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O2 delivery systems
High-flow
Venti-masks (air entrainment masks) Mechanical aerosol systems High-flow humidifier systems
Low-flow
Nasal cannula Simple masks Partial rebreathing masks Non-rebreathing masks
Entrainment ratios
Entrainment ratio 1/25 1/10 1/7 1/5 1/3 1/1.7 1/1 1/0.6 FiO2 0.24 0.28 0.31 0.35 0.40 0.50 0.60 0.70 Minimal flow to operate 4 4 6 8 8 12 12 12 Total flow (L/min) 104 44 48 48 32 32 24 19
Whats my PaO2?
a: On room air? b: On 0.50 FiO2? c: On 0.80 FiO2?
The answers:
PaO2 = FiO2 x (barometric pressure water vapor pressure) - PaCO2/RQ PaO2 = FiO2 X (760 - 43) - PaCO2/0.8 a: PaO2 = .21 X 713 - 40/0.8 = 100 b: PaO2 = .50 X 713 - 40/0.8 = 306 c: PaO2 = .80 X 713 - 40/0.8 = 520
60 40 20 0
20
40
60
80
100
120
140
160
PO2 mmHg
Resorption atelectasis
100% O2
oxygen nitrogen
B
PO2 =673 PCO2 = 40 PH2O = 47
After ~15 minutes, blood N2 is depleted. Poorly ventilated & well perfused units (A) become atelectactic.
Non-rebreathing system
Room air Gas source
Expiratory gas
Reservoir
To patient
One way valves
room air
60 40 20 0
pH
CO2 temp
20
40
60
80
100
120
140
160
PO2 mmHg
Oxygen delivery = # trucks X how full they are loaded X how fast they go
DO2 = 1.38(hgb X sat X CI) + (pO2 X 0.003)
Entrainment ratios
Flow Total Entrainment rate flow FiO2 ratio (O2/air) (L/min) (L/min) 0.24 1-25 4 104 0.28 1-10 4 44 0.31 1-7 6 48 0.35 1-5 8 48 0.4 1-3 8 32 0.5 1-1.7 12 32 0.6 1-1 12 24 0.7 1-0.6 12 19
System Ventimasks
Aerosol
Estimating FiO2
O2 Flow rate FiO2 O2 Flow rate FiO2 O2 Flow rate FiO2
Simple mask
Exhalation ports
Open ports for exhaled gas Air entrained through ports if O2 flow through does not meet peak insp flow 35-55% O2 at 6-10 L/min
O2 inlet
O2
Reservoir
O2 directed into reservoir Insp: draw gas from bag & ? room air Exp: first 1/3 of exhaled gas goes into bag (dead space) Dead space gas mixes with new O2 going into bag Deliver ~60% O2
Non-rebreathing mask
One-way valves
O2
Valve prevents exhaled gas flow into reservoir bag Valve over exhalation ports prevents air entrainment Delivers ~100% O2, if bag does not completely collapse during inhalation
Reservoir