FAQs

Oxygen Therapy
Wivina Bancoro, MD
RJ Mabynn Abonitalla, MD
 WORKSHOP

OXYGEN
THERAPY
w/ Doc Vianney &
Doc Mabynn
Objectives
To discuss basic principles of oxygen physiology

Differentiate Hypoxemia from Hypoxia

Know the clinical signs of Hypoxemia and Hypoxia

Know the different O2 delivery devices

FA IN PEDIATRIC
PULMONOLOG
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6TH SCIENTIFIC
JUNE 5-6, 2024
Oxygen transport from air to tissues

Alveoli

Fluid in
alveoli
HYPOXEMIA

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 MULTIPLE CHOICE
What is the main function of the
respiratory system?

A Gas exchange

B Defend against microbes

C Filter inspired air

D Control blood pH

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 What do you see in this patient?
Increased work of
breathing

Irregular respirations

O2 sat 91% at
room air

FA IN PEDIATRIC
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 Hypoxemia vs.
Hypoxia
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 TRUE OR FALSE

Hypoxemia means low levels of

oxygen in the blood.

True False
 Hypoxemia: Hypoxia:
Low levels of O2 in Inadequate O2 in
the blood tissues for normal
cell and organ
function

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 What are the causes of
Hypoxemia?

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FA IN PEDIATRIC
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A-aDO2 FORMULA
= PAO2 – Pao2
= [FiO2 (Pb-47mmHg) – PCO2/R] – PaO2

A-a oxygen gradient:

integrity of
alveolocapillary
membrane
effectiveness of gas
exchange
FA IN PEDIATRIC
PULMONOLOG
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6TH SCIENTIFIC
JUNE 5-6, 2024
FA IN PEDIATRIC
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6TH SCIENTIFIC
JUNE 5-6, 2024
FA IN PEDIATRIC
PULMONOLOG
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6TH SCIENTIFIC
JUNE 5-6, 2024
 What are the clinical
signs of Hypoxemia?

FA IN PEDIATRIC
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JUNE 5-6, 2024
 MULTIPLE CHOICE
Clinical signs of hypoxemia are
presented as follows:

A tachypnea

B grunting

C retractions

D all of the above

FA IN PEDIATRIC
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 Neonates

Tachypnea

Cyanosis

Grunting

Apnea

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 Children

Tachypnea Alar flaring

Cyanosis Retractions

Grunting Auscultatory
signs
 How do I detect
Hypoxemia?

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 CLINICAL SIGNS

PULSE OXIMETRY

ARTERIAL BLOOD GAS

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 Pulse Oximetry Arterial Blood Gas

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FA IN PEDIATRIC
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Useful anchor points:

O2 sat 100% = PO2 97 mmHg

O2 sat 75% = PO2 40 mmHg

O2 sat 50% = PO2 27 mmHg

FA IN PEDIATRIC
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FA IN PEDIATRIC
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6TH SCIENTIFIC
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 Is there such as thing as
Oxygen toxicity?

FA IN PEDIATRIC
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Intracellular metabolism of
Oxygen

Step 1: produce superoxide

molecule (O2-)

Step 2: produce hydrogen

peroxide (H2O2)

Step 3: produce hydroxyl ion

(OH-)

Step 4: produce water (H2O)

FA IN PEDIATRIC
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Intracellular metabolism of
Oxygen

Superoxide
dismutase

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 Further exposure to high
FiO2

Superoxide
dismutase

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Oxygen Toxicity

FiO2 of 100%
3 hours: chest pain
Damage to the capillary endothelium
0-12 hrs: interstitial edema
12-30 hrs: worsening compliance and vital
capacity
30-72 hrs: thickening of the alveolar-capillary
membrane
Exudative phase follows: low V/Q ratio,
FA physiologic shunting and worsening hypoxemia
IN PEDIATRIC
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 Oxygen is a DRUG.
When appropriately used, it is
extremely BENEFICIAL;
When misused or abused it is
potentially HARMFUL

FA IN PEDIATRIC
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 What are the goals of
Oxygen Therapy?

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 MULTIPLE CHOICE
What are the goals of
Oxygen Therapy?

