Oxygen Therapy

WHY BODY NEED OXYGEN ?

cellular respiration .
immune functions.
HOW OUR BODY GET OXYGEN FROM
ENVIRNOMENT
CONCEPT OF HYPOXIA AND HYPOXCEMIA

Hypoxemia Hypoxia
Dec O2 in Dec O2 in
blood tissue
Clinical use of oxygen

 Oxygen is a treatment for hypoxemia due to any cause.

 Oxygen has not been proven to have any consistent effect on the sensation of
breathlessness in non hypoxaemic patients.
 Clinicians must bear in mind that supplemental oxygen is given to improve
oxygenation, but it does not treat the underlying causes of hypoxaemia which
must be diagnosed and treated as a matter of urgency.
Some common causes of hypoxemia.

• Hypoventilation • Impaired gas

• Dec O2 due to • V/Q
dec mismatch diffusion
environmental O2 • when part of • Conducting
concentration or your lung zone is not
blockage of receives functioning
upper respiratory oxygen without properly
track. blood flow or problems with
blood flow alveolar
• Like CO without membrane .
poisoning. oxygen.  • Copd ,pulmonar
• choking • PTE . y
• High altitudes edema ,aspirati
onal
pneumonia.
Candidates of O2 therapy

 The oxygen saturation should be checked by pulse oximetry in all breathless

and acutely ill patients.
 Monitor oxygen saturation while checking pt vitals .
 If they dropped O2 saturation always offer them supplemental O2.
 Pulse oximetry must be available in all locations where oxygen is used.
 All critically ill patients outside of a critical care area e.g ( ICU ,HDU ,step
down units) should be assess for supplemental O2 on the basis of National
Early Warning Score.
National Early Warning Score or
(NEWS)
 This Score systems alerts clinician about disease severity .
 This scorning system is based upon some vitals analysis on hourly basis .like
 1.  Respiratory rate
2.  Oxygen saturations
3.  Temperature
4.  Systolic blood pressure
5.  Heart rate
6.  Level of consciousness
Treatment strategy for O2 use
 Complete hx of pt disease .
 Physical examination.
 Inv if pt has like CT, cxr echo etc ..past hospital admission record if pt has .
 Closely monitoring with pulse oximeter and atrial blood gases for need of
oxygen .
 Once pt hypoxemia is dx then Calculation of O2 dose .
 Target O2 saturation .
 Mode of O2 delivery equipment .
Physical examination is imp

 Usually pt of hypoxemia has cyanosis .

 Most often tachypnea is accompany with tachycardia
 Often pt who has inc respiratory rate or dec respiratory rate need oxygen
therapy.
 Complete Examination of CVS and respiratory system will some time give you
clue about hypoxemia .
Calculation of O2 dose

 Use pulse oximeter

 Normal range of O2 % normal healthy adult ( 94% to 98%).
 Dec O2 less then 94% hypoxemia .
 Inc O2 more then 98 % hyperoxemia .
 In hypercapnic respiratory drive pts. Normal O2 % is (88 % to 92 % )

 ABGs
 normal PH ( 7.35 to 7.45 ) ……..
 Normal O2 ( 10 to 13 kpa ) (75 to 100 mmhg ) less then 75 hypoxemia .copd less then
65% .
 Normal C02 ( 5.1 to 5.6 kpa ) (35 to 45 mmhg ) more then 6kpa hypercarbia
Targets of O2 saturation

 When you start 02 always write target sat on tx chart .

 In normal adults target sats are (94 to 98 mmhg )
 In pt with hypercapnic res drive ( 88 % to 92 % )
Modes of oxygen delivery equipment’s.
 Modes of oxygen delivery system will help you to titrate O2 up and down to
get target saturation .
Face tent mask Delivers only 40% Oxygen at 10-15 liters per minute

Face tents are used

 to provide a controlled concentration of oxygen and increase moisture for
patients who have facial burn or a broken nose
Critical illnesses requiring high levels of
supplemental oxygen
 Critical illnesses required high dose of oxygen .
 For example : in the cases of Cardiac arrests , Shock, sepsis, major trauma,
near-drowning, anaphylaxis, major pulmonary hemorrhage.
 The initial oxygen therapy is started with a reservoir mask @ 15 l/min.
 If oximetry is unavailable, continue to use a reservoir mask until definitive
treatment is available
 Patients with COPD and other risk factors for hypercapnia who develop critical
illness should have the same initial target saturations as other critically ill
patients pending the results of blood gas measurements, after which these
patients may need controlled oxygen therapy or supported ventilation if there
is severe hypoxemia and/or hypercapnia with respiratory acidosis.
…………………………………………………………………
Cardiac arrest
Shock, sepsis, major trauma, near-
drowning, anaphylaxis, major
pulmonary haemorrhage
Major head injury
Carbon monoxide poisoning
Point to remember
Use bag-valve mask during active
resuscitation Aim for maximum
possible oxygen saturation until the
patient is stable
Also give specific treatment for the
underlying condition
Early intubation and ventilation if
comatose
Give as much oxygen as possible using a
bag-valve mask or reservoir
mask. Check carboxyhaemoglobin
levels
In co posning sats are often normal and
pco2 is also normal but pt has toxicity .
 illnesses requiring moderate levels of
supplemental oxygen if hypoxemia present

