Oxygen Therapy

OXYGEN THERAPY
DR. ANUPAM CHAKRABARTI

ASSOCIATE PROFESSOR
Department of Anaesthesiology
AGARTALA GOVT. MEDICAL COLLEGE & G.B.P. HOSPITAL
LEARNING OBJECTIVES
 BASIC FACTS OF HYPOXIA
 DEFINITION OF OXYGEN THERAPY
 TYPES OF OXYGEN THERAPY
 GOALS OF OXYGEN THERAPY
 INDICATIONS OF OXYGEN THERAPY
 METHODS OF OXYGEN THERAPY
 COMPLICATIONS OF OXYGEN THERAPY
 SUMMARY
WHY OXYGEN IS REQUIRED FOR SURVIVAL?
AEROBIC METABOLISM (OXIDATIVE PHOSPHORYLATION)
GLUCOSE-----------CO2 +H2O + 38 ATP
ANAEROBIC METABOLISM
GLUCOSE -----------LACTIC ACID + 2ATP

H+ + LACTATE
METABOLIC FAILURE AND METABOLIC

ACIDOSIS ----CELL DEATH
 ANOXIA----NO OXYGEN AVAILABILITY IN
TISSUE
 HYPOXIA ----LACK OF OXYGEN

AVAILABILITY IN TISSUE
 HYPOXEMIA ----LACK OF OXYGEN IN BLOOD

WHAT ARE THE TYPES OF HYPOXIA ?
HYPOXIC HYPOXIA ………DECREASE PAO₂
ANEMIC HYPOXIA ………..DECREASE O₂ CONTENT
STAGNANT HYPOXIA
HISTOTOXIC HYPOXIA
………………………………………………………………………………………..
HYPOXIC HYPOXIA CAUSES ARE
1.DECREASED INSPIRED CONCENTRATION (FIO₂)

……HYPOXIC GAS MIXURE
……HIGH ALTITUDE
2.HYPOVENTILATION DUE TO ANAESTHETICS OVERDOSE OR POST OP PAIN
3.DEFFUSION HYPOXIA (FINK EFFECT )
4.SHUNT -SEPTAL DEFECTS
5.DEFFUSION DEFECTS -PNEUMONIA,PULMONARY EDEMA ETC

ANEMIC HYPOXIA CAUSES ARE
1.ANEMIA DECREASED HAEMOGLOBIN
2.METHAEMOGLOBINEMIA,SULPHAEMOGLOBINEMIA
3.CARBON MONOXIDE POISIONING
STAGNANT HYPOXIA CAUSES ARE

1.ARTERIAL OBSTRUCTION
2.THROMBOSIS
3.EDEMA
4.SHOCK
HISTOTOXIC HYPOXIA
CELL CAN NOT UTILISE THE OXYGEN
ELECTRON TRANSPORT SYSTEM OF CYTOCHROME OXIDASE IS PARALYSED

CYANIDE POISONING
BENEFITS OF OXYGEN THERAPY
HYPOXIC HYPOXIA ++++

ANEMIC HYPOXIA +
STAGNANT HYPOXIA +
HISTOTOXIC -
HOW TO ASSESS THE NEED OF OXYGEN THERAPY ?
1.PRESENCE OF CLINICAL INDICATORS
ACUTE –
RESTLESSNESS,
CONFUSION,
IMPAIRED JUDGEMENT,
AIR HUNGER,
CIRCULATORY COLLAPSE
CHRONIC –
FATIGUE,
DROWSINESS,
DECREASE WORK CAPACITY,
APATHY etc.
2.INADEQUATE OXYGEN SATURATION BY
NON-INVASIVE -PULSE OXIMETRY AND CAPNOGRAPHY
INVASIVE ---ARTERIAL BLOOD GAS ANALYSIS

OXYGEN THERAPY IS MUST WHEREVER PAO2 < 60 mmHg
SPO2 <90 %
PACO2 >45 mmHg
DEFINITION OF OXYGEN
THERAPY
ADMINISTRATION OF OXYGEN AT
CONCENTRATION GREATER THAN THAT
IN AMBIENT OR ROOM AIR(21%) TO TREAT
OR PREVENT HYPOXIA ,THAT MAY LEAD TO
CELLULAR INJURY AND DEATH.
TYPES OF THERAPY
ORTHOBARIC
GIVING O2 MORE THAN 21% AT AMBIENT
ATM PRESSURE
HYPERBARIC
GIVING O2 MORE THAN 21% AT HIGH ATM
PRESSURE
 WHAT ARE THE PURPOSE OF THERAPY ?

