Oxygen Therapy

Dr Berinyuy
 Objectives
At the end of this course, the student should be
able to;
1. Define Oxygenotherapy
2. List 5 indications for oxygen therapy
3. List 6 devices and their various indications in
oxygenotherapy
4. List 3 complications of oxygeneotherapy
 Plan
• Introduction
• Definitions
• Indications for oxygenotherapy
• Devices for oxygenotherapy
• Monitoring of oxygenotherapy
• Complications of oxygen therapy
• Conclusion
 Introduction
• Oxygen is a drug and like any drug, should be
prescribed and properly administered.
• Misuse is not without consequences and could
be in the form of toxicity
• Indications, side effects and prescribing
methods.
• Specific oxygen delivering devices are available
• Choice of these devices depends on condition of
individual patients.
 Definitions
• Oxygen, a colorless, odorless gas that liquefies at
temperatures below -183°C
• Oxygen therapy is a treatment providing more
than 21% oxygen to the patients
• Oxygen (O2) is a drug.
• In 2015, 14% of over 55,000 hospital patients in
the UK were using oxygen.
• Forty two percent of patients received this
supplemental oxygen without a valid prescription
 Definitions
• Hypoxemia is a decrease in the partial
pressure of oxygen or oxygen saturation in
arterial blood.
• Hypoxia, on the other hand, means
insufficient organ and tissue oxygenation.
• In adults, hypoxemia is mostly defined as PaO2
< 60 mmHg and SaO2 < 90%
 Definitions
• Hyperoxaemia: Increase in arterial oxygen
partial pressure (PaO2) to a level greater than
120mmHg.
• Hypoxia: Decreased level of tissue
oxygenation, either due to low blood supply or
low oxygen content in the blood (hypoxemia).
 Indications
• The most essential objective indication for
oxygen treatment is the manifestation of
hypoxaemia.
• Oxygen therapy is administered to prevent
cellular hypoxia, caused by hypoxaemia which
can cause irreversible damage to vital organs.
 Indications
Signs of hypoxia:
Confusion, restlessness, difficulty breathing,
rapid heart rate, and bluish skin. Many chronic
heart and lung conditions can put you at risk for
hypoxia.
 Indications
Prescription Guidelines
• Supplemental oxygen is generally not
indicated unless the patient is assessed as
being clinically hypoxic.
• This mandates a medical assessment of all
patients who have saturations below 93% who
do not have a current management plan.
 Indications
Oxygen will be prescribed according to a target
saturation range
• In normal healthy adults/children accepted -
92-96%
• In chronic hypoxia patients accepted 88- 92%
• The target saturation range can be user
defined within certain clinical scenarios as
per specific pathway / policy .
 Indications
• Oxygen should be weaned / stopped if the
saturation is above the target range.
• Those who administer oxygen therapy will
monitor the patient to maintain the patient’s
target saturation range
 Contraindications
• No real contraindication,
• but prudence
Devices for Administration
Algorithm Oxygen Escalation
 Monitoring
• Pulse oxymeter – Oxygen saturation
• Arterial Blood Gases – Partial pressure of
Oxygen (PaO2)
• Clinical state- cyanosis, BP, RR, HR
 Complications from Oxygenotherapy
1. Devices:Skin irritation,b acterial contamination associated with
certain nebulization and humidification systems is a possible hazard.
2. Drying of mucous memebranes
3. Depression of ventilation: E.g COPD patients with chronic
carbondioxide (CO2)retention who have hypoxic respiratory drive to
breath.
4. Pulmonary, optic and central nervous system toxicity: Long term
hyperbaric O2 therapy can lead to
5. Fire hazard:
6. Absorption atelectasis:
7. Retinopathy of prematurity (ROP):Use , 50-80 mmHg PaO2 as target
 Complications from Oxygenotherapy
• 8. Pulmonary toxicity:
• Patients exposed to high oxygen levels for a prolonged period
of time have lung damage. The extent of lung damage is
dependent on FiO2 and duration of exposure. It is due to
intracellular free radicals (such as superoxide, activated
hydroxyl ions, singlet O2 and hydrogen peroxide) formed which
can damage alveolar-capillary membrane. It starts with
increased permeability of the capillaries with resultant edema,
thickened membranes and finally to pulmonary fibrosis.
• Care should be taken in the use of oxygen in patients receiving
bleomycin or have previously used bleomycin.
 References
1. Canterbury District Health Board,Oxygen
Therapy Guidelines, 2019
2. USAID-STAR, Adult oxygen therapy escalation
algorithm,2019
3. Cleveland Clinic , Oxygen Therapy, 2023
Thank You