OXYGEN

THERAPY
by
D.Saputr,S.Psi

12/12/23 1
 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 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
*Delivery Systems

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Hypoxia: is Neelon, 1999
insufficient delivery
of oxygen to the
tissue
 Oxygen is required
to maintain the
Citric Acid (Krebs)
Cycle and the
Cytochrome
Respiratory Chain
– produces the
majority of ATP
– 38 ATP vs 4 ATP
molecules

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 Conceptual Model
Oxygen Delivery Oxygen Utilization

Arterial Oxygen Content (CaO2) Cell

•Oxygen carrying capacity
Mitochondria
•PaO2
•Hemoglobin (gm/dl)
Transport of Oxygen from
•Oxyhemoglobin Saturation (SaO2)
Cell Membrane to the
Mitochondria
Perfusion
•Organ Blood Flow
Function of Cytochrome
•Cardiac Output/Cardiac Index
Respiratory Chain

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 The amount of oxygen available to the tissue is a
function of arterial oxygen content (CaO2) and
blood flow.

 CaO2 = (HgB x 1.38 x SaO2) + PaO2 x 0.0031

 Tissue hypoxia occurs in state of low cardiac

output, low Hemoglobin concentration, or low
SaO2.

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 Allosteric Binding Properties of Hgb and the
Oxyhemoglobin Dissociation Curve
 the binding curve assumes a sigmoid shape,
HGBreflecting
in the R the transition from low to high
Pulmonary veins, left
configuration- ventricle and arteries
affinity
hold onto
as more binding sites become occupied.
 The major effectors of hemoglobin binding are
oxygen-high
affinity
S the concentration of R
A – hydrogen ion
O – carbonHGB in the T
dioxide
2 L configuration-
– body temperature
release oxygen-
low affinity
– red-cell 2,3-bisphosphoglycerate.

Peripheral capillaries and veins

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PaO2 PaO2 7
 Oxyhemoglobin Dissociation Curve

Factors that affect the

standard
dissociation curve :
 Ion H+
 Effect of CO2
 Effect of 2,3-DPG
 Temperature
 Carrbon Monoxide
 Effect of
Methemoglobinemia
 Fetal hemoglobin

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Arterial Oxygen Content (CaO2): 18-20 ml/dl

 Affected by alveolar diffusion and availability of Hgb

receptors
– Hgb carries 1.38 ml of oxygen when fully
saturated

 Formula: CaO2 = [Hgb x 1.38 x SaO2] + .003 PaO2

 Cause of decrease CaO2

– Arterial Hypoxia
– Anemic Hypoxia
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 Ventilation-Perfusion Ratio
shunt
(V/Q)
Normal = .80
 Low V/Q: ventilation nears zero and perfusion is
normal. Ratio nears zero. COPD, alveolar
hypoventilation
 Very low V/Q: intrapulmonary shunting ARDS,
HMD, atelectasis,
 High V/Q: ventilation but no perfusion (ratio
approaches affinity. Alveolar dead space
increase. No gas exchange: pulmonary
embolus. dead space
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Shifts alter SaO2--Changes in SaO2
CaO2 = [Hgb x 1.38 x SaO2] + .003 PaO2

Normal: 15 x 1.38 x .91

= 19.2 ml/100
ml

Low: 15 x 1.38 x .80

That’s a 17% decrease = 16.1 ml/100
ml
in carrying capacity
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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<.21 or decreased barometric pressure(altitude)
 *Impaired ventilation secondary to neuromuscular
weakness or narcotic overdose
 *Impaired oxygenation secondary to Pulmonary
Fibrosis, ARDS

FiO2=Fraction of inspired oxygen, or the percent of oxygen in inspired gas

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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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Change in amount of Hgb

CaO2 = [Hgb x 1.38 x SaO2] + .003 PaO2

Normal: 15 (Hgb) x 1.38 x .96 (SaO2)

= 19.7 ml/100ml

Low: 10 (Hgb) x 1.38 x .96 (SaO2)

= 13.1 ml/100ml
A 34% change in oxygen
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carrying capacity 18
 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,hyperpnea,
 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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 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
 Non Rebreather Masks

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 Nasal Cannulas
 Can provide 23-45% oxygen to patients with
flowrates up to 6 lpm 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 35-55% 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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 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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