OXYGEN THERAPY

DR. ANEELA HUSSAIN

 Oxygen is a drug
Therefore should be prescribed
properly
 Prescribtion should have……

• Flow rate.
• Delivery system.
• Duration.
• Monitoring.
 CHECK LIST
• How can inadequate tissue oxygenation be
recognised?
• When is acute oxygen therapy appropriate and
at what dose?
• Is outcome of disease improved?
• How is oxygen best delivered and is
humidification necessary?
• What are the dangers of oxygen treatment?
• What assessment and monitoring are necessary?
• When should oxygen therapy be stopped?
 EVALUATE……….

• Arterial hypoxaemia
• Low inspired oxygen partial pressure (high
altitude)
• Alveolar hypoventilation (sleep apnoea, opiate
overdose)
• Ventilation­perfusion mismatch (acute asthma,
atelectatic lung zones)
• Right to left shunts
• Failure of oxygen­haemoglobin transport system
• Inadequate tissue perfusion
• Low haemoglobin concentration
• Abnormal oxygen dissociation curve
(haemoglobinopathies, high
• carboxyhaemoglobin)
• Histotoxic poisoning of intracellular enzymes
(cyanide poisoning,
• septicaemia)
 Recognizing hypoxia…
• Dyspnea.
• Altered mentation
• Cyanosis.
• Arrhythmia.
Arterial oxygen saturation (Sao2) and Pao2
are readily measured and remain the
principal clinical indicators for initiating,
monitoring, and adjusting oxygen treatment.
mixed venous oxygen partial pressure (Pvo2),
which is measured in pulmonary artery blood,
approximates to mean tissue Po2 and is a
better index of tissue oxygenation.
 Indications………
Empirically: without another thought…..
Shock.
Cardiac arrest.
Resp arrest.
Hypotension.
 Guidelines for initial oxygen
dose….

Cardiac or respiratory arrest…….100%

Hypoxemia with paco2 < 40mmhg…….40-60%
Hypoxemia with paco2 > 40mmhg…….24%
AMERICAN COLLEGE OF CHEST
PHYSICIANS AND NATIONAL HEART
LUNG AND BLOOD
RECOMMENDATIONS FOR INSTITUTING
OXYGEN THERAPY
• Cardiac and respiratory arrest.
• Hypoxemia paO2 < 60 mmhg /SaO2<90%
• Hypotension ( sys< 100 mmhg)
• Low cardiac output and metabolic acidosis.
(HCO3 < 18mmol/l)
• Resp rate > 24/min.
 Pointers…….
• Increasing the FiO2 ( Fraction of inspired
oxygen) increases hb sat of O2 and plasma….
• Acute conditions( asthma, PE) ……60-100%....
Correct paO2 from 60 – 70 mmhg
• Copd…… 24- 27% and keep paO2 above 50
mmhg. And pH above 7.26
 BTS guidelines for critical illness…
• Start with 15 l/min……5-10l/min
• Once stable, reduce the dose and aim for 94-
98% spo2.
• Do ABGs after 30-60 mins.
• In copd / other risk factors of hypercapnea
who develop critical illness, manage as above
initially then controlled oxygen therapy
keeping spo2 88-92%
BTS guidelines for acute oxygen
therapy.
BTS guidelines for low dose controlled
O2 therapy
• 28% venturi mask..4l/min….spo2 88-92%
• If paco2 normal then 94-98%( unless hx
ippv/niv) and check ABGs after 30-60 mins.
• If still <88% then shift to 5l/min on simple
mask.
• If paco2 raised with >7.32 pH then maintain as
explained.
• If paco2 raised with <7.32 pH then consider
NIV.
 Conditions for which o2 not required
till patient hypoxemic
• Initially 2-6l/min on nasal cannulae and 5-10
l/min on simple face mask…if spo2< 85% use
reservoir mask…..
• Keep spo2 94-98%.
• Poisonings.
• Obstetric emergencies.
• MI
• Renal/ metabolic causes.
 O2 delivary devices
• Low flow devices.
• Nasal cannulae.
• Nasal catheters.
• Simple mask.
• Trans tracheal catheters.
• Reservoir/pendant reservoir.
• Non re-breather/ partial re-breather mask.
• Face tent.
• Tracheal mask.
Nasal cannulae
Simple mask
• High flow devices:
• Venturi mask.
• Aerosol mist mask system.
Venturi mask
NIV
• Nasal cannulae: 1-6 l/min 24-44% FiO2….

( For each litre of flow add 4% to FiO2)

• Simple mask 5-12 l /min….40-50% FiO2

(at < 5l co2 will not be flushed)

• Re-breather mask: FiO2 50-70%
 Monitoring of the effectiveness of O2
therapy

• Pulse Oximetry
• Arterial Blood gases
• Work of Breathing
• Tidal Volume and Respiratory Rate
• Pulse and Blood Pressure
 When to stop o2??
• When the spo2 is >90%....
• R/R < 24/min.
• Po2 above 60-70mmhg
• Clinically relaxed.
• Pulse normal with sys bp> 100