oxygen therapy and toxicity
TRANSCRIPT
OXYGEN THERAPYOXYGEN THERAPY
-Dr. Raghavendra Babu S
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Definition:Definition:
*Oxygen therapy is the administration of oxygen at concentrations greater than room air ( 21%)
*With goal of treating or preventing the symptoms and manifestations of hypoxia(a state of oxygen deficiency reaching the tissues)
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DEVICESDEVICES
The oxygen delivery devices can be categorized as
Low flow systemsReservoir systemsHigh flow systemsEnclosure systems
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Oxygen TherapyOxygen TherapyDesign & PerformanceDesign & Performance
Low flow Devices Flow does not meet inspiratory
demand O2 is diluted with air on inspiration Devices deliver Fio2 ranging from
22-60%E.g Nasal cannula Transtracheal catheter
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Nasal CannulaNasal Cannula
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NASAL CANNULANASAL CANNULA low oxygen devicelow 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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Method Amount Delivered
F1o2 (Fraction Inspired Oxygen)
Priority Nursing
Interventions
Advantages Disadvantages
Nasal Cannula Low flow
24-44%
1 L\min=24%
2 L\min=28%
3 L\min=32%
4 L\min=36%
5 L\min=40%
6 L\min=44%
Check frequently that both prongs are in clients nares
Never deliver more than 2-3 L\min to client with chronic lung disease
Client able to talk and eat with oxygen in place
Easily used in home setting
may cause irritation to the nasal and pharyngeal mucosa if oxygen flow rates are above 6 liters/minute Variable FIO2
Reservoir SystemReservoir System Simple oxygen face mask Partial rebreathing mask Nonrebreathing mask
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SIMPLE FACEMASKSIMPLE FACEMASK low oxygen devicelow oxygen device
The simple facemask at an oxygen flow of 6 L/min delivers approximately 35-60 % 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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Partial Rebreathing Mask with reservoirPartial Rebreathing Mask with reservoir
Moderate oxygen deviceModerate 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
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Reservoir
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High Flow systemHigh Flow system
It provide oxygen at flow rates high enough to satisfy patient’s inspiratory demands.
Such high flows( i.e. 35-40 lit approx) are possible by
1.Entrainment of room air2.High flow rates and reservoirsE.g Venturi masks High flow aerosol nebuliser04/11/23 24
Oxygen TherapyOxygen TherapyHigh Flow Devices - High Flow Devices - EntrainmentEntrainmentAE Devices
AEM (Venti-Mask)
AE Nebulizer (Large Volume Nebulizer) cool/heated Aerosol
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Oxygen TherapyOxygen TherapyHigh Flow DevicesHigh Flow Devices
Air Entrainment systemWhat is Entrainment?
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VENTURI EFFECTVENTURI EFFECT
Oxygen is forced through a jet orifice entering the mask. As there is pressure drop across jet orifice, room air entrainment occurs through side ports
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Air Entrainment Mask
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Copyright ©1998 BMJ Publishing Group Ltd.
Bateman, N T et al. BMJ 1998;317:798-801
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T-pieceT-piece
Used on end of ET tube when weaning from ventilator
Provides accurate FIO2
Provides good humidity
Enclosure systemsEnclosure systems
Tents Hoods
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Oxygen HoodOxygen Hood High oxygen deviceHigh 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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CPAPCPAP
Administering oxygen by
CPAP(continuous positive airway pressure):
1-Nasal CPAP.2-Endotracheal CPAP.
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Nasal CPAPNasal CPAP::
Nasal CPAP: It consists of a single nasopharyngeal tube that deliveries 2-8 cm of positive pressure with or without o2.
Nursing care : - Frequent suction .- Tube care.- Change the nasal tube.
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Endotracheal CPAPEndotracheal CPAP
Endotracheal CPAP: Positive pressure delivering via an ETT.
Nursing care : - Use sterile suctioning
techniques- Mouth care - Change the ETT every seven
days .
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Oxygen is a drug and should be administered keeping following things in mind: mode of administration, flow rate, FiO2 (venturi), treatment goal, monitoring, when to stop.
Oxygen toxicityOxygen toxicity
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What is free radical?What is free radical?A free radical is an atom or group
of atoms possing one or more unpaired electrons.
Radical + radical reactions typically very fast
Radical + Non-radical reactions twide range of reaction rates.
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What is an Antioxidant?What is an Antioxidant?A substance that, when present
at a low concentration compared with that of an oxidizable substrate, inhibits or prevents oxidation of the substrate.
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