NEONATAL AND PEDIATRIC O2 THERAPY

• ABG – most reliable

• Transcutaneous monitoring

• Pulse oximetry

• Hypoxemia is suspected when the patient shows signs of respiratory distress

Diagnosis for hypoxemia

60 mmHg

52 – 67 mmHg

AGE RELATED PO2 VALUES

NORMAL PRETERM

@ 1-5 hour

74 mmHg

62 – 86 mmHg

AGE RELATED PO2 VALUES:

NORMAL TERM INFANTS

(@5 hrs)

76 mmHg

62-92 mmHg

AGE RELATED PO2 VALUES

NORMAL PRETERM INFANTS & TERM INFANTS (5 days)

90 mmHg

80- 100 mmHg

AGE RELATED PO2 VALUES

CHILDREN,

ADOLESCENTS, ADULTS

• Tachycardia

• Tachypnea

• Nasal flaring

• Intercostal retraction

• Expiratory grunting

Signs and Symptoms of mild to moderate hypoxemia

• Bradycardia

• Apnea

signs and symptoms of severe hypoxemia

Decreased levels of activity, muscle tone, alertness and playfulness

signs and symptoms of increasing hypoxemia

Cyanosis

In children, it is not always a clear-cut indicator of hypoxemia

• Monitoring

• Humidification

• Infection control

Principles of oxygen administration includes:

routine maintenance

Ensures proper calibration and check valve function to prevent contamination of the medical air supply with oxygen

in-line oxygen analyzer

Monitoring

Highly Recommended

• Continuous measurement of blended oxygen systems via an ______ with high and low limits

8-12

in-line oxygen analyzer needs to be recalibrated every ________ hours

transcutaneous monitors

monitoring tool used primarily in infants and toddlers

4 hours

transcutaneous monitors need to change electrode every _____ to prevent skin burns

adequate perfusions

pulse oximetry - apply adhesive probes firmly but loosely to allow _________ at the site and digits distal to the probes

Humidification

Reduces detrimental effects of dry medical gases on the airway

• Impairment of ciliary activity

• Retention and thickening of secretions

• Inflammation of ciliated pulmonary epithelium

• Atelectasis

• pneumonia

detrimental effects that humidification reduces

humidification

administered as water vapor and aerosol

• desired FiO2 and inspiratory flow rate

• Patient’s fluid balance

• Thickness of respiratory secretions

Selection of humidification device should depend upon:

smaller tidal volume to weight ratios, gas to tissue surface area

Younger patients may require humidification even at low flows due to ______ and _____

drying

The addition of humidity at high flow helps prevent _____ of the airways

• Low flow

• High flow

2 classes of humidification devices:

Low flow

type of humidifier that supplies a relatively small amount of humidity and does not heat the gas

bubble, diffuser

low flow humidifiers are classified as ______ or ________ humidifiers

Low flow

TYPE OF HUMIDIFIER

Allows the gas to bubble up through a reservoir of sterile water

cannulas, simple mask

Low flow humidifiers are used with _______ and _______

10 L/min

high flow humidifiers have flows greater than ___

high flow humidifier

TYPE OF HUMIDFIER

provide a fully saturated gas at a desired temperature

large volume jet nebulizers, advanced bubble humidifier, passover humidifiers

high flow humidifiers used with ______, _______ and ______.

Bernoulli’s principle

large volume jet nebulizers produce and aerosol using _____

• lowers the lateral pressure around the jet that draws water up a capillary tube

• When water reaches the jet, the gas breaks it up into an aerosol

• Aerosol is carried with the gas to the patient

Principe on large volume jet nebulizers (Bernoulli)

Passover Humidifier

TYPE OF HIGH FLOW HUMIDFIER

direct gas over a water surface

• Simple reservoir type

• wick type

• Membrane type

3 types of passover humidifier

Simple reservoir type

type of passover humidifier that directs gas over the surface of a volume of water

simple reservoir type

TYPE OF PASSOVER HUMIDFIER

typically used with heated fluids for use with mechanical ventilation

room temperature fluids

simple reservoir type humidifier may also be used with ________ with noninvasive ventilatory support (nasal CPAP or BiPAP).

wick type

type of passover humidifier uses an absorbent material to increase the surface area for dry air to interface with heated water

wick type

type of passover humidifier that continually draws water up from the reservoir and keeps the wick saturated

membrane-type humidifier

this type of passover humidifier separates the water from the gas stream by means of a hydrophobic membrane

hydrophobic membrane

water vapor molecules can easily pass through this membrane, but liquid water (and pathogens) cannot

• maintain saturation as high flow rates.

