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Oxygen Therapy

dr. Eleazar Permana Gadroen SpAn., MSc.


Definition
• Oxygen therapy is the administration of
oxygen at concentrations greater than
ambient air (21%)
• With the intent of treating or preventing the
symptoms and manifestation of hypoxia
• Oxygen therapy is indicated whenever tissue
oxygenation is impaired
• Oxygen has :
– Physiologic actions
– Pharmacologic actions
– A dose response relationship
– Adverse effect
Types of hypoxia
• Hypoxic hypoxia
– Low PaO2 (arterial oxygen tension) secondary to FiO2<0.21 or decrease
barometric pressure (altitude)
– Impaired ventilation secondary to neuromuscular weakness or narcotic
overdose
– Impaired oxygenation secondary to pulmonary fibrosis, ARDS
• Circulatory hypoxia
– Inadequate pumping of the blood from the hearts to tissues, maybe
secondary to disorder causing decrease cardiac output such as MI,
hypovolemic, hypotension, poor supply of arteries
• Hemic hypoxia
– Decrease oxygen carrying capacity as in anemia or carbon monoxide poisoning
• Demand hypoxia
– Increased tissues consumption of oxygen in hypermetabolic states (fever)
• Histotoxic hypoxia
– Utilization of oxygen is abnormal such as in cyanide poisoning
Sign and Symtoms
• Tachypnea, dyspnea, hyperpnea
• Tachycardia, dysrythmias, pulse changes,
hypertensions
• Anemis, polycythemia
• Restlessness, disorientation, lethargy
• Cyanosis, digital clubbing
Indication
• Cardiac arrest
• Respiratory arrest
• Respiratory failure type I and II
• Cardiac failure
• Myocardial infarction
• Shock of any cause
• Increased metabolic demand
• Post operative states
• Carbon monoxide poisoning
Contraindication and precaution
• With PaO2 >60, patient with chronic CO2
elevation may experience ventilatory depression
• With FiO2>50%, oxygen toxicity, absorption
atelectasis, or depression of ciliary and/or
leukocytic function
• Administer with caution to patients receiving
bleomycin cancer therapy
• Fire hazzard is increased in the presence of
oxygen concentration
Oxygen cascade
mmHg
• Inspired air 150
• Alveolar 103
• Arterial 100
• Capillary 51
• Tissue 20
• Mitochondial 1-20
Oxygen dissociation curve
• Shift to the left
– Hypothermia
– Increased pH (alkalemia)
– Decreased PCO2
– Decreased 2.3 DPG
– Fetal Hb
– Carboxy Hb
– Met Hb

• Shift to the right


– Hyperthermia
– Decreased pH (acidemia)
– Increased PCO2
– Increased 2.3 DPG
Apparatus/devices for oxygen therapy
• Nasal catheter
• Semi rigid mask (hudson, harris, edinburgh)
• Ventury type mask
• Soft plastic mask (pneumask, polymask, oxyaire)
• Ventilators
• Anaesthetic circuits
• CPAP circuits
• Plastic head hood
• Oxygen tent/cot
• Incubator
Hazzards of oxygen therapy
• CO2 narcosis
– When high FiO2 are administered to patients
dependent on a hypoxic(chemoreseptor) drive
• O2 toxicit
– Neurological effects (Paul Bert effects)
– Lung toxicity
– Retrolental fibroplasia
– Barotrauma
Hyperbaric Oxygen Therapy (HBO)
• HBO therapy delivers 100% oxygen at a pressure above
atmospheric, in a pressurized multi or one man
chamber
• Indication:
– CO2 Poisoning
– Burns
– Gas Gangrene
– Osteomyelitis
– Osteoradionecrosis
– Crush injuries
– Ischaemic skin grafts
• Complications:
– Barotrauma to ears, sinuses, and lungs
– Oxygen toxicity
– Grand mal fits
– Changes in visual acuity

Paediatric oxygen therapy


• Oxygen headbox or hood
• Incubator
• Oxygen cot or tent