OXYGEN THERAPY

Prepared by: Josephine Grace P. Camarillo, RTRP

 KEY TERMS:
• Absorption atelectasis • Low-flow oxygen delivery
• Air entrainment mask system
• Anatomic reservoir • Nasal cannula
• FIO2 • Nonrebreathing mask
• Head box • Oxygen analyzer
• High-flow oxygen • Partial rebreathing mask
delivery system • Retinopathy of prematurity
• Hypoxemia • Simple oxygen mask
• Isolette • Transtracheal catheter
AARC Clinical Practice Guideline Oxygen Therapy in the
Acute Care Hospital

INDICATIONS:
• Documented hypoxemia.
• An acute care situation in which hypoxemia is suspected
substantiation of hypoxemia is required within an appropriate
period of time following initiation of therapy.
• Severe trauma
• Acute myocardial infarction
• Short-term therapy or surgical intervention
CONTRAINDICATIONS:
• No specific contraindications to oxygen therapy exist when
indications are judged to be present.
 PRECAUTIONS AND/OR POSSIBLE
COMPLICATIONS:
• With PaO2 or 60 torr, ventilatory depression may occur in
spontaneously breathing patients with elevated PaCO2.
• With FIO2 or = 0.5, absorption atelectasis, oxygen toxicity, and/or
depression of ciliary and/ or leukocytic function may occur
• Supplemental oxygen should be administered with caution to
patients suffering from paraquat poisoning and to patients
receiving bleomycin.
• During laser bronchoscopy, minimal levels of supplemental oxygen
should be used to avoid intratracheal ignition.
• Fire hazard is increased in the presence of increased oxygen
concentrations.
• Bacterial contamination associated with certain nebulization and
humidification
 LIMITATIONS OF PROCEDURE:
• Oxygen therapy has only limited benefit for the
treatment of hypoxia due to anemia, and benefit
may be limited with circulatory disturbances.
• Oxygen therapy should not be used in lieu of but
in addition to mechanical ventilation when
ventilatory support is indicated.
 ASSESSMENT OF NEED:
• Need is determined by measurement of inadequate oxygen tensions and/or
saturations, by invasive or noninvasive methods, and/or the presence of
clinical indicators as previously described.

• ASSESSMENT OF OUTCOME:
• Outcome is determined by clinical and physiologic assessment to establish
adequacy of patient response to therapy.
 MONITORING:
Patient:
• Clinical assessment including, but not limited to,
cardiac, pulmonary, and neurologic status
• Assessment of physiologic parameters: measurement
of oxygen tensions or saturation in any patient treated
with oxygen
 In conjunction with the initiation of therapy; or
 Within 12-hours of initiation with FIO2 0.40
 Within 8-hours, with FIO2 or 0.40 (including postanesthesia recovery)
 Within 72 hours in acute myocardial infarction
 Within 2 hours for any patient with the principal diagnosis of COPD
 Within 1 hour for the neonate
 MONITORING:
Equipment
• All oxygen delivery systems should be checked at least once per
day.
• More frequent checks by calibrated analyzer are necessary in
systems.
 Susceptible to variation in oxygen concentration
 Applied to patients with artificial airways
 Delivering a heated gas mixture
 Applied to patients who are clinically unstable or who require an FIO2 of 0.50 or
higher
• The standard of practice for newborns appears to be continuous
analysis of FDO2 with a system check at least every 4 hours, but
data to support this practice may not be available.
 THEORY OBJECTIVES
At the end of this chapter, the reader should be able to:
•State the indications for oxygen therapy.
•Define high-flow and low-flow oxygen delivery systems, and categorize six
administration devices.
•Explain the role of the nasopharynx and the oropharynx, and the effect of
tidal volume and respiratory rate, on the delivered FIO2 by low-flow oxygen
systems.
•Explain the principle of operation for the majority of high-flow oxygen
delivery systems.
•Diagram the flow of oxygen and air through an air entrainment mask.
•Given an oxygen flow and entrainment ratio, calculate the total flow.
•Differentiate between the indications for the use of a low-flow or high-flow
oxygen system.
•Explain the rationale for the use of a humidifier with oxygen delivery devices.
 THEORY OBJECTIVES
• List the oxygen delivery devices that can be categorized as enclosures and
their advantages and disadvantages and FIO2 ranges.
• Describe the oxygen percentages that can be delivered by the different
enclosures.
• Describe the proper use of an oxygen analyzer.
• Describe the two most common types of oxygen analyzers.
• Explain the following conditions associated with oxygen administration:
• — Absorption atelectasis
• — Interruption of hypoxic drive
• — Oxygen toxicity
• — Retinopathy of prematurity
• •Discuss the role of arterial blood gas analysis in the administration of
oxygen.
What is oxygen therapy?

