[Link].
Dr. AR. Mahoori
Mahoori
CardiacAnesthesiologist
Cardiac Anesthesiologist
Definition
Definition
Types
Types of
of Hypoxia
Hypoxia
Signs
Signs and
and symptoms
symptoms of
of Hypoxia
Hypoxia
Indications
Indications of
of O2
O2 therapy
therapy
Contraindications
Contraindications and
and Precautions
Precautions
Delivery
Delivery Systems
Systems
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.
hypoxia
The evolving and expanding outbreak of SARS-CoV2 infections has created
important challenges to Oxygen therapy
Approximately 12%-19% of COVID-positive patients require hospital
admission and 3%-6% become critically ill
Low PaO2(arterial Deficiency of oxygen
oxygen tension) reaching the tissues
of the body
Hypoxic
Hypoxic Hypoxia
Hypoxia
Circulatory
Circulatory Hypoxia
Hypoxia
Hemic
Hemic Hypoxia
Hypoxia
Demand
Demand Hypoxia
Hypoxia
Histotoxic
Histotoxic Hypoxia
Hypoxia
Low PaO2(arterial oxygen tension) secondary to
FiO2<0.21 or decreased barometric pressure
(altitude)
Impaired ventilation secondary to neuromuscular
weakness or narcotic overdose
Impaired oxygenation secondary to Pulmonary
Fibrosis, ARDS or Covid 19.
Inadequate pumping of the blood from the lungs 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.
Decreased oxygen carrying capacity as in anemia or
carbon monoxide poisoning
Methemoglobinemia? Methemoglobin reductase
Sulfhemoglobinemia? Oxidation of iron by drugs
Increased tissue consumption of oxygen
in hypermetabolic states: like fevers
Utilization of oxygen is abnormal such
as in cyanide poisoning
Cyanide I cytochrom oxidase
Tachypnea, dyspnea, hyperpena
Tachycardia, dysrythmias, pulse change,
hypertension
Restlessness, disorientation, lethargy
Anemia, polycythemia
Cyanosis, digital clubbing
PaO2 <60mmHg or SaO2 <90%
Severe trauma
Acute Myocardial Infarction
Short term, post operative
-Administration of O2 to remove gas
-Carbon Monoxide Poisoning
-Gas Embolism & Decompression Sickness -
Acute Infections
- Support of Arterial Oxygenation
A physician's order is required for oxygen therapy, except in emergency use.
With PaO2>60, patients with chronic CO2 elevations may experience
ventilatory depression.
With FIO2>0.50, oxygen toxicity, absorption atelectasis, or
depression of ciliary and/or leukocytic function
Administer with caution to patients receiving bleomycin cancer
therapy
Fire hazard is increased in the presence of oxygen concentration.
Oxygen toxicity is cellular injury of the lung parenchyma and
airway epithelium due to release of cytotoxic, free oxygen radicals.
FIO2 100% 12h, FIO2 80% 24h, FIO2 60% 36h
Administration of FIO2 0.5 for long term usually does NOT result in
toxicity.
Retrlental Fibroplasia in prematurity
Suppress of ventilation
Convulsion (> 2ATA)
Nasal Cannula
Simple Masks
Partial Rebreather Masks
Non Rebreather Masks
Venturi Masks
High-flow nasal oxygen therapy (HFNOT)
Can provide 24-44% oxygen to patients with flowrates
below 6 L. min depending on the ventilatory pattern.
The “reservoir” for a nasal cannula is the patients nose.
Each liter of flow will increase the FiO2 2%-4%.
Adults 6 LPM
Infants/toddlers 2 LPM
Children 3 LPM
Flowrates in excess of 6 [Link] 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 [Link].
Can provide 40-60% oxygen to patients at flowrates between 5-10
[Link].
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.
Less than 5 [Link] is not recommended because a minimum of 5
[Link] is needed to flush the exhaled CO2 from the mask.
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.
A partial rebreather face mask is a valve less system that
includes an oxygen reservoir bag.
With oxygen flows 6-10 [Link] the inhaled concentration of
oxygen are between 60%-80% or greater.
A non-rebreather face mask includes unidirectional valve plus
an oxygen reservoir bag.
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+ [Link]
Can provide 24%-40% oxygen by mixing room air with a
precise amount of oxygen thereby delivering a precise FIO 2.
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.
High-flow nasal oxygen therapy
(HFNOT) is increasingly used as part
of both ward-based and critical care
management of respiratory failure.
HFNOT provides warmed and
humidified gases at flows of up to 60
litre min−1, with
inspired oxygen concentrations of
up to 100%.
HFNOT No oxygen
therapy
Thank You
Thank You For
For Your
Your
Attention
Attention
