Dr. Adil Farooq presented on oxygen therapy and different devices used to deliver oxygen to patients. There are many ways to prescribe oxygen that are often not followed properly. The goal of oxygen therapy is to treat hypoxemia, decrease work of breathing, and decrease myocardial work. The appropriate oxygen delivery method depends on factors like the needed FiO2 level, humidification needs, and patient comfort. Common devices include nasal cannulas, masks, Venturi masks, hoods and tents. Proper prescription and monitoring are important to provide benefits while avoiding risks like hypoventilation.

1. Presenter : Dr Adil Farooq
Moderator: Dr Renuka H
Shri B.M. Patil Medical College
Hospital and Research Center,
VIJAYAPUR, KARNATAKA

2. Introduction:
 Oxygen is one of the most important drugs you will ever use,
but it is poorly prescribed by medical staff.
 In 2000, Nicola Cooper and colleague did survey of treatment
with oxygen.
 They first looked at prescriptions of oxygen in postoperative
patients in a large district hospital. They found that there were
many ways used to prescribe oxygen and that the
prescriptions were rarely followed.

3. 1. Documented hypoxemia
In adults, children, and infants older than 28
days, arterial oxygen tension (PaO2) of <
60 mmHg or arterial oxygen saturation
(SaO2) of < 90% in subjects breathing
room air.
In neonates, PaO2 < 50 mmHg or SaO2< 88%
or capillary oxygen tension (PcO2)< 40
mmHg

4. 2 . An acute care situation in which hypoxemia is
suspected.
3. Severe trauma.
4. Acute myocardial infarction.
5. Routine surgery
6. Short-term therapy (e.g., post-anesthesia recovery)
7. Anxiety
8. During Childbirth
9. Increased metabolic demands, i.e. burns, multiple
injuries, and severe infections.

5. Three clinical goals of O2 therapy
1. Treat hypoxemia
2. Decrease work of breathing (WOB)
3. Decrease myocardial Work

6.  Need is determined by measurement of inadequate oxygen
tensions or saturations, by invasive or noninvasive methods,
or the presence of clinical indicators as previously described.
 Arterial blood gases
 Pulse oximetry
 Clinical presentation

7. FACTORS THAT DETERMINE WHICH SYSTEM
TO USE
1. Patient comfort / acceptance by the Patient
2. The level of FiO2 that is needed
3. The requirement that the FiO2 be controlled
within a certain range
4. The level of humidification and nebulization
5. Minimal resistance to breathing
6. Efficient & economical use of oxygen

8.  Based on performance of device
A. Fixed performance -Venturi mask
B. Variable performance -Nasal prongs,
Face mask
 Based on Flow delivered by device
A. High flow - Venturi mask
B. Low flow -Nasal prongs,
Face mask,
Partial and Non
Rebreathing bag,
Tracheostomy mask.

9.  Based on Patient:
Patient Dependent -Face mask
Nasal prongs
Nasopharyngeal catheters
CPAP
Patient independent -Ventilators
 Based on degree of dependency:
Low dependency -Face mask, Nasal prongs
Medium dependency -CPAP
High Dependency -Non Invasive and Invasive
Positive pressure Ventilation

10.  Oxygen is provided at a certain flow rate in
L/minute.
 The patient’s rate and depth of breathing
determines the FiO2 and is mostly not fixed at
a fixed flow rate.
 i.e Fast and deep breathing results into lower
FiO2 because it draw more room air into lungs
and thus dilutes the inspiratory gas and oxygen
concentration.

12.  Variable performance, low flow device with no
capacity.
 A flow rate of 0–6 L/minute can be used with nasal
cannula depending upon the size of patient and
requirement of oxygen.
 At flow rate of more than 6 L/minute does not help in
improving oxygenation and of no use.
 Above a flow rate of 4 L/minute (without
humidification) there is increased chance of nasal
irritation
 In neonates and infants (flow rate 0.025–1.0 L/minute). Nasal
cannula can be considered a high-flow device for infants and
neonates because inspiratory flow rate for infants and neonates
is very low.