• Is the administration of oxygen at concentrations

greater than that in room air to treat or prevent
hypoxemia
• Oxygen therapy, when indicated and administered
by a knowledgeable respiratory care practitioner,
may have a dramatic effect on the condition of a
patient when suffering hypoxemia.
• Oxygen is a drug.
What is oxygen
•Element
•Gas and
•Drug
3 basic essential in life

•Oxygen
•Water
•Food
Estimated pao2

• 103.5 - (0.42 X age)

• What is the best way to assess the need for

oxygen?
Question:

•What is the PRIMARY indication

for oxygen therapy?
GOALS OF OXYGEN THERAPY:

Correct Hypoxemia
Decrease myocardial work
Decrease the work of breathing
Signs and symptoms

• Tachypnea, Dyspnea, Hyperpnea

• Tachycardia, dysrhythmias, pulse change,
hypertension
• Anemia, polycythemia
• Restlessness, disorientation, lethargy
• Cyanosis, digital clubbing
 Low flow oxygen delivery systems:
• It is defined as a system that supplies oxygen-enriched
gas as part of a patient’s inspiratory flow needs.
• Low flow devices rely on the nasal and oral pharynx to
serve as a reservoir enhancing FiO2 by temporarily
holding a small amount of 100% oxygen.
• This reservoir is referred to as the anatomic reservoir.
• Low flow devices only provide part of the inspiratory
needs, the delivered fraction of inspired oxygen (FiO2
expressed as a decimal) may vary, depending of several
factors
• It does not provide a constant or know concentration of
inspired O2
Application of low flow oxygen system

• The low flow oxygen devices are adequate for

administering oxygen to the majority of patients.
• The FiO2 cannot be accurately measured therefore
if the patient must receive a precise oxygen
concentration, these devices would not be
indicated.
• Unusual respiratory rates and depths can
significantly alter the FiO2
Factors that may alter fIo2

• Flow of oxygen through the device

• The higher the flow the higher the FiO2
• Patient’s RR and tidal volume
Low flow oxygen devices
• Nasal cannula
• Simple Oxygen Mask
• Partial Rebreathing Mask
• Nonrebreathing Mask
 Nasal cannula
• It is designed to rest on the upper lip
with the two prongs directed into each
into each naris of the nose.
• ADVANTAGE: quite comfortable, and
hardly notice its presence.
Application:

• The tubing of the cannula is looped over each ear and the slide is
adjusted so it is barely snug under the chin.
Oxygen Concentration
 Transtracheal Catheter
• is a small catheter that is
inserted into the trachea
surgically at the second
cartilaginous ring of the trachea.
• lower liter flows used
• These devices are used for
patients who require continuous
low-flow oxygen delivery
Transtracheal Catheter
Simple oxygen mask
• It delivers low flow of oxygen, meeting only part pf
a patient’s inspiratory flow needs.
• The principle behind a mask is to add an oxygen
reservoir external to the patient.
• The volume of the mask serves as the reservoir
which is greater than the anatomical reservoir
• The volume of the mask is filled with 100% oxygen
at the end inspiration.
 Simple oxygen mask
• Delivers a low flow of oxygen,
meeting only part of a patient’s
inspiratory flow needs.
• The underlying principle in use of a
mask is to add an oxygen reservoir
external to the patient.
• The FIO2 - ranges between
• 35% and 55%
• flow minimum of 5 L/min
 partial rebreathing mask
• Takes the reservoir concept of a
simple mask one step further by the
addition of a reservoir bag.
• It has a one-way valve
• deliver 60% to 80% oxygen
 nonrebreathing mask
• It is similar to a partial rebreathing
mask.
• The one-way valve between the mask
and bag
• This valve may consist of a disk and
spring or a simple diaphragm valve.
• The valve/s over the side port/s
prevent the entrainment of ambient
air on inspiration.
• It is possible to deliver 60% to 80%
oxygen if the fit of the mask is good
 Hi-Ox
• is a disposable high-FIO2
delivery mask that incorporates
a reservoir bag and multiple
one-way valves.
• The one-way valves are
configured in a manifold
between the reservoir bag and
the mask.
• Oxygen concentrations 80% at8
L/min.
Hi-Ox
Hi-Ox
 Oxymask
• Disposable low-flow delivery device
• Depending on the flow rate, the mask
delivers between 24% and 90% oxygen
 Oxymask
• The oxygen diffuser (inlet)
is proximal to the nose and
mouth, delivering 100%
oxygen close to the point
of entry into the
respiratory tract.
• The larger ports on the
sides of the mask improve
patient comfort, and they
facilitate communication
and oral intake of fluids
with a straw.
High flow oxygen delivery systems
• It provides all of the total inspiratory flow required
by the patient.
• Any inspired gas is provided solely by the device.
• Respiratory pattern and rate will not affect the
delivered FiO2 by these devices.
• The majority of high flow systems utilize jet mixing
and precisely mix oxygen and ambient air to
deliver a specific FiO2.
Vapotherm Precision Flow High-Flow
Cannula
• is a high-flow oxygen therapy system that is capable of delivering
oxygen flows from 1 to 40 L/min at humidity contents of 55 mg/L at a
temperature of 41°C.
 Air Entrainment Masks
• High-flow oxygen systems use jet mixing and
precisely mix oxygen and ambient air to deliver
a specific FIO2.
• Use the principle of viscous shearing and
vorticity.
• The high-velocity gas (oxygen) exiting the
nozzle (jet) causes shear forces to develop
distal to the nozzle orifice and along the axis of
the gas flow.
Venturi mask
CLINICAL APPLICATIONS OF LOW-
FLOW AND HIGH-FLOW OXYGEN
SYSTEMS
• The low-flow oxygen devices are adequate for
administering oxygen to the majority of patients
• FIO2 cannot be accurately measured
• High flow systems are indicated for patients who
require a constant, precise FiO2.
• When using these devices, FiO2 will not vary from
what has been set.
HUMIDIFICATION
• Oxygen from a cylinder or piping
system is anhydrous.
• All oxygen administration devices
should be used with a separate
humidifier.
• With an air entrainment mask, it is
more efficient to provide
humidification externally by using a
collar to attach a nebulizer to the air
entrainment port.
enclosures

