Oxygen therapy

Oxygen therapy

— Administration of oxygen at concentrations greater than that in room air to treat or prevent hypoxemia

> Increase oxygen saturation in tissues where the saturation levels are too low due to illness or injury.

> Increases the amount of oxygen in the blood.

> Reduces the extra work of the heart

> Decreases shortness of breath.

hypoxic respiratory drive

— Clients with COPD should receive oxygen at low flow rates (usually 1 to 3 L/min), to prevent inhibition of

Excessive amounts of oxygen

for prolonged periods of time will cause retrolental fibroplasia and blindness in infants who are premature

Oxygen delivered without humidification

— will result in drying and irritation of respiratory mucosa, decreased ciliary action, and thickening of respiratory secretions.

Nasal prongs/cannula.

— Comfortable and simple, and allows clients to move about in bed.

— Most common and inexpensive

— Well-tolerated by the client

— Delivers a low concentration of 02 at 24% - 45% at flow rates of 2-6 L/min

Simple 02 face mask

— Delivers 02 concentration from 35% - 65% at liter flows of 8-12 L/min

— The mask should mold the face

— Poorly tolerated—used for short periods of time; feeling of “suffocation.”

— Significant rebreathing of carbon dioxide at low oxygen flow rates.

— Hot—may produce pressure sores around the nose and mouth.

Non-rebreather reservoir mask

— Delivers 02 concentration at 60% - 100% at liter flows of 6- 15 L/min

— Prevents the room air and the exhaled air from entering the bag

— Reservoir bag has a one-way valve preventing the client from exhaling back into the bag.

— Oxygen flow rate prevents collapse of bags during inhalation.

— Ideal for severe hypoxia, but clients may complain of feelings of suffocation.

Venturi mask

— Delivers 02 concentration at 24% - 40% or 50% at liter flows of 4-10 L/min

— Has wide-bore tubing

— Has color-coded jet adapters

— Allows for accurate delivery of prescribed concentration of oxygen.

— Useful in long-term treatment of COPD.

Endotracheal Tubes

— Provides humidification and enriched oxygen mixtures to tracheostomy or endotracheal tube.

— Delivers up to 100% oxygen at flow rates at least twice the minute ventilation.

High-frequency oscillatory support

: Used to open the alveoli in situations such as atelectasis and ARDS

Pressure-cycled

Gas flows into the client until a predetermined airway pressure is reached. Tidal volume is not constant

Volume-cycled

Fixed volume of air is delivered with each inspiration. Most common ventilators used; tidal volume is determined

Ventilators Modes

— How breaths are delivered to the patient

Controlled Mechanical Ventilation (CMV)

— The machine delivers a breath at a fixed rate regardless of the client’s respirations or O2 demands

Continuous mandatory ventilation (assist-controlled)

— The machine senses a client’s effort and will deliver a fixed tidal volume with each effort

Intermittent mandatory ventilation

— Breaths are delivered by the machine and the client breathes spontaneously without machine assistance

Synchronized Intermittent Mandatory Ventilation (SIMV)

— The patient does more of the breathing

— breaths are delivered by the machine, but the client may also breathe spontaneously without machine assistance.

Positive End-Expiratory Pressure (PEEP)

— Maintenance of positive airway pressure at the end of exhalation

— Applied in the form of continuous positive airway pressure (CPAP) for the client breathing spontaneously or continuous positive-pressure ventilation (CPPV) for the client receiving mechanical breaths. Applied in 3- to 5-cm H2O increments. Levels greater than 10 to 15 cm H2O are associated with cardiovascular dysfunction and hemodynamic compromise.

Pressure support

— client breathes spontaneously and determines ventilator rate. Tidal volume determined by inflation pressure and client’s lung-thorax compliance.

Minute ventilation

— determined by the respiratory rate and the tidal volume. A respiratory rate of 10 to 15 breaths/min is considered appropriate. Close monitoring is required to achieve desired (not necessarily normal) PaCO2.