OXYGEN

THERAPY
Indications for Oxygen Therapy
Hypoxemia
Inadequate amount of oxygen in the blood
SPO2 < 90%
PaO2 < 60 mmHg
Excessive work of breathing
Excessive myocardial workload
Factors influencing Oxygen
Transport
 Hypoxemia
decrease in the arterial oxygen content in the
blood

Hypoxia
decreased oxygen supply to the tissues.
Causes of Hypoxemia
Shunt
Hypoventilation
As carbon dioxide increases oxygen falls
V/Q mismatching (ventilation/perfusion)
Pneumonia
Pulmonary edema
ARDS
Increased diffusion gradient
asbestosis
Early pulmonary edema
Causes of Hypoxia
Lung disease such as COPD, pneumonia and
pulmonary edema
Strong pain meds
Heart problems
Anemia
Cyanide poisoning
Complications of Oxygen
Therapy
Respiratory depression patient with chronic COPD
who is chronically hypoxic is most affected. Maintain PaO2
between 50 and 65 mm Hg for these patients.
Atelectasis High O2 concentrations in the lung can
wash out nitrogen in lung and reduce production of
surfactant. Maintain FiO2 below 60%.
Oxygen toxicity High O2 concentrations result in
increased O2 free radicals therefore lung tissue toxicity.
This leads to ARDS.
Reduced mucociliary activity Maintain FiO2 below
60%. The beating of cilia in the mucociliary blanket is not
as active when high FiO2 levels are used.
Retinopathy of Prematurity caused by high PaO2
Classification of Oxygen Delivery
Systems
Low flow systems
contribute partially to inspired gas patient breathes
do not provide constant FIO2

High flow systems

deliver specific and constant percent of oxygen independent of
clients breathing
LOW FLOW OXYGEN DEVICES
Nasal Cannula

Delivers 24% to 40% O2 at flow rates of

2 to 4 LPM
Flow rates in excess of 4L cause drying
and irritation
Depth and rate of breathing affect
amount of O2 reaching lungs
adults 6 LPM
infants/toddlers 2 LPM
children 3 LPM
FIO2 is not affected by mouth breathing
Simple Oxygen
Mask Delivers 35% to 50% O2 at
flow rates of 5 to 10 LPM
Patient exhales through ports
on sides of mask
Should not be used for
controlled O2 levels
Minimum flow rate of 5 lpm is
required to prevent buildup of
exhaled CO2 in mask.
Partial Rebreathing Mask
Consists of mask with exhalation ports and
reservoir bag
Delivers 40% to 70% O2 at flow rates of 10 to
15 lpm
Reservoir bag must remain inflated
Only the first part of the patients exhaled gas
enters the reservoir bag. This is the gas that
was left in the upper airway from the previous
inspiration and is therefore high in O2 and low
in CO2. (anatomic deadspace).
Non-Rebreathing
Mask
Consists of mask, reservoir bag, 2
one-way valves at exhalation
ports and bag
Delivers 60% to 80% O2 at flow
rates of 10 -15 lpm
Patient can only inhale from
reservoir bag
Bag must remain inflated at all
times
HIGH FLOW OXYGEN DEVICES
Venturi Mask
Most reliable and accurate method
for delivering a precise O2
concentration
Consists of a mask with a jet
Excess gas leaves by exhalation
ports
O2 flow rate 4 to 15L & Narrowed
orifice
Can cause skin breakdown; must
remove to eat
Tracheostomy
Collar/Mask
Delivers 30% to 60% O2
(depending on nebulizer setting)
at flow rates of 10 to 15 lpm
Adequate flows are ensured by
visible mist flowing out of the
exhalation port at all times.
Provides good humidity;
comfortable
 T piece or Briggs
adaptor
Used on end of ET tube when
weaning from ventilator
Delivers 21% to 100% O2 based
on nebulizer setting at flow rates
of 8 to 15 lpm
Used on intubated or
tracheostomy patient
Provides accurate FIO2
Provides good humidity
Face Tent
Low flow
Delivers 21% to 40% O2
(depending on nebulizer
setting) at flow rates of 8 to
15 lpm
Used primarily for patients
with facial trauma or burns or
for those who cannot tolerate
a mask
High Flow Nasal Cannula
Provides high flow therapy
(HFT) by use of thermally
controlled humidification
system.
Infants = 8 lpm
Adults = 40 lpm
Provides O2 percentage up
to 80%.
High flow reduces anatomic
dead space by washing out
CO2 from nasopharynx. This
increases alveolar PO2 levels
and results in increased PO2
Hyperbaric Oxygen Therapy
Hyperbaric Chambers
delivery of O2 at greater
than atmospheric pressure and
is accomplished by placing
patient in hyperbaric chamber.
pressurized at 3 atm as
patient breathes 100% O2.
Cautions for Oxygen Therapy
Oxygen toxicity can occur with
Fio2 > 60% longer than 36 hrs.
Fio2>80%longer than 24 hrs
Fio2>100%longer than 12hrs
Suppression of ventilation will lead to increased CO2 and
carbon dioxide narcosis
Danger of fire
Absorbtion Atelectasis
Need for Oxygen is assessed
by:
Pulse Oximetry

Non-invasive monitoring technique that estimates

the oxygen saturation of Hgb (SaO2)
May be used continuously or intermittently
Must correlate values with physical assessment
findings
Normal SaO2 values 95 to 100%
Factors Affecting SaO2
Measurements
Low perfusion states
Motion artifact
Nail polish(Blue) when using a finger probe
Intravascular dyes(methylene blue, indocyanine green,
indigocarmine)
Vasoconstrictor medications
Abnormal Hgb (met-CoHb)
Too much light exposure
Oxygen Therapy

Goal of therapy is an SPO2 of >90% or for documented COPD

patients(Spo2 8892%)-(Pao2=55-60)
As SPO2 normalizes the patients vital signs should improve
Heart rate should return to normal for patient
Respiratory rate should decrease to normal for patient
Blood pressure should normalize for patient
Optimizatio
n
Check my source!
Ensure the O2 delivery
device is attached to oxygen
not medical air.
Follow tubing back to source
and ensure patency
Are all connections tight?
Is the flow set high
enough?
All nebs especially high flow
large volume nebs need to be
run at the highest rate.
Turn flow meter to maximum
for large volume nebs.
 Reposition patient. Listen to chest.
Avoid laying patient flat on back. Wheezing?
Raise head of bed. Do they need a bronchodilator?
Encourage deep Crackles?
breathing/coughing Encourage deep
breathing/cough.
Are they fluid overloaded?
 Can I improve the mechanics of breathing?
Patient position
Pursed lip breathing
Abdominal breathing.
Anxiety relief?
 What do I do if my patient is really hypoxemic (on low
flow oxygen)?
Assess patient to determine cause of increasing oxygen
requirements.
Best short term solution is non-rebreathe mask at 15
lpm. (reservoir stays inflated)
Goal saturation is still 88 92%.
Increase flow as required until re-assessed by physician
 What do I do if my patient is really hypoxemic (on
high flow oxygen)?
Assess patient to determine cause of increasing
oxygen requirements.
Adjust FIO2 upwards in 10% increments titrating for
target SPO2.
Call physician for further assessment