Oxygen therapy

1. PRINCIPLES OF OXYGEN THERAPY
IN HOSPITALAND HOME SETTING
DR SUJIT KR BHATTACHARYA
HOD, DEPT. OF CHEST
MEDICINE ,DHGMC.

2. WHY DO WE NEED OXYGEN?
 Oxygen is the fundamental element for almost all
vertebrates in this world.
 O2 is needed for cellular level respiration which takes
place in mitochondria of every cell in a human body to
generate ATP(Adenosine Triphosphate).
 In humans O2 diffuses through membranes of lungs &
in to red blood cells which is carried to different parts
of vital organs for its proper function & energy
production.

3. INDICATION OF O2 THERAPY IN
HOSPITALIZED PATIENTS
 Any documented hypoxemia.
 Acute respiratory failure(COPD,ARDS,PNEUMONIA)
 Acute myocardial infarction.
 Cardiac failure.
 Shock.
 Pneumothorax.
 Hypermetabolic states like trauma,burns or sepsis
 Anemia
 During CPR

4. CLINICAL SIGNS OF HYPOXIA
 RESPIRATORY : Breathlessness,Cyanosis,
Tachypnea.
 CARDIOVASCULAR: Tachycardia, Diaphoresis,
Angina,Shock, Increased cardiac output.
 CNS: Headache, Confusion, Delirium, Impaired
judgement, Seizures.
 NEUROMUSCULAR: Weakness, Tremor, Asterixis
 METABOLIC: Sodium & water retention, Acidosis.

5. OXYGEN DELIVERY SYSTEMS
 NASAL CANNULA.
 SIMPLE MASK.
 PARTIAL RE-BREATHER MASK.
 NON-RE BREATHER MASK(NRBM).
 VENTURI MASK.
 AMBU BAG.

6. NASAL CANNULA
1. A DISPOSIBLE PLASTIC DEVICE
WITH TWO PROTRUDNG PRONGS FOR
INSERTION INTO THE NOSTRIL
CONNECTED TO AN OXYGEN SOURCE.
2. USED FOR LOW MEDIUM
CONCENTRATION OF OXYGEN (FiO2
24-44%)

7. ADVANTAGE
1. PATIENT CAN TALK AND EAT WITH OXYGEN IN PLACE
2.EASILY USED IN HOME SETTINGS
3. SAFE AND SIMPLE
4. EASILY TOLERATED
5.DELIVERS LOW CONCENTRATION OXYGEN
DISADVANTAGE
1.UNABLE TO USE WITH NASAL OBSTRUCTION
2. DRIES THE MUCUS MEMBRANE SO NEEDS TO BE HUMIDIFIED
3. EASILY DISLODGABLE FROM NOSE

8. SIMPLE MASK
1.MADE OF CLEAR FLEXIBLE
PLASTIC OR RUBBER THAT
CAN BE MOULDED TO FIT
THE FACE
2. HELD TO THE HEAD WITH
ELASTIC BANDS
3. IT DELIVERS 35-60% OF
OXYGEN

9. ADVANTAGES
1. USED IN INCREASED DELIVERY OF OXYGEN NEEDED FOR SHORT
PERIODS
DISADVANTAGES
1. TIGHTER SEAL IS REQUIRED TO DELIVER HIGHER CONCENTRATION
2. DIFFCULT TO KEEP MASK IN POSITION OVER NOSE AND MOUTH
3. UNCOMFORTABLE FOR PATIENT WHILE EATING AND TALKING
4. PRESSURE SORES OVER THE FACE

10. PARTIAL RE-BREATER MASK
1. THE MASK IS WITH THE RESERVOIR
BAG THAT MUST REMAIN INFLATED
DURING BOTH INSPIRATION AND
EXPIRATION
2. COLLECTS A PART OF PATIENT’S
EXHALED AIR
3. IT IS USED TO DELIVER AN OXYGEN
CONCENTRATION UPTO 80%
4. OXYGEN FLOW RATE MUST BE A
MINUMUM OF 6L/min TO ENSURE
THAT THE PATIENT DOESN’T
REBREATH LARGE AMOUNT OF
EXHALED AIR

11.  ADVANTAGES
 PATIENT CAN INHALE ROOM AIR THROUGH OPENINGS IN
THE MASK IF OXYGEN SUPPLY IS BRIEFLY INTERRUPTED
 DISADVANTAGES
 REQUIRE TIGHT SEAL (EATING AND TALKING DIFFICULT AND
UNCOMFORTABLE )

