube
For infant- 500ml; for children- 1000 to 2000ml; for adult-
3000-5000ml is reqd.
More experience is reqd. to use
Fresh gas flow should be
<10 kg= 2l/min
10-50 kg= 4L/min
>50 kg= 6L/min
Risk of barotrauma and hypercarbia is more
Effective ventilation is determined by adequate chest
movement.
PEEP or CPAP can be provided by adjusting pop off valve.
Endotracheal Airway
Most effective and reliable method of
assisted ventilation because:
The airway is isolated, ensuring
adequate ventilation and O2 delivery
Reduces aspiration chance
Interposition of ventilations with chest
compressions can be accomplished
efficiently.
Insp. Time and PIP can be controlled
PEEP can be delivered.
Indications for Intubation
Inadequate CNS control of ventilation
Functional or anatomic airway
obstruction
Loss of protective airway reflexes
Excessive work of breathing
Need of high PIP or PEEP
Need of MV support
Potential occurrence of any of the above
if patient is transported
Endotracheal Tube
A cuffed ET tube is generally indicated
for children aged 8-10 yrs or older.
In younger children normal anatomic
narrowing at the level of cricroid
cartilage provides a functional cuff.
ET tube size= age/4 + 4; length= age/2
+12 or depth of insertion= tube size*3
ET tube 0.5 mm smaller and larger
should be readily available.
Adjuncts to Oxygen Delivery
Oropharyngeal Airway
Flange + Bite block Segment+
curved body
Curved body is designed to fit over
the back of tongue to hold it and soft
hypophalengeal structures away
from post. Pharyngeal wall.
Indicated in in unconscious pt. if
procedure to open airway fail to
provide and maintain a clear,
unobstructed airway.
Oropharyngeal airway should be
inserted by using the tongue
depressor or
The airway can be inverted for
insertion into the mouth , using the
curved portion as depressor. As the
airway approaches the back of
oropharynx , it is rotated 180 into
proper position.
Nasopharyengeal Airway
Soft rubber or plastic tube that provide airflow between
nares and posterior pharyngeal wall
Shortened ET tube can also be used
Responsive pt. can tolerate well.
Length= tip of the nose to tragus of the ear
The airway is lubricated and inserted through the nostril
in a posterior direction perpendicular to the plane of the
face and passed gently along the floor of nasopharynx.
Patency must be frequently evaluated
Too long size may irritate vagus nerve, epiglottis or
vocal cords and stimulate cough, vomit or
laryangospasm.
Summary
Low flow systems are:
Face mask-
Simple Face Mask
Partial rebreathing Mask
Venturi Mask
Face tent
Oxygen tent
Nasal Cannula
High Flow Systems
Non Rebreathing Mask
Oxygen Hood
Bag Valve Mask Ventilation
Endotracheal Airway
Proper device should be selected
according to the patients need.
Proper size of device should be used
for effective oxygen delivery.
References
Pediatric Advance Life Support
Paramedic: Airway Management
2011
Pediatric Critical Care Medicine:
Basic Science And Clinical
Evidence edited by Derek S.
Wheeler, Hector R. Wong, Thomas P.
Shanley
Thank You