13. Fio2 ranges from
24-40% of O2 at
1-5ltr of O2
1 - 24%
2 - 28%
3 - 32%
4 - 36%
5 - 40%

14. Advantages Disadvantages
 Inexpensive Pressure sores
 well tolerated, comfortable Crusting of secretions
 easy to eat, drink,speak Drying of mucosa
 used in pt with COPD Epistaxis

15.  Variable performance, low flow device with no
capacity.
 Catheter size 8-14 FG
 Catheter should be well lubricated prior to insertion.
 Depth of insertion should be equal to the distance from
Alae Nasi to the Tragus.
Disadvantages
Not commonly used because
 Hygenic care is difficult
 Skin irritation
 Pain in the frontal sinus

16.  Low flow, variable performance,
small capacity device.
 The placing of mask over the
patient’s face increases the size of
the oxygen reservoir beyond the
limits of the anatomic reservoir
;therefore a higher FiO2 can be
delivered.
 The oxygen flow must be run at a
sufficient rate, usually 4 ltr/min or
more to prevent rebreathing of
exhaled gases.

17.  Oxygen is delivered through a 7 mm diameter oxygen
tubing from oxygen source.
 This is most commonly used in post-anesthesia care
units in patients recovering from anesthesia.
 This is always recommended for short-term use in
patients with chronic lung disease for acute hypoxic
breathlessness.
 O2 flow rate(ltr/min) FiO2
5-6 40%
6-7 50%
7-8 60%
 It should be better used with some humidification
device if planned for prolonged use or used in pediatric
or neonatal patients.

18.  Advantages: simple, lightweight, FiO2 upto 60%, can be used
with humidity
 Disadvantages: need to remove when speak, eat, drink,
vomiting, expectoration of secretions, drying / irritation of
eyes, uncomfortable when facial burns / trauma application
problem when RT in situ

19.  Low flow, variable, medium capacity device.
 It is connected to a nebulizer
 It delivers water/drug in Aerosol form.
 Max FiO2 estimated is 50%

20. •High oxygen , Low flow, variable
performance Device
• FLOW 6-10 L/min can provide 40-70%
O2
•Bag should be half to 1/3rd full on
inspiration
Advantages:exhaled oxygen from anatomic
dead space is conserved.
Disadvantages: insufficient flow rate may
lead to rebreathing of CO2, claustrophobia;
drying and irritation of eyes

21. Features:
 unidirectional valve system to
prevent mixing of expired gases
and fresh gas flow.
 Fio2 60-80% with 10L/min.
 High flow to prevent rebreathing
Disadvantage:
Humidification system is not used so
long term oxygenation causes nasal
and oral mucosal irritation.

22.  Low flow,
 variable performance,
 low capacity device.
 These are same as simple face
mask used at tracheostomy site
in patients with permanent or
temporary tracheostomy.

23.  The minimum flow rate required as in facemask is 3–4
L/minute to prevent expired gas rebreathing, carbon
dioxide accumulation.
 The delivered FiO2 is highly variable based on the
patient’s inspiratory flow, fitting of mask and patient’s
respiratory rate and pattern.

25.  High-flow or fixed performance oxygen therapy
devices provide oxygen at a certain concentration or
FiO2.
 With a properly functioning device and proper set up of
device, fixed or pre determined FiO2 is always
available to the patient.
 If patient’s inspiratory demand exceeds the output of
this device, it can no longer be classified as “high-
flow” and FiO2 will decrease.

26.  A Venturi is a simple design of valve that uses high-
flow oxygen supplied through a narrow port which
allows room air to be drawn in from atmosphere
 The rate of flow generated by this Venturi mask may be
equal to peak inspiratory flow of patient.
 There are coloured dilutor jets which deliver a
particular FiO2 (24–50% depending upon the use of
dilutor jet) at a particular flow rate set.

