OXYGEN THERAPY

Citra Rencana Perangin angin

Anesthesiology Division
Faculty of Medicine UKRIDA
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 manifestation of
hypoxia
Oxygen therapy is indicated whenever
tissue oxygenation is impaired

Tissue Oxygenation

FiO2
Ventilation:
Resp Center
Airway
Alveoli PaO2
Pillows: Ms Bones
Diffusion
Perfusion
CVS:
COP
Volume
Peripheral circulation
Hb: Bind - Release
Anemia O2 Delivary
Abnormal ex CarboxyHb
2,3 DPG
Utilization by cell:
Cyanide poisoning

Oxygen is a drug. It has:
Physiological actions
Pharmacological actions
A dose-response relationship
Adverse effects
Topics
Types of Hypoxia
Signs and symptoms of Hypoxia
Indications
Contraindications and precautions
Delivery systems
Mechanisms of Hypoxia
Aerobic Metabolism requires:
O2 Utilization

O2 Delivery O2 Utilization

O2 Delivery


Shift from aerobic to anaerobic metabolism
Increase Lactic acid
Progressive Acidosis

Cell Death


Types of Hypoxia
Hypoxic Hypoxia
Circulatory Hypoxia
Hemic Hypoxia
Demand Hypoxia
Histotoxic Hypoxia
Hypoxic Hypoxia
Low PaO
2
(arterial oxygen tension)
secondary to FiO
2
< 0.21 or decreased
barometric pressure (altitude)
Impaired ventilation secondary to
neuromuscular weakness or narcotic
overdose
Impaired oxygenation secondary to
Pulmonary Fibrosis, ARDS
Circulatory Hypoxia
Inadequate pumping of the blood from
the hearts to tissues, maybe secondary to
disorders causing decreased cardiac
output such as MI, hypovolemic,
hypotension, poor supply of arteries. If
the patient has myocardial ischemia
supplemental O
2
is definitely indicated
Hemic Hypoxia
Decreased oxygen carrying capacity as in
anemia or carbon monoxide poisoning
Demand Hypoxia
Increased tissue consumption of oxygen in
hypermetabolic states: like fevers
Histotoxic Hypoxia
Utilization of oxygen is abnormal such as
in cyanide poisoning
Signs and symptoms of Hypoxia
Tachypnea, dyspnea, hyperpnea
Tachycardia, dysrythmias, pulse changes,
hypertension
Anemia, polycythemia
Restlessness, disorientation, lethargy
Cyanosis, digital clubbing
Indication
Cardiac arrest
Respiratory arrest
Respiratory failure type I & II
Cardiac failure
Myocardial infarction
Shock of any cause
Increased metabolic demands
Post operative states
Carbon monoxide poisoning

Contraindication & precautions
With PaO
2
> 60, patients with chronic CO
2

elevations may experience ventilatory
depression
With FiO
2
> 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.

Cautions For Oxygen Therapy
Oxygen toxicity can
occur with FIO2 >
50% longer than 48
hrs
Suppression of
ventilation will lead
to increased CO2 and
carbon dioxide
narcosis
Danger of fire
Infection

Oxygen cascade
mmHg
Inspired air 150
Alveolar 103
Arterial 100
Capillary 51
Tissue 20
Mitochondrial 1-20
ALVEOLUS
Lung capillary
Free air:
PiO2 : 20.9 % x 760 = 159
mmHg
PiCO2 : 0.04 % x 760 = 0.3 mmHg
PiN2 : 78.6 % x 760 = 597mmHg
PiH2O : 0.46 % x 760 = 3.5 mmHg
N2 H2O
O2
PAO2:
104
mmHg
CO2
PACO2:
40 mmHg
O2
PaO2:
40 mmHg
O2
PaO2:
102
mmHg
CO2
PaCO2:
45
mmHg
CO2
PaCO2:
40
mmHg
Diffusion
process
PAN2:
573
mmHg
PAH2O:
47 mmHg
Oxygen dissociation curve





Oxygen dissociation curve
Factors increasing P50 (curve shift to right)
Hyperthermia
Decreased pH (acidemia)
Increased PCO
2
(Bohr effect)
Increased 2,3 DPG










Oxygen dissociation curve
Factors decreasing P50 (curve shifts to left)
Hypothermia
Increased pH (alkalaemia)
Decreased PCO
2
Decreased 2,3 DPG
Fetal haemoglobin
Carboxyhaemoglobin
methaemoglobin
Delivery systems
= VARIABLE PERFORMANCE SYSTEMS
1. FiO
2
depends upon oxygen flow
2. Device factors
3. Patients factors
Classification of Oxygen Delivery
Systems
Low flow systems
contribute partially to inspired gas client
breathes
do not provide constant FIO2
Ex: nasal cannula, simple mask , non-re
breather mask , Partial rebreather mask
High flow systems
deliver specific and constant percent of
oxygen independent of clients breathing
Ex: Venturi mask,, trach collar, T-piece
VARIABLE PERFORMANCE
SYSTEMS
No capacity system
Small capacity systems
Large capacity systems
No capacity system
Nasal catheters at low flow rates
( < 2 L/i )

Small capacity system
Nasal catheters at high flows
Simple, semi-rigid plastic masks (MC,
Edinburgh, Harris, Hudson)
Tracheostomy masks
Laryngeal mask and simple plastic facemask
T-piece circuit
Face tent
Large capacity system
Soft plastic masks (e.g. Pneumask,
polymask, oxyaire)
Apparatus/devices for oxygen
therapy
Nasal catheters
Semi-rigid mask (e.g. MC, Edinburgh, Hudson, Harris)
Venturi-type mask
Soft plastic masks (e.g. Pneumask, Polymask Oxyaire)
Ventilators
Anaesthesia circuits
CPAP circuits
Plastic head hood
Oxygen tent/cot
Incubator
Methods of oxygen administration:

1- Nasal cannula
Nasal cannula (prongs):

It is a disposable.
plastic devise with two protruding
prongs for insertion into the nostrils,
connected to an oxygen source.

