Oxygen Therapy

Ali Melhem
Respiratory therapist

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 Oxygen Administration

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 Objectives

 Understand the indications for oxygen

therapy
 Identify and understand the use of different
oxygen delivery systems
 Implications for humidification

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  Living cells must be fuelled with oxygen in
order to survive!

 The respiratory system functions to supply

oxygen to the cells and remove carbon
dioxide from the tissues

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  How much oxygen is in the air?

 Illness and injury increase tissue oxygen

demand

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 Introduction
 Oxygen is a colorless, odorless, tasteless gas that is
essential for the body to function properly and to survive

 The air that we breathe in contains approximately 21%

oxygen, and the heart relies on oxygen to pump blood

 If not enough oxygen is circulating in the blood, it’s

difficult for the tissues of the heart to keep pumping

 Supplemental oxygen is used to treat medical conditions

in which the tissues of body do not have enough oxygen

 Oxygen is a gas, but when administered as a

supplement to normal atmospheric air, may also be
considered as a medication (or drug)
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 Indications for oxygen therapy

 Respiratory compromise
– Cyanosis
– Tachypnoea
– Hypoxaemia
– Partially obstructed airway

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 Indications for oxygen therapy
 Cardiac compromise
– Chest pain
– Shock
– Tachycardia
– Arrhythmias

 Neurological deficits
– CVA
– Spinal injuries
– Coma
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 Aims of oxygen therapy

 to increase PaO2 to acceptable level with

concentration of oxygen

 to decrease respiratory rate and work of

breathing

 Hypoxaemia with high PaCO2

- 24% initially
9 - careful monitoring with regular ABG’s
 Types of oxygen delivery

 Nasal cannulae
 Medium concentration mask
 Fixed concentration mask
 Non-rebreathe bag
 Humidified circuits
 High flow systems

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 Nasal Cannula

 Unable to determine exact concentration

 Comfortable – allows patient to eat, drink talk
 Can still be used if patient is mouth breathing

11 LAITH AL-QUDAH
 NASAL CANNULA
low oxygen device

 This device delivers an unpredictable amount of oxygen

ranging from 25-45 % at 1 - 6 L/min depending on how
much the patient inhales through the mouth

 Higher flow rates are uncomfortable for the patient

 A high flow rate can quickly dry out the nasal mucosa
and become rapidly uncomfortable

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 NASAL CANNULA Cont…
low oxygen device

Delivers 25-45% FIO2 at 1-6 L/min flow

1. Flow 0 liters per minute: 21% (Room
Air)
2. Flow 1 liters per minute: 25%
3. Flow 2 liters per minute: 29%
4. Flow 3 liters per minute: 33%
5. Flow 4 liters per minute: 37%
6. Flow 5 liters per minute: 41%
7. Flow 6 liters per minute: 45%

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 Nasal Prongs

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 Medium concentration mask

 ‘Hudson’/ MC mask
 Flow rate must be at least 5l/min
 Exact concentration of oxygen depends on
patient’s respiratory pattern
 Poor humidification
 Useful post-operatively

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 SIMPLE FACEMASK
low oxygen device

 It seals poorly and its large ventilation holes allow the

oxygen flow to be diluted with air

 The simple facemask at an oxygen flow of 6 L/min

delivers approximately 35-40 % oxygen

 Increasing the flow to 10 L/min may increase oxygen

concentration to about 50 %

 If the flow rate is less than 6 L/min (as cylinder nears

empty), the patient may re-breathe much of his own
exhalation and thus, the concentration of oxygen
delivered will be low, possibly severely hypoxic 

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 Face Mask (“Hudson”)

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 Fixed concentration
 ‘Venturi’ masks
 Deliver a fixed concentration of oxygen
 Must be set at minimum flow rate as shown
on barrel
 FiO2 0.24 – 0.6
 Able to increase flow rate without altering
concentration
 Bernouilli principle

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 The Bernoulli
30 l/min Effect

2 l/min oxygen jet

14 l/min air entrained 14 l/min air entrained

2 l/min oxygen jet

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 Bateman, N T et al. BMJ 1998;317:798-801

21 LAITH AL-QUDAH
Copyright ©1998 BMJ Publishing Group Ltd.
 Venturi Mask

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 Oxygen flow rate and concentration
Respiratory distress Non-respiratory distress

Minute vol l/min 30 l/min 5

)RR x TV( )40bpm x 750ml( )10bpm x 500ml(

l/min 2 l/min 2
O2 flow rate
l/min of 100% oxygen 2 l/min of 100% oxygen 2
+ +
Oxygen l/min air drawn into mask (21%) 28 l/min air drawn into mask (21%) 3
concentration = =
l/min minute volume 30 l/min 5
= FiO2 = FiO2
30 /. )0.21x28( + )1.0x2( 30 / )0.21x3( + )1.0x2(
)26%( 0.26 = )53%( 0.53 =

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 :Non Rebreathing bags

 ‘Reservoir bags’
 Deliver FiO2 0.6 – 0.8
 Flow rate must be set to 15l/min
 Fill reservoir 2 thirds before applying
 Useful in acute situation
 Should not be worn >24hrs

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 Non-rebreather

25 LAITH AL-QUDAH
Partial Rebreathing Mask with reservoir
Moderate oxygen device

 Delivers 35-60% Oxygen at 6-10 L/min flow rate

Ω First third of exhaled gases mix with reservoir
Ω Exhaled gases from upper airway are oxygen rich

Reservoir

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Non-Rebreathing Mask with reservoir
High oxygen device

 Delivers 95% Oxygen at 10-12 L/min

 Two valves added to Rebreathing mask
prevents:
– Entrainment of room air during inspiration
– Retention of exhaled gases during expiration

Valves
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 Oxygen Hood
High oxygen device

 Clear plastic shell encompasses the baby's head

 Well tolerated by infants
 Size of hood limits use to younger than age 1 year
 Allows easy access to chest, trunk, and extremities
 Allows control of Oxygen Delivery:
o Oxygen concentration
o Inspired oxygen temperature and humidity
 Delivers 80-90% oxygen at 10-15 liter per minute

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 Humidification

 Prevents cilia destruction

 Prevents damage to mucus glands

 Aids sputum clearance

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 Indications for humidification

 Oxygen therapy at higher flow rates

 Patients with copious secretions

– Systemic hydration
– IV fluids
– Saline nebulisers

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 Complications with humidified oxygen

 Bronchoconstriction

 Decreased lung function if over-humidified

 Increased risk of infection

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 High flow oxygen

 30-50 l/min
 Same concentration
 Severely hypoxic patients
 Used in high dependency setting

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 Summary

 Oxygen is required for cell metabolism

 Oxygen requirements are higher in critically
ill patients
 Be aware of different delivery systems
 Always consider humidification
 Safety aspects

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