• These are devices designed to contain all

part of the patient’s body in an oxygen-
enriched atmosphere
• newborns and infants
ISOLETTE
• Thermally
controlled
• Oxygen-enriched
• Humid
environment
• Plexiglass
 HEAD BOX or Oxygen Hood
• Newborn infant
• It encloses only the head
• Plexiglass
• Warmed, humidified oxygen is
supplied to the box by means
of large bore aerosol tubing
HAZARDS ASSOCIATED WITH
ENCLOSURES:
• fire hazard
• No battery-powered electric toys, radios or other
electrically powered appliances
• No visitors
• No smoking
 TYPES OF OXYGEN ANALYZERS
• Galvanic Oxygen Analyzer
 Uses a chemical reaction of oxygen combining with
water and electrons to form hydroxyl ions (OH).
 oxidation-reduction reaction
• Polarographic Oxygen Analyzers
 Same with galvanic oxygen analyzer with addition
battery to polarize the electrodes
 Use of an Oxygen Analyzer

•Before measurement – calibrated

• Calibration is performed at room air (21%) and at
100% (pure oxygen)
•To measure the FIO2, sample the gas -
close to the patient.
• Percentage
• Fraction of the inspired oxygen
HAZARD OF OXYGEN THERAPY

• Absorption Atelectasis
• Oxygen-Induced Hypoventilation
• Oxygen Toxicity
• Retinopathy of Prematurity (ROP)
 ABSORPTION ATELECTASIS
• Prolonged exposure to high concentrations of oxygen causes the
gradual washout of nitrogen from the lungs.
• The atmosphere - 78% nitrogen.

• As the nitrogen is washed out and replaced by oxygen, the

oxygen is absorbed into the blood. As it absorbed, the alveolar
volume decreases, resulting in a diffuse microatelectasis.
• In the patient who is compromised and breathing very shallowly,
this effect, termed absorption atelectasis, - pronounced.
 OXYGEN-INDUCED
HYPOVENTILATION

• COPD - retain levels of CO2

• When these patients are given moderate to high
concentrations of oxygen, the body’s chemoreceptors slow
respiratory rate and depth as a result of the now adequate
levels of PaO2
• As a result of the induced hypoventilation, arterial CO2 levels
may rapidly increase, with resulting rapid shifts in pH.
Oxygen Toxicity

• Prolonged exposures to high concentrations

of oxygen at ambient pressures - produce
detrimental changes in the pulmonary
system.
• Progressive changes: consolidation,
thickening of the capillary beds, formation of
hyaline membranes and fibrosis, edema, and
atelectasis
RETINOPATHY OF PREMATURITY

• It is a potential complication of oxygen therapy in the

newborn.
• Administration of a high concentrations of oxygen causes
vasoconstriction in the retina.
• The vessels become obliterated and normal growth ceases
in the periphery of the retina and eventually lead to partial
retinal detachment and blindness.
• PaO2 should be maintained between 50 to 80 mmHg.