OXYGEN THERAPY

INTRODUCTION: 

Oxygen is an odorless, tasteless,

colorless, and transparent gas .That is slightly
heavier than air.
Because oxygen supports combustion, there is
always danger of fire, when oxygen is being used,
oxygen can be dispensed from a cylinder, piped
in system, liquid oxygen reservoir or oxygen
concentrated .
What is oxygen therapy?

Providing adequate oxygen in the blood , while

decreasing the work of breathing and reducing stress in
the myocardium.
Indications:

  Oxygen relieves:

a-Hypoxemia ( low tissue oxygenation)

b-Hypoxia.
 
Early use of oxygen therapy:
It may prevent of the development of :-

1- Cyanosis –late sign .

 
2- Labored breathing –indicate severe
respiratory distress .
3- Myocardial stress –increase the heart
rate and stroke volume (cardiac output) is the
primary mechanism for the compensation for
hypoxemia and hypoxia .
Oxygen delivery system:

Oxygen may be administered by nasal cannula,

various types of masks, head box, tent, catheter, T-piece.

It can also be applied directly to the endotracheal tube via

mechanical ventilator .

The method selected depends on the required

concentration of oxygen.
 
 
 
Devices Suggested O2% Advantages Disadvanta
flow ges
rate(L/min)

Cannula 1liter 24% Light Nasal

2liter 28% weight mucosa
3liter 32% ,comfortabl ,drying ,
4liter 36% e variable
5liter 40% ,inexpensive fio2
6liter 44% , continuous
use with
meals and
activities.

Catheter 1-6liter 23-40% Inexpensive Variable

fio2,require
s frequent
change
,gastric
distension
can occur
Simple mask 5liter 40% Simple to Poor fitting,
6liter 45-50% use , variable
8liter 55-60% inexpensive fio2,must
  remove to
feeding .

Mask partial 6-15liter 70-90% Moderate O2 Warm, poor

re-breather concentration fitting ,must
be removed to
feeding

Mask non- 12liter 82-100% High o2 Poor fitting

breather concentration
NRM
 •Partial re-breather mask
• venturi mask

•Non rebreather mask

•Tracheostomy mask
Mask non 12liter 82-100% High o2 Poor fitting
rebreather concentratio
NRM n

Mask 4 -6liter 24,26,28 Provide low Must be

venturi     levels of removed to
    supplement eat
    al o2.
6-8liter 30,35,40  
Precise fio2
additional
humidity
available

Mask 8-10 30-100% Good Uncomforta

aerosol humidity, ble some.
accurate
fio2

Tracheosto 8-10liter 30-100% Good `uncomforta

my collar humidity, ble some
accurate
fio2
Mask non- 12liter 82-100% High o2 Poor fitting
re breather concentratio
NRM n

Mask 4 -6liter 24,26,28 Provide low Must be

venturi     levels of removed to
    supplement eat
    al o2.
6-8liter 30,35,40  
Precise fio2
additional
humidity
available

Mask 8-10 30-100% Good Uncomforta

aerosol humidity, ble some.
accurate
fio2

Tracheosto 8-10liter 30-100% Good `uncomforta

my collar humidity, ble some
accurate
fio2
T-piece 8-10 liter 30-100% Same as Heavy with
Briggs tracheostom tubing
y collar

Face tent 8-10 liter 30-100% Fairly Bulky

accurate compressor
fio2
:intervention

1-   Determine the current vital signs ,level of

consciousness, and most recent ABG’s
2-   Check the vital signs
3-   Assess risk for CO2 retention with O2 administration
4-   Make sure that the humidifier that is filled to the
appropriate mark
5-   Set the flow rate at prescribed liter per minute .
6-   Feel to determine if oxygen is flowing.
 
 
  -Assess the patient conditions ABG’s or PaO2
and the functioning of the equipments at
regular intervals.
8- Determine patient comfort with oxygen use .
9- Remove mucus or saliva from the O2 device.
10- Monitor closely to ensure an accurate flow
rate for specific FiO2.
 