• Add little or no resistance to spontaneous breathing circuits

• do not generate aerosols and therefore pose minimal risk for spreading infection

advantages of passover humidifier

48 hours

Humidification and oxygen devices should be changed every ______

sterile distilled water

All aerosol units should be filled with ______ water

• maintain a PaO2 that is high enough to avoid hypoxemia, but low enough to avoid the dangers of ROP, BPD. and oxygen toxicity

• arterial Pao2 of 50-70 mmHg

GOAL OF THERAPY

• Oxygen Blenders & flowmeters

• Oxygen Analyzers

• Humidifiers

• Oxygen Hoods

• Cannulae & Catheters

• Oxygen Masks

• Tents

• Incubators

• Resuscitators

• Aerosols

Equipment for O2 therapy

E cylinders

gas cylinder that is used for brief intervals due to its relatively small capacity

E cylinders

gas cylinder that is used for transport of patient

H cylinders

type of gas cylinders that contains 10x much more gas

135

H cylinders are heavy, approximately _______ pounds

• invasive via ETT or tracheostomy

• Noninvasive

  • nasal cannula or nasal prongs

  • low flow O2 mask (simple face mask)

  • mask with reservoir bags

    • partial rebreathing mask

    • non-rebreathing mask

  • high flow O2 mask (venturi mask)

  • commercial O2 cages

oxygen delivery systems

oxygen blender

usual starting point for the administration of various concentrations of oxygens

50psi

oxygen blender is connected to a ___ source of oxygen and air

0.21 – 1.0

OXYGEN BLENDER

Any concentration of oxygen from ____ is possible

• Bourdon gauge

• Thorpe tube

2 types of oxygen flowmeter

Bourdon Gauge Flowmeters

aka fixed orifice flowmeter

Bourdon Gauge Flowmeter

type of flowmeter that accuracy is dependent upon the size of the orifice of the flowmeter outlet

cylinder regulators

bourdon gauge flowmeters are found on ____

Thorpe tube

it is a tapered tube with a small end at the bottom and large end at the top

V-shaped tube

Thorpe Tube Flowmeters

_______ provides a variable orifice

float

Thorpe Tube Flowmeters

A ____ is suspended in the tube by the flow of gas

oxygen analyzer

it is used when a precise oxygen percentage is desired

room air, 1.00

oxygen analyzer should be calibrated to _________ and ________ oxygen to ensure accuracy

8 hours

oxygen analyzer calibration should be done every _______

oxygen hood

a clear, plastic hood that fits over the infant’s head

oxygen hood

provide oxygen-enriched environment for the patient with relative ease and comfort

less than 0.50

oxygen hood is used with FiO2 of ______

large neck opening and less than tight seal around the edges of the hood

difficult to maintain consistent concentration above 0.50 due to _________ and __________

thermoregulation problem

high or low gas temperatures blown into the hood may cause the infant to overheat or become chilled

hypoxemia

Level of oxygen in the blood that is less than normal

• if too low a gas flow is used, there is a chance CO2 retention in the hood

• infant’s breathing might be hampered by the face being pressed against the wall of the hood; or the neck opening being too light

• thermoregulation problems

oxygen hood hazards

cannulas

used on those patients with chronic oxygen needs

oxygen cannulas and mask

delivers a constant flow of O2 to the nasopharynx and oropharynx

oxygen cannulas and masks

Can also be a tool to wean the patient from the oxygen hood

1 L/min

oxygen cannulas and masks

flows used on neonates are usually less than ____

4 L/min

oxygen cannulas and masks

Flows greater than _____ may lead to nasal mucosal drying and epistaxis

pediatric - sized prongs

oxygen cannulas and masks

shorter in length and smaller in diameter compared to adult

neonatal cannula

has prongs that are even shorter and smaller

• easy to use.

• well tolerated

• does not interfere with eating

advantages of oxygen cannulas and masks

• inability to achieve high FIO2 in patients with high ventilatory demand

• difficult to keep in place

  • tape to the face

disadvantages of oxygen masks and cannulas

low flow O2 mask (simple face mask)

mask that has no valves and reservoirs

5-10 L/min

simple face mask delivers O2 at flow rates between ____

5 L/min

simple face mask

the minimum flow rate _____ is needed to clear exhaled gas from the mask \

60%

simple face mask

max FiO2:

simple face masks

noninvasive equipment where there is nothing gained at higher flow rates

• it will add slightly higher FiO2 than nasal cannula

advantages of simple face mask

• interfere with feeding and speech

• cant be tolerated by some patients

disadvantages of simple face masks

• partial rebreathing mask

• non-rebreathing mask

masks with reservoir bags

Partial rebreathing system

no exhalation valve to prevent CO2 into reservoir.

70 - 100%

PARTIAL REBREATHING SYSTEM

higher FIO2 up to ____

• uses less oxygen than other masks.

• higher possible FIO2.

advantages of partial rebreathing masks

• interferes with feeding & speech.

• aerosolized bronchodilator therapy is not possible

disadvantages of partial rebreathing mask

non-rebreathing mask

Valve at the reservoir to prevent expired gas going into the reservoir.

90+

non-rebreathing mask

higher possible FiO2 up to ____

non-rebreathing mask

mask with reservoir bags that vents all expired tidal volume

• Highest possible FIO2.

• fixed performance.

advantages of non-rebreathing mask

• interferes with feeding & speech.

• aerosolized bronchodilator therapy is not possible

disadvantages of non-rebreathing mask

venturi mask

O2 with high flow, no valves, no reservoir