12. NON RE-BREATHER MASK(NRBM)
1.WHEN A PATEINT EXHALES AIR ,
THE ONE WAY VALVE CLOSES AND
ALL OF THE EXHAED AIR IS
DEPOSITED INTO THE ATMOSPHERE,
NOT THE RESERVOIR BAG.
2.THIS WAY PATIENT DOESN’T
REBREATH ANY EXPIRED AIR .
3.THIS MASK PROVIDES HIGHEST
CONCENTRATION OF OXYGEN 95-
100%

13.  ADVANTAGES
 DELIVERS HIGHEST POSSIBLE OXYGEN CONCENTRATION
 SUITABLE FOR PATIENT BREATHING SPONTANEOUSLY WITH
SEVERE HYPOXEMIA
 DISADVANTAGES
 IMPRACTICAL FOR LONG TERM THERAPY
 MALFUNCTIONNCAN CAUSE CO2 BUILD-UP
 SUFFOCATION
 EXPENSIVE AND UNCOMFORTABLE

14. VENTURI MASK
1. CONSTRUCTED IN A
WAY THAT THERE IS
ALWAYS A CONSTANT
FLOW OF ROOM AIR
BLENDED WITH
CONCENTRATION OF
OXYGEN
2. DELIVERS HIGH
FLOW OXYGEN OF 40-
50%

15.  ADVANTAGES
 DESIGNED WITH WIDE BORE TUBING AND VARIOUS COLOR
CODED JET ADAPTERS FOR SPECIFIC CONCENTRATION OF
OXYGEN
 DELIVERS MOST PRECISE OXYGEN CONCENTRATION
 DOESN’T DRY MUCUS MEMBRANES
 DISADVANTAGES
 UNCOMFORTABLE
 PRODUCES RESPIRATORY DEPRESSION IN COPD PATIENTS
WITH HIGH OXYGEN CONCENTRATION

16. AMBU BAG
1. AMBU aka ARTIFICAL
MANUAL BREATHING UNIT IS
A HAND HELD DEVICE
COMMONLY USED TO
PROVIDE POSTIVE POSITIVE
PRESSURE VENTILATION TO
PATIENTS WHO ARENT
BREATHING ADEQUATELY

17.  USES
 USED IN EMERGENCY SETTING FOR RESUSCITATION
 CAN DELIVER POSITIVE PRESSURE VENTILATION WITHOUT A
COMPRESSED GAS SOURCE
 USED FOR INDUCTION OF ANASTHETIC AGENTS DURING
SURGERY
 TO SAVE PATIENT WHO HAVE STOPPED BREATHING OF THEIR
OWN

18. HOME OXYGENATION

19.  HOME OXYGENATION CAN BE DELIVERED TO THE PATIENT
SUFFERING FROM DISEASES SUCH AS COPD, ASTHMA ,ILDs ,
CCF etc WHO NEEDS OXYGEN IN MILDER FORMS
 PORTABLE O2 DISPENSERS ,OXYGEN CYLINDERS etc CAN
EASILY BE MANIPULATED IN HOME SETTINGS
 HOME OXYGEN NOT ONLY IMPROVES THE DISEASE
CONDITION BUT ALSO IMPROVES THE OVERALL QUALTY OF
LIFE
 THERE ARE LESS CHANCES OF CONTRACTING HOSPITAL
ACQUIRED INFECTIONS
 REDUCES THE CHANCES OF HOSPITAL ADMISSIONS

20. SAFETY PRECAUTIONS DURING
OXYGENATION THERAPY
 THERAPEUTIC GASES MUST BE PRESCRIBED AND ADJUSTED
ONLY BY A HEALTHCARE PROVIDER
 OXYGEN IS A HIGHY COMBUSTIBLE GAS WHICH WARRANTS
APPROPRIATE PRECAUTIONS FROM OPEN FLAME SOURCES,
MALFUNTIONED ELECTRICAL DEVICES , SMOKING etc
 ALWAYS ENSURE OPTIMAL CONCENTRATION OF OXYGEN
NEEDED FOR THE PATIENT TO AVOID OXYGEN TOXICITY.

21. OXYGEN TOXICITY
 CONDITION OCCURING DUE TO INSPIRATION OF HIGH
CONCENTRATION OF OXYGEN FOR PROLONGED PERIODS OF
TIME
 OXYGEN IS A HIGHLY REACTIVE MOLECULE WHICH CAN
FORM OXYGEN DERIVED FREE RADICALS LIKE PEROXIDES,
SUPEROXIDES AND HYDROXY RADICALS.
 COMPLICATION OF PROLONGED O2
THERAPY
 RETRO LENTAL FIBROPLASIA IN INFANTS
 ABSORPTION ATELECTASIS
 SYSTEMIC TISSUE DAMAGES