Definition • Oxygen therapy is the administration of oxygen at concentrations greater than ambient air (21%) • With the intent of treating or preventing the symptoms and manifestation of hypoxia • Oxygen therapy is indicated whenever tissue oxygenation is impaired • Oxygen has : – Physiologic actions – Pharmacologic actions – A dose response relationship – Adverse effect Types of hypoxia • Hypoxic hypoxia – Low PaO2 (arterial oxygen tension) secondary to FiO2<0.21 or decrease barometric pressure (altitude) – Impaired ventilation secondary to neuromuscular weakness or narcotic overdose – Impaired oxygenation secondary to pulmonary fibrosis, ARDS • Circulatory hypoxia – Inadequate pumping of the blood from the hearts to tissues, maybe secondary to disorder causing decrease cardiac output such as MI, hypovolemic, hypotension, poor supply of arteries • Hemic hypoxia – Decrease oxygen carrying capacity as in anemia or carbon monoxide poisoning • Demand hypoxia – Increased tissues consumption of oxygen in hypermetabolic states (fever) • Histotoxic hypoxia – Utilization of oxygen is abnormal such as in cyanide poisoning Sign and Symtoms • Tachypnea, dyspnea, hyperpnea • Tachycardia, dysrythmias, pulse changes, hypertensions • Anemis, polycythemia • Restlessness, disorientation, lethargy • Cyanosis, digital clubbing Indication • Cardiac arrest • Respiratory arrest • Respiratory failure type I and II • Cardiac failure • Myocardial infarction • Shock of any cause • Increased metabolic demand • Post operative states • Carbon monoxide poisoning Contraindication and precaution • With PaO2 >60, patient with chronic CO2 elevation may experience ventilatory depression • With FiO2>50%, oxygen toxicity, absorption atelectasis, or depression of ciliary and/or leukocytic function • Administer with caution to patients receiving bleomycin cancer therapy • Fire hazzard is increased in the presence of oxygen concentration Oxygen cascade mmHg • Inspired air 150 • Alveolar 103 • Arterial 100 • Capillary 51 • Tissue 20 • Mitochondial 1-20 Oxygen dissociation curve • Shift to the left – Hypothermia – Increased pH (alkalemia) – Decreased PCO2 – Decreased 2.3 DPG – Fetal Hb – Carboxy Hb – Met Hb
• Shift to the right
– Hyperthermia – Decreased pH (acidemia) – Increased PCO2 – Increased 2.3 DPG Apparatus/devices for oxygen therapy • Nasal catheter • Semi rigid mask (hudson, harris, edinburgh) • Ventury type mask • Soft plastic mask (pneumask, polymask, oxyaire) • Ventilators • Anaesthetic circuits • CPAP circuits • Plastic head hood • Oxygen tent/cot • Incubator Hazzards of oxygen therapy • CO2 narcosis – When high FiO2 are administered to patients dependent on a hypoxic(chemoreseptor) drive • O2 toxicit – Neurological effects (Paul Bert effects) – Lung toxicity – Retrolental fibroplasia – Barotrauma Hyperbaric Oxygen Therapy (HBO) • HBO therapy delivers 100% oxygen at a pressure above atmospheric, in a pressurized multi or one man chamber • Indication: – CO2 Poisoning – Burns – Gas Gangrene – Osteomyelitis – Osteoradionecrosis – Crush injuries – Ischaemic skin grafts • Complications: – Barotrauma to ears, sinuses, and lungs – Oxygen toxicity – Grand mal fits – Changes in visual acuity
Paediatric oxygen therapy
• Oxygen headbox or hood • Incubator • Oxygen cot or tent