Oxygen therapy..

(neonate –pedia –adult)

Done by :
Miss ; saja A. Al-
marshad..
th     
RT 4 level student.
Enjoy my presentation that I
guarantee it will be full of
oxygen .. & interesting
things to know , SO
BE READY ^_^
SAJO ..
Info.
• 1774 – J . Priestly produced O2 –
“Dephlogisticated Air”
• 1776 – A . L . Lavoisier termed this vital air –
OXYGEN
• Late 1800 – Bonnaire gave O2 to preterm “ Blue
Baby ”
with success .


• 1907 – A . Lane invented NASAL CATHETER

• 1919 – L . Hill developed O2 TENT.
• 1920 - O2 therapy became routine for “ SICK NEW
BORN ”
•
Impotency of o2..
• Living cells must be fuelled with
oxygen in order to survive!
• The respiratory system functions to
supply oxygen to the cells and
remove carbon dioxide from the
tissues.
• Illness and injury increase tissue
oxygen demand


•
 Definition


• Oxygen therapy is the administration

of oxygen at concentrations greater
than that in ambient air (21%) with
the intent of treating or preventing
the symptoms and manifestations
of hypoxia
Indications for oxygen
therapy
• Hypoxemia (Actual or suspected)
• PaO2 < 60 mm Hg
• SaO2 < 90%
• Adult, children and infants > 28 days on room air
PaO2 and/or SaO2 below desirable range for specific

clinical situation (e.g..

• patients with intra-cardiac shunting).
• Neonates PaO2 < 50 mm Hg, SaO2 < 88%, or capillary
PO2 < 40 mm Hg
• Severe trauma
• Short term therapy
• Post anesthesia recovery
CONT..
• Respiratory • Cardiac
compromise compromise
– Cyanosis – Chest pain
– Tachypnoea – Shock
– Hypoxemia – Tachycardia
– Partially – Arrhythmias
obstructed 

airway
• Neurological
deficits


• – CVA
 – Spinal injuries
– Coma
Aim of o2 therapy:

therap THERAPUTIC GOAL,,
• to increase PaO2 to USE the lowest FIO2

acceptable level possible for shortest

with concentration time possible to
of oxygen. achieve satisfactory
Pao2(50-70 mmhg ,
• newborns 60-80,
• to decrease infant 80-100, child-
respiratory rate and adult)
work of breathing Carful monitoring

• especially in neonate
is required.
• Dec. The effect of

Hypoxemia & high
 Precautions/ Complications

• Ventilatory depression
• PaO2 > 60 mm Hg may depress ventilation in some
patients with chronic
Hypercapnia.

FiO2 > 50%

• O2 toxicity
• Absorption atelectasis
• Decreased ciliary function, leukocyte function
• Fire hazard
• Retinopathy of prematurity (PaO2 > 80 mm Hg)
• Bacterial contamination
• Humidification system
 Oxygen Delivery and
Devices
• The therapeutic application of
supplemental oxygen is integral
part in the treatment of a wide
range of disease states and may be
accomplished utilizing a variety of
oxygen administration devices.
• Appropriate application of supplemental
oxygen requires:
requires
– An understanding of the proper application
of the available oxygen delivery devices
and
– Knowledge of the indications and potential
hazards of oxygen therapy
 Classification of o2 delivery
devices
1 - Low flow system ;;


• Nasal Cannula
• Simple oxygen
mask
• Partial rebreathing
oxygen mask
• Non-rebreathing
oxygen mask
•
Cont. of the classification;
2 - High - flow oxygen


delivery devices .
• Venturi Mask
• Aerosol Mask
• Trach collar
• Face tent
• Briggs Adapter
(T-piece)

other oxygen delivery
devices;
Oxygen-Conserving


Devices:
• Reservoir Cannula
•
• Demand Oxygen
Delivery
Systems or
Pulse Dose
Oxygen Devices
•
• Transtracheal
Oxygen
Catheters
 Additional Delivery
Devices:

• O2 Tents/Croup
Tents
• Oxygen Hoods
• Incubators or
isolettes
•
 LFS VS HFS
• LFS- uses only • HFOS must be
partial capable of
patient’s need meeting the
• HFOS – the flow patient’s PIF to
rate and ensure
reservoir consistent
capacity FIO2.
adequate to • Device delivers
provide the at least 3xMV
total inspired • Advantage
flow needed. 1.consistent
• FIO2
 Criteria for use of LFS
 When the • In LFOS the
larger the TV
patient is
or the faster
breathing the RR the
ØVT 300- lower the FIO2
700 • The smaller the
ØRR  25 VT or the
slower the RR
ØVentilatory the higher the
pattern FIO2
regular •  MV 
and FIO2
 Nasal Cannula
• Most used oxygen • The use of NC for
therapy device. long term use led to
discovery of
• limitation
• If used with flow • During expiration
larger than 4 lpm there is waist of
bubble humidifier flow to the room .
indicated.. 