  

 
Mechanical ventilation:
 
Objectives:
To provide for the safe and efficient care of stable
neonate requiring mechanical ventilation.
 
Types of ventilations:
1- Pressure cycle ventilator
2- Time cycle ventilator
3- Volume cycle ventilator
4- Micro processor ventilator.
Modes of ventilations:
 
1- Controlled
2- Assist controlled
3- Synchronized intermittent mandatory
ventilation(SIMV)
Ventilator controls and settings:

1. - Tidal volume.

2. - Rate .

3. - Fraction of inspired oxygen(FIO2)

4. - Peak airway inspiratory pressure (PIP)

5. - Continuous positive airway pressure (CPAP)

6. - positive end expiratory pressure (PEEP).

Indications for mechanical ventilations:
 
• Pao2 less than 50 mmHg with fio2 more than 0.60.
•Pao2 more than 50 mmHg with ph less than 7.25.
•Vital capacity less than 2 times tidal volume.
•Negative inspiratory force less than 25 cm H2O.
•Respiratory rate more than 35 per minute.
 Complications of Mechanical ventilator :
 
1- Air way obstruction(thickened secretions,
mechanical problems with artificial airway or
ventilator circuitry.
2- Tracheal damage
3- pulmonary infection
4- Barotrauma (pneumothorax or tension
pneumothorax)
5- Decrease cardiac output.

6- Atelectasis.

7- Alteration in GI(dilation, bleeding).

8- Alteration in renal function.

9- Alteration in cognitive perceptual

status
intervention:
 
-Immediately after intubation :

-Check symmetry of chest expansion .

-Auscultate breath sounds anterior and

lateral chest bilateral .

-Obtain order for chest x-ray .

-Ensure high humidity.

-Administer O2 concentration as prescribed.

-Secure the tube to the patient face with

tape and mask.

-Use sterile suction technique.

- positioning every 2 hrs.

• Extubation:
 
- Explain the procedure
- Ambu bag and mask ready in case
ventilatory assistance .
- Suction the tracheobronchial tree and
oropharynx
- Give oxygen for few breaths and insert new
nasal cannula or catheter .
•Normal blood gas value:

pH: 7.35-7.45
PCO2: 35-45 mmHg
HCO3: 22-27mEq/liter
PO2 : 80-100 %
Analysis Arterial Blood Gas results:
If you can remember the following pyramid points
and steps, you will be able to analyze any blood
gas report.

Pyramid points:

• In acidosis, the pH is down.

• In alkalosis, the pH is high.
• The respiratory function indicator is the PCO2.
• The metabolic function indicator is the HCO3
Pyramid steps:

Pyramid step 1:-

look at the blood gas report. Look at the pH, is
it up or down; if it is up; it reflects alkalosis. If it is
down; it reflects acidosis.

Pyramid step 2:-

look at the PCO2, is it up or down; if it reflects
an opposite response to the pH, then you know that
the condition is a respiratory imbalance.
If it does not reflect an opposite response to the pH; then
move on to pyramid step 3.

Pyramid step 3:-

look at the HCO3. Does the HCO3 reflect a
corresponding response with the pH; if it does, then the
condition is a metabolic imbalance.

Pyramid step 4:-

Remember, compensation has occurred if the pH is in a
normal range of 7.35-7.45. If the pH is not within normal
range, look at the respiratory or metabolic function
indicators.
Respiratory Imbalances :

• if the condition is a respiratory imbalance look at

the HCO3 to determine the state of compensation.

• if the HCO3 is normal, then the condition is

uncompensated.

• if the HCO3 is abnormal, then the condition is

partial compensation.
Thanks
Any question?
Metabolic Imbalance :

• If the condition is metabolic imbalance, look at

the PCO2 to determine the state of compensation.

• If the PCO2 is normal, then the condition is

uncompensated.

• If the PCO2 is abnormal, then the is partial

compensation.