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Oxygen Delivery Systems

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HANA' Mahmud
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14 views6 pages

Oxygen Delivery Systems

Uploaded by

HANA' Mahmud
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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OXYGEN DELIVERY SYSTEMS

Oxygen devices and flow rate


Type Oxygen flow Oxygen Indication/
concentration common usage
delivered at
optimum oxygen
flow
1) High 15L/min 60-90% High dose O2
concentration therapy
reservoir mask Trauma &
(non- emergency use
rebreathing
mask)

1) Simple face 5-10 L/min 40-60% Respiratory failure


mask without
Build up CO2 in hypercapnia (type
the mask and I)
rebreathing if use Not suitable for
O2 flow <5L/min hypercapnia (type
2 respiratory
failure)
2) Venturi mask Different FiO2 Recommended
concentration when a fixed O2
from 24-60% concentration is
desired in
patients whose
ventilation is
dependant on the
hypoxic drive
3) Nasal cannula 1-4 L/min <40% Low medium
If more than concentration of
4l/min, can cause O2
discomfort More tolerable by
patient
Principle of oxygen supplementation
1. Assessing patient
 O2 is treatment for hypoxemia, not breathlessness.
 High concentration of O2 given (15L/min) immediately for critically ill
patients
 Supplement O2 is given to improve oxygenation, but it does not treat the
underlying causes of hypoxemia which must be diagnosed and treated as
a matter of urgency.
 Clinical assessment is recommended if the saturation falls by ≥3% or
below the target range for the patient.
 Pulse oximetry used to measure oxygen saturation.
 Use NEWS score to guide early warning signs

2. Target O2 prescription: Target O2 saturation 94-98%


3. O2 administration: use appropriate devices and flow rates to achieve the
target saturation
4. Monitoring and maintenance of target saturation
5. Weaning and discontinuation of O2 therapy
 O2 should be reduced in stable patients with satisfactory O2 saturation
 O2 should be discontinued once the patient can maintain saturation within
or above the target range breathing air

Hypoxemia: when arterial oxygen tension (Pao2) is below normal (normal Pao2 =
80–100mmHg). Hypoxia: the failure of oxygenation at the tissue level. It is not
measured directly by a laboratory value (though an increased arterial lactate
level usually accompanies tissue hypoxia).
Hypoxia and hypoxemia may or may not occur together.
Generally, the presence of hypoxemia suggests hypoxia. However, hypoxia may
not be present in patients with hypoxemia if the patient compensates for a low
Pao2 by increasing oxygen delivery. This is typically achieved by increasing
cardiac output or decreasing tissue oxygen consumption.
Conversely, patients who are not hypoxemic may be hypoxic if oxygen delivery
to tissues is impaired or if tissues are unable to use oxygen effectively.
Nevertheless, hypoxemia is by far the most common cause of tissue hypoxia.
Most common aetiology of hypoxemia:
- Sepsis
- Cardiac abnormalities
- Pulmonary embolism
Clinical assessment:
- Patient susceptible to hypoxemia: cardiac or pulmonary disease, smoker,
history of respiratory illness
- Atelectasis and pneumonia risk factors: elderly, obese, neurological
disease, pt on sedatives or opiates
- SOB/ dyspnea, mental confusion
- Tachypnea (RR>24/min), can be absent in severe hypoxemia or limited
cardiac reserve
- Cynosis, hypothermia: tissue hypoxia
Management:
- Patient assessment: stable or life-threatening—check vital signs: HR, RR,
BP, mental status
- Unstable pt or SPO2 <90%:
o Start on O2/ immediate high-flow O2 therapy
o Send ABG & arterial lactate
o Chest x-ray,
o Determine O2 device and flow rate (venturi mask/CPAP/ intubation)
o Another workup to consider: C&S if infection suspected, cardiac
studies (ECG, echo, pulmonary artery catheterization)
- Stable patient:
o Order pulse oximetry
 Normal saturation (>95%): hypoxemia unlikely, but ± tissue
hypoxia
 VBG—check serum bicarbonate (abnormal: <18 or
>30)  acid-base disorders
o Normal serum bicarbonate: observation
o Grossly abnormal: chest x-ray, ABG, arterial
lactate
 Saturation 90-95%
 Trial of low-flow O2 (by nasal cannula)
 Chest x-ray
 Observe for the response to O2
o If improving (SPO2 >98%): observe further with
indicated any diagnostic test
o If does not rise: ABG & arterial lactate. Consider
high-flow O2 or intubation

Intubation indication:
1) Need for positive pressure ventilation
2) Airway obstruction
3) Airway protection (eg: neurological impairment. GCS <8)
4) Provide tracheobronchial toilet when pt is unable to generate an effective
cough
Criteria for intubation:
1) Failure to maintain PaO2 of <70 on 100% O2
2) CO2 retention with a CO2 of >50
3) RR >35
4) Use of accessory muscle
5) Failure to protect airway—in neurological impairment (GCS <8)

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