• Oxygen
concentrations •
delivered by the
nasal cannula
according to flow.
NC. Cont..
 Advantages
Flow
 • Use in adults, children,
infants, Easy to apply,
• Up to 6 L/min. Disposable,
• Low cost, Well tolerated
• Humidifier should be
used when flow  Disadvantage
exceeds 4 L/min • Unstable, Easily dislodged,
High flows uncomfortable,
• < 2 L/min (infants) Can

FiO2 range
 • cause dryness/bleeding,
Deviated septum may
• 22 - 45% block flow,
• mouth breathing may reduce
FiO2 stability
 FiO2

• Variable  Best use

• Stable patients needing low
FiO2, Home care patients
 Guide lines for estimating FIO2
with NC
te F IO 2
1 .24
2 .28
3 .32
4 .36
5 .40
6 .44
?
?
nt one liter O2 there is increase by 4 %
 Simple mask
Flow rate must be at least
5l/min
Exact concentration of
oxygen depends on
patient’s respiratory pattern
Useful post-operatively
Flow Disadvantages
• 5 - 12 L/minute • Uncomfortable, Must
FiO2 range be removed for
• 35 - 50% eating, Blocks
vomits in
FiO2 stability
unconscious
• Variable patients
‫ــــــــــــــــــــــــــــــــ‬
 Best use

‫ـــــــــ‬ • Emergencies, Short-

term therapy

requiring moderate
Advantages
 FiO2
• Use on adults, children
and infants, Quick,
easy to apply,
• Disposable,
 REBREATHER MASK
• Reservoir bags’ WITH one
way valve = non
rebreather.. Without
valve= partial-
rebreather..
• Flow rate must be set to
15l/min
• Fill reservoir 2 thirds
before applying
• Useful in acute situation
• Should not be worn
Partial rebreather 

Flow
• 6 - 10 L/minute
(Prevent bag
collapsing on Insp.)
FiO2 range

• 35 - 60%
FiO2 stability

• Variable
Advantages
• Use on adults, children and infants, Quick,
easy to apply,
• Disposable, Inexpensive, Moderate to high
FiO2
Disadvantages

• Uncomfortable, Must be removed for

eating, Blocks vomits in unconscious
patients,
• potential suffocation hazard
Best use

• Emergencies, Short-term therapy requiring

moderate to high FiO2
 Non rebreather..

Flow Advantages
• 6 - 10 L/minute • Same as partial-
(Prevent bag Rebreathing Mask,
collapsing on Insp.) High FiO2
FiO2 range Disadvantages

• 55 - 70% • Same as partial-

FiO2 stability Rebreathing Mask,
potential suffocation
• Variable
hazard
• Best use

• Emergencies, Short-
 Air Entrainment >or= 3
•
years
Total amount of air
depends on:
1. The size of

entrainment port.
2. The velocity of

oxygen at jet.
•The smaller the orifice the greater is the
velocity of oxygen and the more air is
entrained.
The largest jet provides the lowest oxygen
velocity and thus the least air entrainment and
the higher FiO2
Flow
• Varies, should provide
output flow > 60
L/min
FiO2 range

• 24 - 50%
FiO2 stability

• Fixed


 Advantages
• Easy to apply, Disposable, Inexpensive,
Stable, Precise FiO2’s
 Disadvantages
• Limited to adult and pediatric use,
Uncomfortable, Noisy,
• Must be removed for eating, FiO2 > 40%
not ensured, FiO2
• varies with back pressure
 Best use
• Unstable patients requiring precise low
FiO2
Oxygen hoods and tents
• Oxygen hoods used to deliver O2
to infants.
• Receive oxygen from a high flow
humidification system.
• Flow is set at 10 – 15 liters / min.
to provide a constant flow
through the hood , maintain a
constant FIO2 , and wash out of
CO2.
•
 Tents
• Uses a frame and a large , soft plastic material
to enclose the patient.
• Used in pediatrics especially with croup.
• Tents receive O2 from a high flow aerosol
system .
• FIO2 is difficult to be controlled because of
large volume.
•
O2 DELIVERY IN pedia & infant ..
 KEY POINTS with neonates….
• Use the lowest FIO2 to Keep PaO2 50 – 80 mm. Hg. ,
• SpO2 88 - 95 %


 n O2 is a DRUG only should be used Ø Documented hypoxia

 Ø Resp. Distress
 Ø Cynosis
•
• n When prescribing O2– specify - Ø Dose
• Ø Device
• Ø Duration
• Ø Monitoring
•
• n Take care when the devices is used to prevent – NOS.
INFECTION

•
 ‫الحمد لله على السلمه‬

‫‪Thanq ‬‬