OXYGEN THERAPY

Faculty of Critical Care Medicine

College of Anaesthesiologists & Intensivists of Sri Lanka
In collaboration with
Ministry of Health Sri Lanka
Why you need oxygen
therapy?
■ Hypoxia(to enrich O2 for inspired air)
■ Hypoventilation( to remove CO2)
■ Preoxygenation(for denitrogenation)
Why oxygen for hypoxia..?

■ O2 Flux = O2 content of blood × CO

■ O2 content = (SpO2 × Hb × c ) + D
What is Hypoxia…?

■ Diminished availability of Oxygen in tissue level

■ Causes
– Low FiO2
– Lung disorders(shunt, V/Q mismatch)
– Anemia
– Circulatory failure
– Cellular dysfunction
What is Hypoxemia….?

■ Decreased PaO2 in the blood below normal range.

– PaO2 of < 60mmHg or SaO2 of < 94% in subjects
breathing room air or…
– PaO2 and/or SaO2 below desirable range for specific
clinical situation.
– Low SpO2 < 92% of pulse oximeter with oxygen
supplementation.
How to identify a Critically ill
patient..

■ Check vital signs….

■ A,B,C,D
■ MEWS score
How to detect hypoxia

■ Clinical assessment
– Dyspnea(Type 1 RF ??)
– Altered conscious level
– cyanosis
■ Pulse oximetry /SpO2
■ Blood gas/ PaO2
■ MEWS
When do we use oxygen?

■ To correct hypoxaemia

■ To prevent hypoxaemia in unwell patients

■ To prevent hypoxaemia with poor reserves

Who are at high risk of hypoxia?

Low reserves
■ Poor stores of oxygen
■ Low Hb
INDICATIONS

■ Documented hypoxemia(ABG)
■ Severe asthma
■ Severe trauma/ Head injury/ Haemorhage
■ Acute myocardial infarction
■ Short-term therapy or surgical intervention
– post-anaesthesia recovery, sedation
■ CO poisoning
Methods of
administration
■ Fixed performance devices
– FiO2 is constant, despite changes in inspiratory flow rate.
– Examples include an oxygen tent, anaesthetic breathing
circuit,
– High flow nasal oxygen(HFNO)
– Venturi masks
– face mask with reservoir bag
Venturi masks
Venturi mask

■ Mixes oxygen with room air, creating high-flow enriched oxygen

of a settable concentration.
■ Provides an accurate and constant FI,O2.
■ Typical FI,O2 delivery settings are 24, 28, 31, 35,40 and 60%
oxygen.
 face mask with reservoir bag
The non rebreathing mask
➢
This mask provides the highest

concentration

➢oxygen (95-100%) at a flow rate6-15

L/min.

➢The bag is an oxygen reservoir

 Disadvantages Advantages Priority Nursing Amount Method
Interventions Delivere
d
F1o2

➢Impractical ➢Delivers the ➢Maintain flow ➢Low

for long term highest rate so Flow
Therapy possible reservoir bag 6-15 L
Malfunction oxygen collapses only \min
can cause CO2 concentration slightly during
buildup ➢Suitable for inspiration ➢80%- Non
➢suffocation pt breathing ➢Check that
100%
➢Expensive spontaneous valves and rebrea
➢Uncomfortabl with sever rubber flaps thing
e hypoxemia are function
➢Costly properly (open MASK
during
expiration )
➢Monitor SpO2
with pulse
oximeter.
HFNO
HFNO
HFNO

■ Advantages
■ 1. Humidified oxygen
■ 2. Heated air
■ 3. High flow rate up to 60 L/min
■ 4. Can give oxygen% up to 100%
■ 5. Can give small PEEP ( flow PEEP)
Variable performance devices

■ Actual FiO2 depends on inspiratory flow rate. Examples include

– nasal cannulae
– Simple face mask
Nasal prongs(nasal canula)
Disadvantages Advantages Priority Nursing Amount Method
Delivered
Interventions F1o2
(Fraction
Inspired
Oxygen)

➢may cause ➢ patients are

➢Check Nasal
irritation to able to talk frequently that Low flow Cannula
and eat with both prongs 24-44 %
the nasal
oxygen in are in patients
and 1 L\min=24%
place nares
pharyngeal 2 L\min=28%
mucosa ➢Easily used ➢Never deliver 3 L\min=32%
in home more than 2-3 4 L\min=36%
setting L\min to 5 L\min=40%
patients with 6 L\min=44%
chronic lung
disease
 The simple Oxygen mask

➢ Simple mask is made of clear,

flexible , plastic or rubber
that can be molded to fit the
face.
➢ It is held to the head with
elastic bands.
➢ Some have a metal clip that
can be bent over the bridge of
the nose for a comfortable fit.
 Disadvantages Advantages Priority Nursing Amount Method
Interventions Delivered
F1o2
(Fraction
Inspired
Oxygen)

✓Tight seal required ✓Can ✓check ✓Low Flow

to deliver higher provide placement of the ✓6-10 L\min
concentration increased mask frequently.
✓Difficult to keep delivery of ✓claustrophobia ✓
35%-60%
mask in position over oxygen for is a concern
nose and mouth short period ✓replace mask
✓Potential for skin of time with nasal
breakdown (pressure, cannula during
moisture) meal time Simple
✓Wasting mask
✓Uncomfortable for
pt while eating or
talking
✓Expensive with
nasal tube
How to set up O2 therapy

Prescription for oxygen

■ Set up a target
■ Determine how much(percentage/dose)
■ What device to use
■ How to monitor
– What parameters
– How frequent
Set up a target

■ 100% oxygen ???

■ In all acutely unwell patients, not at risk of T2RF, the

recommended target saturation range is 94–98%

■ In patients at risk of T2RF a target saturation range of 88–92%

( you need little hypoxic drive eg. COPD) is suggested when
pending the availability of ABGs
Recommendations

■ All acutely ill patients should be monitored for oxygen saturation

■ Amount of oxygen should be recorded with SpO2/PaO2
■ If O2 requirement is going up or SpO2 is going below 85% with
O2 seek expert help
■ Do early ABG and FBC in significantly hypoxic patients
■ Pulse oximeter should be available in all the places where
critically ill patients are managed
■ Following devices should be available
– Nasal cannula
– Non rebreathing face masks
– Wide range of Venturi masks(esp. 28% - 60%)
– HFNO
 Thank you

Faculty of Critical Care Medicine

College of Anaesthesiologists & Intensivists of
Sri Lanka