 The initial oxygen therapy is nasal cannulae at 2–6 l/min (preferably) or simple face mask
at 5–10 l/min unless stated otherwise.
 c For patients not at risk of hypercapnic respiratory failure who have saturation ,85%,
treatment should be commenced with a reservoir mask at 10–15 l/min.
 c The recommended initial oxygen saturation target range is 94–98%.
 c If oximetry is not available, give oxygen as above until oximetry or blood gas results are
available.
 c Change to reservoir mask if the desired saturation range cannot be maintained with
nasal cannulae or simple face mask (and ensure that the patient is assessed by senior
medical staff).
 c If these patients have co-existing COPD or other risk factors for hypercapnic respiratory
failure, aim at a saturation of 88–92% pending blood gas results but adjust to 94–98% if the
PaCO2 is normal (unless there is a history of previous hypercapnic respiratory failure
requiring NIV or IPPV) and recheck blood gases after 30–60 min.
Acute hypoxaemia
Acute asthma Grade , Pneumonia , Lung cancer,
acute heart failure, ,pleural effusion .pul edema
Reservoir mask at 10–15 l/min if initial SpO2 ,85%,
otherwise nasal cannulae or simple face mask
Management depends on underlying cause.
Consider CPAP or NIV in cases of pulmonary oedema.
Most patients with minor pulmonary embolism are
not hypoxaemic and do not require oxygen therapy .
Most patients with pleural effusions are not
hypoxaemic. If hypoxaemic, treat by draining the
effusion as well as giving oxygen therapy
conditions requiring controlled or low-
dose oxygen therapy
 COPD and other conditions requiring controlled or low-dose oxygen therapy.
 Prior to availability of blood gases, use a 28% Venturi mask at 4 l/min and aim
for an oxygen saturation of 88–92% for patients with risk factors for
hypercapnia but no prior history of respiratory acidosis.
 Aim at a prespecified saturation range (from alert card) in patients with a
history of previous respiratory acidosis. These patients may have their own
Venturi mask. In the absence of an oxygen alert card but with a history of
previous respiratory failure (use of NIV or IPPV), treatment should be
commenced using a 28% oxygen mask at 4 l/min in prehospital care or a 24%
Venturi mask at 2–4 l/min in hospital settings with an initial target saturation
of 88–92% pending urgent blood gas results
 c If the saturation remains below 88% in prehospital care despite a 28% Venturi
mask, change to nasal cannulae at 2–6 l/min or a simple mask at 5 l/min with
target saturation of 88–92%. All at-risk patients with alert cards, previous NIV or
IPPV or with saturation ,88% in the ambulance should be treated as a high priority.
Alert the A&E department that the patient requires immediate senior assessment
on arrival at the hospital.
 If the diagnosis is unknown, patients aged .50 years who are long-term smokers
with a history of chronic breathlessness on minor exertion such as walking on level
ground and no other known cause of breathlessness should be treated as if having
COPD for the purposes of this guideline. Patients with COPD may also use terms
such as chronic bronchitis and emphysema to describe their condition but may
sometimes mistakenly use ‘‘asthma’’. FEV1 should be measured on arrival in
hospital if possible and should be measured at least once before discharge from
hospital in all cases of suspected COPD
 c Patients with a significant likelihood of severe COPD or other illness that
may cause hypercapnic respiratory failure should be triaged as very urgent
and blood gases should be measured on arrival in hospital.
 Blood gases should be rechecked after 30–60 min (or if there is clinical
deterioration) even if the initial PaCO2 measurement was normal
 If the PaCO2 is raised but pH is >7.35 ([H+ ] (45 nmol/l), the patient has
probably got long-standing hypercapnia; maintain target range of 88–92% for
these patients. Blood gases should be repeated at 30–60 min to check for
rising PaCO2 or falling pH.
 c If the patient is hypercapnic (PaCO2 .6 kPa or 45 mm Hg) and acidotic
(pH ,7.35 or [H+ ] .45 nmol/l) consider non-invasive ventilation, especially if
acidosis has persisted for more than 30 min despite appropriate therapy
COPD and other conditions causing fixed airflow
obstruction (eg bronchiectasis)
Neuromuscular disease, neurological condition and chest
wall deformity, Morbid obesity
May need lower range if acidotic or if known to be very
sensitive to oxygen therapy. Ideally use ‘Alert cards’ to
guide therapy based on previous blood gas results.
Increase Venturi mask flow by up to 50% if respiratory
rate is above 30 bpm
May require ventilatory support. Risk of hypercapnic
respiratory failure
Oxygen toxicity

 Hyperoxemia O2 % more then 98 %....

 causes
 pt is poorly monitored for target saturation.
 Incomplete instructions for staff on tx charts.
 Complications
 Worsening of hypercapnic respiratory failure.( PaO2 is raised above 10 kPa)
 Damage from oxygen free radicals.(inc cellular stress )
 Increased systemic vascular resistance.(stroke and MI risk inc ).
 Delay in recognition of physiological deterioration.
 Absorption atelectasis ( inc po2 (increased V/Q mismatch) --- atelectasis

Topics that are related to oxygen therapy but
we missed in this lecture due to shortage of time

 • Oxygen use for high altitude activities.

 • Oxygen use during air travel.
 • Underwater diving and diving accidents.
 • Oxygen use in animal experiments.
 • Oxygen use in high-dependency units.
 • Oxygen use in intensive care units.
 • Interhospital level 3 transfers.
 • Hyperbaric oxygen.
 • Respiratory support techniques including tracheal
 intubation, invasive ventilation and non-invasive ventilation (NIV) (CPAP is included).
 • Self-initiated use of oxygen by patients who have
 home oxygen for any reason.
 • Ongoing care of hypoxaemic patients at home
Thankyou ……