27.  Venturi Mask is most commonly used for chronic
obstructive pulmonary disease patients requiring
a specific FiO2 that will not fluctuate with
changes in breathing pattern
 And also may be used in patient during weaning
from long-term oxygen therapy to gradually
lower the FiO2.
 Long-term and high-flow dilutor mostly need
humidification device to be used.
 HAFOE- this system is also called as High
airflow with oxygen enrithment.

28. •The Bernoulli effect describes the
change in pressure that occurs
when a fluid flows through a
constriction.
•The Venturi principle uses this
phenomenon to allow a second
fluid to be entrained into the stream
of the first, either through a side
arm that opens into the area of low
pressure or via a co-axial
arrangement

29. VENTURI VALVE

30. Venturi valve
Color FiO2 O2 Flow
Blue 24% 2 L/min
White 28% 4 L/min
Orange 31% 6 L/min
Yellow 35% 8 L/min
Red 40% 10 L/min
Green 60% 15 L/min

31.  Multi-vent Venturi mask is an adjustable
Venturi mask, in which, in same mask it is
possible to use different flow rate and desired
FiO2 for changing oxygen requirement.
 It has color coded air-entrainment

32.  The amount of FiO2 provided by this is almost 100%
(no oxygen dilution) and patients requiring this amount
of oxygen are generally having critical oxygenation
problems and they should be either in intensive care
units or high dependency units.

33. Face tent Mask
•The face tent mask provides
oxygen to the nose and mouth
without the discomfort of a
mask.
• It has an added. advantage to
be used for patients with facial
trauma or burns.
• A face tent delivers oxygen
concentrations of 28% to 100%
with flow rates from 8 to 12
L/min.

34.  A t-tube is a t-shaped
device with a piece that
connects the oxygen
source to the artificial
airway (endotracheal
tube or tracheostomy).
 The recommended flow
rate when using a t-tube
is 10 L/min, with a
nebulizer set at the
appropriate oxygen
concentration.

35. Transtracheal oxygen
•Can be used in long term Oxygen
Therapy in COPD patients.
•Sleep Apnoea Syndrome.
•Cosmetically Accepted.

36.  Oxygen hood
 Aerodynamic design allows
consistent and even flow of
oxygen to baby.
 Maintains stable temperature.
 Fully transparent allows clear
view of baby.
 Oxygen concentrations of 80 to
90% can be achieved with oxygen
flow rates of 10 to 15 L/min

37. Oxygen hood
 Oxygen enters the
hood through a gas
inlet.
 Exhaled gas exits
through the opening
at the neck.

38. Oxygen tent
•An oxygen tent is a bendable
piece of clear plastic held over
child's bed or crib by a frame.
•The plastic is then tucked
under the mattress.
•Child can move around on
his bed without having to
wear an oxygen mask
• humidity helps prevent the
loss of water from child's
body as he breathes.

40.  Oxygen-induced hypoventilation
 Oxygen toxicity/O2 narcosis
 Absorption atelectasis
 Retinopathy
 Drying of mucous membranes
 Infection
 Fire hazards

41.  Nasal cannulae and nasopharyngeal catheters are used
to provide low level supplemental oxygen. They are
also used to supplement oxygen in patients who are
being fed so that there is no interruption in oxygen
supplementation.
 Simple oxygen masks are used to provide supplemental
oxygen in the moderate range (0.35 to 0.50, depending
on size and minute ventilation) for short periods of time
(e.g., during procedures, for transport, in emergency
situations).

42.  Air-entrainment nebulizers, can be used when high
levels of humidity or aerosol are desired.
 Partial rebreathing masks are used to conserve the
oxygen supply when higher concentrations (FiO2 > 0.4,
< 0.6) are warranted (e.g. during transport).
 Non-rebreathing masks are used to deliver
concentrations > 0.60.
 Venturi masks are used when precise FiO2 has to be
delivered e.g. COPD.

43.  Davey AJ, Diba A. Ward’s Anaesthetic
equipment.
 Dorsch J A, Dorsch SE. Understanding
Anesthesia Equipment .
 Tata Memorial; Objective Anesthesia Review.
 Baheti; Understanding Anesthetic Equipment
& Procedures A Practical Approach.