A Treat hypoxemia

B Decrease work of
breathing
C Decrease myocardial
work
D All of the above

FA IN PEDIATRIC
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Goals of Oxygen Therapy:
Treat hypoxemia

Decrease work of breathing

Decrease myocardial work

FA IN PEDIATRIC
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JUNE 5-6, 2024
 Oxygen delivery
devices

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 Sources of Oxygen

Oxygen Cylinders

Oxygen Concentrators

Central piped oxygen

FA IN PEDIATRIC
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 Sources of Oxygen

Oxygen Cylinders

Oxygen Concentrators

Central piped oxygen

FA IN PEDIATRIC
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 Sources of Oxygen

Oxygen Cylinders

Oxygen Concentrators

Central piped oxygen

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 Methods of
O2 delivery

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 TRUE OR FALSE

Low flow systems deliver low FiO2

(<30%), while high flow systems deliver
high FiO2 like (>80%)

True False

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 Low flow High flow

DO NOT provide patient’s entire Provide patient’s entire

ventilatory requirement ventilatory demand
Lower O2 flow than actual Meeting or exceeding patients
inspiratory flow peak inspiratory flow rate
Air entrainment NO air entrainment
FiO2 diluted Accurate FiO2

FA IN PEDIATRIC
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FA IN PEDIATRIC
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 Low flow

Nasal Cannula

Blow by oxygen

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Each L/min of
nasal O2
increases the
FiO2 by ~4%

FA IN PEDIATRIC
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 Low flow

Nasal Cannula

Blow by oxygen

FA IN PEDIATRIC
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Can I increase O2 at 6LPM
via nasal cannula??
In respiratory distress

Alar flaring

Grunting

O2 sat 89 % at 4LPM

FA IN PEDIATRIC
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 ANATOMIC
Nose RESERVOIR IS
ANATOMIC
ALREADY FILLED
Nasopharynx RESERVOIR
Oropharynx
Total volume: ~50ml

O2 at 6LPM
via nasal
cannula
FA IN PEDIATRIC
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How can I have a
BIGGER nose?

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FA IN PEDIATRIC
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 Simple face mask Holes for
exhalation

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 Oxygen mask should NEVER run
at less than 5LPM.
EXHALED AIR accumulating in
the mask reservoir might be
REBREATHED

FA IN PEDIATRIC
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What if I need more FiO2? How do we
increase the oxygen reservoir further?

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 Mask with reservoir bag

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Partial rebreather
vs.
Non-rebreather
mask

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 SPOT THE DIFFERENCE!

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A B
 A. PARTIAL REBREATHER MASK

NO valves

Expiration:
O2 + first 1/3 of exhaled gas enters
reservoir bag
Last 2/3 of exhaled gas escapes through
ports
2 open
Inspiration: exhalation
Oxygen + first 1/3 exhaled gas ports with
NO valves

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 B. NON-REBREATHER MASK

3 one-way valves
Between the oxygen reservoir bag and the
mask
exhaled gas
Exhalation ports oxygen

Inhaled gas

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 reservoir bag should remain
INFLATED:
Ensure highest FiO2 given
Prevent CO2 rebreathing

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FA IN PEDIATRIC
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 Venturi mask

Changeable ports

Deliver Fixed FiO2

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 Venturi mask

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 Advanced Oxygen
delivery systems

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HFNC

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 INDICATIONS CONTRAINDICATIONS

Severe respiratory distress & Acutely impaired mental status

able to maintain airway (alert
and able to swallow)
Hypoxemic respiratory failure
Hypercapnic respiratory failure
Facial anomalies (e.g. choanal atresia)
Excessive oral/nasal secretions
Active vomiting (risk of aspiration)
Bowel obstruction
Existing air leak

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 Cannula selection

Occupy 50% of internal diameter

of nares to permit some leak and
prevent excessive airway pressure

Distance of prongs wide enough

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 Initial settings:

Temp: 34-37’C

Flow rate: age or size

FiO2: 0.21– 1
O2 SAT goal: 94-99%

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 Assessment of
effectiveness

Vital signs

Work of breathing

Oxygen requirement

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 Bubble CPAP

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 Components

Continuous gas flow via air

compressor
Nasal interface

Expiratory limb to generate

PEEP

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FA IN PEDIATRIC
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FA IN PEDIATRIC
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*Pediatric ICU –
1.5-2L/kg/min
JUNE 5-6, 2024
Summary:
Oxygen therapy is a crucial intervention for
managing various respiratory conditions
Proper administration, monitoring, and adjustment
are essential for efficacy and safety.
Understanding the indications, delivery methods,
and potential risks helps ensure optimal patient
outcomes.

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FA IN PEDIATRIC
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Sources:
UpToDate. High-flow Nasal cannula oxygen therapy in children. June 3, 2024
UpToDate. Non-invasive ventilaton for acute and impending respiratory failure in children. June 3, 2024
West Respiratory Physiology 10th ed.
WHO. Oxygen Therapy for Children. 2019

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Sources

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