Used for low-medium concentrations
of Oxygen (24-44%).

Face mask
The simple Oxygen mask
The partial rebreather mask:
The non rebreather mask:
The venturi mask:



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.


The simple Oxygen mask
It delivers 35% to 60% oxygen .
A flow rate of 6 to 10 liters per minute.
It has vents on its sides which allow
room air to leak in at many places,
thereby diluting the source oxygen.
Often it is used when an increased
delivery of oxygen is needed for short
periods
(i.e., less than 12 hours).

The partial rebreather mask:

The mask is have with a reservoir bag must
romaine inflated during both inspiration &
expiration
It collection of the first parts of the
patients' exhaled air.
It is used to deliver oxygen concentrations
up to 80%.
The partial rebreather mask
The oxygen flow rate
must be maintained at a
minimum of 6 L/min to
ensure that the patient
does not rebreathe large
amounts of exhaled air.
The remaining exhaled
air exits through vents.

The non rebreather mask

This mask provides the
highest concentration of

oxygen (95-100%) at a flow

rate6-15 L/min.

It is similar to the partial

rebreather mask

except two one-way valves

prevent conservation of
exhaled air.

The bag is an oxygen

reservoir

The non rebreather mask
When the patient exhales
air.
the one-way valve closes
and all of the expired air
is deposited into the
atmosphere, not the
reservoir bag.
In this way, the patient is
not rebreathing any of the
expired gas.


Venturi mask
It is high flow
concentration of oxygen.
Oxygen from 40 - 50%
At liters flow of 4 to 15
L/min.
The mask is so
constructed that there is
a constant flow of room
air blended with a fixed
concentration of oxygen
The venturi mask
is designed with wide- bore tubing and various
color - coded jet adapters.
Each color code corresponds to a precise
oxygen concentration and a specific liter flow.

The venturi system,
Room air dilutes the oxygen entering the
tubing to a certain concentration
The amount of air drawn in is determined by
the size of the orifice (jet adapter).
The venturi mask
The narrower the jet adapter,
the greater the air dilution, and the
lower the concentration of oxygen.

It is used primarily for patients with
chronic obstructive pulmonary disease
Tracheostomy Collar/ Mask
Inserted directed into trachea
Is indicated for chronic o2
therapy need
O2 flow rate 8 to 10L
Provides accurate FIO2
Provides good humidity.
Comfortable ,more efficient
Less expensive
T-piece
Used on end of
ET tube when
weaning from
ventilator
Provides
accurate FIO2
Provides good
humidity


Devices

Suggested
flow
rate(L/min)

O2%

Advantage
s

Disadvanta
ges

Cannula

1liter
2liter
3liter
4liter
5liter
6liter

24%
28%
32%
36%
40%
44%

Light
weight
,comfortabl
e
,inexpensiv
e ,
continuous
use with
meals and
activities.

Nasal
mucosa
,drying ,
variable
fio2

Catheter

1-6liter

23-40%

Inexpensiv
e

Variable
fio2,require
s frequent
change
,gastric
distension
can occur

Simple mask

5liter
6liter
8liter


40%
45-50%
55-60%

Simple to
use ,
inexpensive

Poor
fitting,variabl
e fio2,must
remove to
feeding .

Mask partial
re-breather

6-15liter

70-90%

Moderate O2
concentratio
n

Warm,poor
fitting ,must
be removed
to feeding

Mask non-
breather
NRM

12liter

82-100%

High o2
concentratio
n

Poor fitting

Mask
nonbrather
NRM

12liter

82-100%

High o2
concentrati
on

Poor fitting

Mask
venturi

4 -6liter



6-8liter

24,26,28



30,35,40

Provide
low levels
of
supplemen
tal o2.

Precise
fio2
additional
humidity
availabe

Must be
removed to
eat

Mask
aerosal

8-10

30-100%

Good
humidity,ac
curate fio2

Uncomfort
able some.

Trachestom
y colar

8-10liter

30-100%

Good
humidity,ac
curate fio2

`uncomfort
able some

T-piece
briggs

8-10 liter

30-100%

Same as
trachestom
y colar

Heavy with
tubing

Face tent

8-10 liter

30-100%

Fairly
accurate
fio2

Bulky
compreso
m

Hazards of Oxygen therapy
CO
2
Narcosis
O
2
toxicity
CO
2
Narcosis
When high FiO
2
s are administered to
patients dependent on a hypoxic
(chemoreceptor) drive
Oxygen toxicity
Neurological effects (Paul Bert effects)
Lung toxicity
Retrolental fibroplasia
Barotrauma
HYPERBARIC OXYGEN THERAPY
Hyperbaric oxygen (HBO) therapy delivers
100% oxygen at a pressure above
atmospheric, in a pressurized multi or one
man chamber
HYPERBARIC OXYGEN THERAPY
Indications:
Carbon monoxide poisoning
Burns
Gas gangrene
Osteomyelitis
Osteoradionecrosis
Crush injuries
Ischaemic skin grafts
HYPERBARIC OXYGEN THERAPY
Complications
Barotrauma to ears, sinuses and lungs
Oxygen toxicity
Grand mal fits
Changes in visual acuity
PAEDIATRIC OXYGEN THERAPY
Oxygen headbox or hood
Incubator
Oxygen cot/tent
Thank you for
Your Attention