SENIOR RESIDENT DEPARTMENT OF PEDIATRICS INTRODUCTION Oxygen is a drug monitor effects and side effects 21 of room air contains oxygen adequate for healthy person Higher concentration of oxygen is required in various illness effecting oxygenation ID: 914926
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OXYGEN THERAPY
DR RASMIYA MOHIYADHEEN
SENIOR RESIDENT
DEPARTMENT OF PEDIATRICS
Slide2INTRODUCTION
Oxygen is a drug; monitor effects and side
effects.
21% of room air contains oxygen. (adequate for healthy person)
Higher concentration of oxygen is required in various illness effecting oxygenation.
Slide3MONITORING BLOOD OXYGENATION
CLINICAL EXAMINATION
Signs of respiratory distress, cardiac failure.
PULSE OXIMETRY
(SpO2)
Non invasive
Indirectly measures arterial hemoglobin-O2 saturation by differentiating from deoxygenated hemoglobin using their respective light absorption at 660nm (red) and 940 nm (infrared)
Slide4Most pulse oximeters recognize all types of hemoglobin as either
oxygenated
or deoxygenated hemoglobin
(inaccurate
information in the presence of
carboxyhemoglobin
and
methemoglobin)
Slide5ARTERIAL BLOOD GAS MEASUREMENT
(pA02
)
Invasive; arterial (preferably),venous and capillary blood can also be used in children (warm and well perfused extremities).
Measures pH, pco2, pO2,
bicarb
levels and other electrolytes as well
Ideal for patients on mechanical ventilation and those with central
hypoventillation
and muscular paralysis. (indicates co2 retention)
Slide6CAPNOGRAM
Effectiveness of
ventillation
and
pulmunory
circultation
Slide7INDICATIONS
Oxygen saturation (SpO2 <90) or paO2<60mmHg
Cardiac dysfunction (shock, cardiac failure) ;to increase oxygen content of blood and maximize oxygen delivery
Slide8OXYGEN DELIVERY DEVICES
LOW FLOW SYSTEMS
Not meant to satisfy entire peak inspiratory demands of the patient
Delivered FiO2 varies in relation to oxygen flow rate, tidal volume and respiratory rate of the patient
Nasal
canula
/prongs, Hudson mask(simple face mask), Mask with reservoir bags, oxygen hood/ head box.
Slide9HIGH FLOW SYSTEMS
High enough to completely satisfy patients inspiratory needs either by high flow of oxygen or by controlled entrainment of ambient air.
Venturi
masks
Slide10NASAL CANULA/PRONGS
Simple to use, well tolerated and provide access to patient (feeding, chest physiotherapy)
Nasal patency must be ensured and gas should be humidified
0.5-5L/minute provide Fio2 24-40%
Flow rate >5-6 L/min should not be given as it causes drying, irritation, abdominal distention and nasal regurgitation
Effective in nose breathers(oxygen entrained from
nasopharynx
)
Slide11Slide12HUDSON MASK/SIMPLE FACE MASK
5-10L
/minute provide Fio2 24
-55%
Fio2 determined by o2 flow rate relative to inspiratory flow rate and tidal volume
They increase anatomical dead space and flow rates must be sufficient to prevent Co2 accumulation
Exhaled gases are expelled through air entrainment pores
Slide13Slide14MASKS WITH RESERVOIR BAGS
Useful if FiO2 greater than 60% required.
Reservoir bag with valves is attached to oxygen mask.
Flow rate adjusted to keep the reservoir bag continuously inflated
Slide15PARTIAL REBREATHING MASK
These have one way valves in exhalation port which permit expulsion of exhaled gases but prevent air entrainment during inspiration
No valves between mask and reservoir bag
Initial one third of exhaled gases( anatomical dead space which has not participated in gas exchange) flows into reservoir bags along with fresh gases. Rest of gases is forced out through exhalation ports.
Slide16Fi02 ranging from 60-80% may be achieved depending on inspiratory flow rate, tidal volumes and air leaks.
Slide17NON REBREATHING MASKS
Two system of one way valves: between bag and mask and over exhalation ports
During inspiration, patient has dual supply of oxygen from fresh gas source and from reservoir bag. (100% oxygen supply to patient)
High flow system
as flow satisfies patients inspiratory flow demands.
Exhalation only via the one way valve between mask and atmosphere.
Slide18Delivers high Fi02 at low flow rates of oxygen but flow should be sufficient to prevent collapse of the bag during inhalation.
Slide19OXYGEN HOOD/ HEAD BOXES
Clear
plexi
-gas boxes of various sizes placed over infants head and neck to ensure adequate and stable Fi02.
Flow rates should be adequate to prevent CO2 accumulation (>6L/min)
May achieve oxygen concentrations
upto
90-95%Disadvantage: Patient must be taken out for access and feeds
Slide20Slide21VENTURI MASKS
Designed to deliver specific O2 concentrations
Useful in chronic lung diseases where control of Fi02 is crucial, as coexisting problems with
hypercapnia
maybe present.
Based on Bernoulli principle (O2 flow through jet orifice at a fixed flow rate and room air enters through entrainment ports.
Fio2 depends on size of jet, O2 flow rate and size of entrainment ports.
Slide22A predictable O2 concentration between 24 and 60%if manufacturers instructions are followed
Slide23HAZARDS OF OXYGEN THERAPY
Retinal damage in premature infants
Damage to alveolar capillary membrane
resultiong
in increased permeability alveolar edema secondary to free radical damage.
Decreased
mucociliary
activity and risk of bacterial tracheitis
Absorption atelectasis secondary to Nitrogen washout
Slide24THANK YOU