OXYGEN

THERAPY

Hasanul Arifin

2/9/2020 1
 Definition:
 *Oxygen therapy is the administration of oxygen
at concentrations greater than ambient air(21%)

 FiO2= fractioned inspired oxigen

 *With the intent of treating or preventing the
symptoms and manifestations of hypoxia(a
deficiency of oxygen reaching the tissues of the
body)

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 Topics of Discussion
*Types of Hypoxia
*Signs and symptoms of Hypoxia
*Indications
*Contraindications and Precautions
*Delivery Systems

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 Types of Hypoxia
1-Hypoxic Hypoxia
2-Circulatory Hypoxia
3-Hemic Hypoxia
4-Demand Hypoxia
5-Histotoxic Hypoxia

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 Hypoxic Hypoxia
 *Low PaO2(arterial oxygen tension) secondary
to FiO2< 0.21 or decreased barometric
pressure(altitude)
 *Impaired ventilation secondary to
neuromuscular weakness or narcotic overdose
 *Impaired oxygenation secondary to
Pulmonary Fibrosis, ARDS

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 Circulatory Hypoxia
 *Inadequate pumping of the blood from the
heart to tissues , maybe secondary to disorders
causing decreased cardiac output such as
MI,low fluid volume, hypotension,poor supply
of arteries. If the patient has myocardial
ischemia supplemental O2 is definitely
indicated.

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 Hemic Hypoxia
 Decreased oxygen carrying capacity as in
anemia or carbon monoxide poisoning

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 Demand Hypoxia
 Increased tissue consumption of
oxygen in hypermetabolic states:
like fevers

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 Histotoxic Hypoxia
 Utilization of oxygen is abnormal
such as in cyanide poisoning

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Signs and Symptoms of Hypoxia

 Tachypnea,dyspnea,hyperpenea,
 Tachycardia,dysrythmias,pulse
change,hypertension
 Anemia, polycythemia
 Restlessness, disorientation, lethargy,
 Cyanosis, digital clubbing

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 Indications
 1)PaO2 <60mmHg or SaO2 <90%, or as ordered by the MD for
a specific clinical situation.
 PaO2=partial pressure of oxygen as measured in the arterial
blood, SaO2=hemoglobin’s saturation of oxygen in the arterial
blood
 2)Acute situation where hypoxemia is suspected
 3)Severe trauma
 4)Acute myocardial infarction
 5)Short term, post operative

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 Contraindications &
Precautions
 1)with PaO2 > 60, patients with chronic CO2
elevations may experience ventilatory depression
 2)With FiO2 > 0.50, oxygen toxicity, absorption
atelectasis, or depression of ciliary and/or
leukocytic function
 3)Administer with caution to patients receiving
bleomycin cancer therapy
 4)Fire hazard is increased in the presence of oxygen
concentration.

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 Definitions

 FiO2= Fraction of inspired oxygen, or the percent of

oxygen in the inspired gas

 Oxygen toxicity is cellular injury of the lung

parenchyma and airway epithelium due to release of
cytotoxic free oxygen radicals.
 There is no exact threshold at which O2 toxicity
occurs, however signs of gas exchange abnormalities
occur within 24-48 hours if on 100%
oxygen.Atelectasis leading to drop in PO2,decreased
lung compliance, infiltrates on x-ray.
 Breathing FiO2 up to 0.5 for 2-7 days usually does
NOT result in toxicity.

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 Additional Information

 The national fire protection association

requires a no smoking, oxygen in use sign be placed at the entrance of
any patients room where oxygen is being delivered
regardless of the fact that smoking is prohibited throughout the
hospital

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 Delivery Systems
 “Low Flow” deliver 100% O2 to the patient at
flows less than the patient’s full breath. Therefore,
the patients inspired oxygen concentration is
supplemented by the device, and the actual
concentration of oxygen depends on the flow from
the device, the reservoir for storing the oxygen
between breaths, and the size and speed of the
patients breath. With low flow devices, flowrate is
stable, but FiO2 varies.

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 Delivery Systems
 Nasal Cannula
 Simple Mask
 Venturi Mask
 Aerosol Devices
 Non Rebreather Masks

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 Nasal Cannulas
 Can provide 23-45% oxygen to patients with
flowrates up to 6lpm depending on the ventilatory
pattern. The “reservoir” for a nasal cannula is the
patients nose. Once the reservoir is filled between
breaths, the oxygen is directed into the room.
During inspiration, the first part of the patients
breath includes the oxygen stored in the nose, and
then is supplemented with the oxygen flowing out
of the cannula.

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 Nasal Cannulas cont.
 Each liter of flow will increase the FiO2
approximately 2%-4%. Flowrates in excess of 6
lpm do not augment the inspired gas significantly
because the extra gas is directed out to the room
and is not available for inspiration. High flows can
also result in drying of the nasal mucosa.
Humidification of nasal cannulas with a “bubble
device” is recommended for flow rates in excess
of 4 lpm.

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 Simple Masks
 Can provide 31-61% oxygen to patients at
flowrates between 5-10 lpm. The reservoir
in a simple mask is the space between the
mask and the patients face. Since this space
is larger than the space in the nose, more
oxygen is stored and is available for the
next breath, resulting in higher potential of
FiO2.
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 Simple Masks cont.
 Less than 5 lpm is not recommended because a
minimum of 5 lpm is needed to flush the exhaled
CO2 from the mask. If the PaO2 is too high on 5
lpm, a switch to a nasal cannula would be
recommended. The popularity of simple masks has
fallen because of the availability of Venti-Masks,
with control of the FiO2, and are not subject to the
changes in FiO2 that occur with a simple mask

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 Venturi Masks
Venti-Masks

 Can provide 24%-50% oxygen by mixing

room air with a precise amount of oxygen
thereby delivering a precise FiO2. The size
of the port and the oxygen liter flow
determine the FiO2. The mask should be
fitted to the patient as best as possible to
prevent entrainment of room air around the
mask which would alter the FiO2.
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 Aerosol Devices
Face tents, face masks,trach collar,t-piece

 Use the same principle as venturi masks

however the FiO2 is dialed in on the top of
the aerosol bottle. To provide an FiO2 > or
= 0.50 use two aerosol bottles connected
using a wye system to provide adequate
flow to ensure the FiO2. A heater is added
to the trach collar and t-piece because the
trach has bypassed the natural warming and
humidifying system-the nose
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 Non-rebreather masks
 Deliver the highest FiO2 of our simple
oxygen devices. With a perfect fit the FiO2
may approach 1.0 however the FiO2 is
usually in the range of 60%-90% depending
on the fit of the mask. The flowrate must be
high enough to keep the bag inflated during
inspiration. The flow is set at 10+ lpm

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 Reference Chart
Method FiO2 Flowrate
(Approximate) (L/min)
Non rebreather Mask 60-80% 10-15
Venti Mask 24% 3
26% 3
28% 6
31% 6
35% 9
40% 12
50% 15
Simple Face Mask 35-55% 5-10lpm
Nasal Cannula 24% 1
28% 2
32% 3
36% 4
40% 5
44% 6
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