1.TREAT HYPOXIA
2.DECREASE WORK OF BREATHING
3.DECREASE MYOCARDIAL WORK LOAD
INDICATIONS OF THE THERAPY
1.HYPOVENTILATION – CEREBRAL INJURY,
CHEST INJURY, POST OPERATIVE PAIN , UPPER
AIRWAY OBSTRUCTION, INADEQUATE
REVERSAL
2.INTRAPULMONARY SHUNT – COPD, ENDO-
BRONCHIAL INTUBATION, ATELECTASIS,
PNEUMOTHORAX
3.WASTED VENTILATION — PULMONARY
HYPERTENSION, CARDIAC FAILURE, SHOCK
4.DEFFUSION DEFECTS – RETAINED SECRETION,
PULMONARY EDEMA
5.INCREASED DEMAND — POST OPERATIVE
SHIVERING, CONVULSION, HYPERTHERMIA etc.
OXYGEN DELIVERY SYSTEM / DEVICES
LOW FLOW /VARIABLE PERFORMANCE
DEVICES:
*FLOW RATE LESS THAN THE PATIENTS INSPIRATORY
FLOW RATE
*FIO2 VARIES WITH RR &TV
*FIO2 NOT PREDICTABLE
HIGH FLOW /FIXED PERFORMANCE DEVICES:

*FLOW RATE MORE THAN PATIENT INSPIRATORY FLOW
RATE
*NOT INFLUENCED BY RR &TV
*FIO2 FIXED AND ACCURATE
DEVICES FOR LOW FLOW------
1.NASAL CATHETER
2.NASAL CANNULA
3.SIMPLE FACE MASK (MARY CARTERALL MASK ),
4.MASK WITH RESERVOIR (PARTIAL REBREATHING AND NON REBREATHING

MASK),
5.OXYGEN HOOD AND TENT,
6.TRACHEOSTOMY COLLAR ,
7.T-PIECE
DEVICES FOR HIGH FLOW-----
 VENTURI MASK (WITH OR WITHOUT NEBULIZER )
 ANAESTHESIA BAG AND MASK
 HIGH FLOW NASAL CANNULA OXYGINATION (HFNOC)

NASAL CANNULA
 DISPOSABLE ,PLASTIC DEVICE WITH TWO PRTRUDING
PRONGS FOR INSERTION INTO THE
NOSTRILS,CONNECTED TO AN OXYGEN SOURCE
 USED FOR LOW -MEDIUM CONCENTRATIONS OF OXYGEN

(24-44%)
 FLOW RATE (LITRE/MIN) FIO2

1 24%
2 28%
3 32%
4 36%
5 40%
6 44%
 MERITS…. SAFE, SIMPLE. EASILY TOLERATED, ABLE TO TALK
AND EAT WITH IT.
 DEMERITS… UNABLE TO USE IN NASAL OBSTRUCTION, DRYING
OF MUCOUS MEMBRANE, CHANCE OF DISLODGEMENT
FACE MASK—SIMPLE OXYGEN MASK
 MADE OF CLEAR,FLEXIBLE,PLASTIC OR RUBBER THAT CAN BE
MOULDED TO FIT THE FACE
 HELD TO THE HEAD WITH ELASTIC BANDS
 METAL CLIP THAT CAN BE BENT OVER THE BRIDGE OF THE NOSE
FOR COMFORTABLE FIT
 DELIVERS 35 TO 60% OXYGEN AT A FLOW RATE 6 TO 8 LITRE/MIN
 MERITS--- -INCREASED DELIVERY FOR SHORT PERIOD

 DEMERITS—TIGHT SEAL,UNCOMFORTABLE WHILE EATING AND
TALKING, DRYING/IRRITATION OF EYES
PARTIAL REBREATHER MASK(POLYMASK):
 MASK WITH A RESERVOIR BAG THAT MUST REMAIN INFLATED DURING

BOTH INSPIRATION &EXPIRATION
 USED TO DELIVER FIO2 UPTO 80%
NON RE-BREATHER MASK
 PROVIDES THE HIGHEST CONC (95 TO 100%) AT A FLOW RATE 6 TO 15
LITRE/MIN.
 TWO ONE WAY VALVE S PREVENT CONSERVATION OF EXHALED AIR
 MERITS-- DELIVERS THE HIGHEST POSSIBLE OXYGEN CONCENTRATION
 DEMERITS- -IMPRACTICAL FOR LONG TERM THERAPY, SUFFOCATION,

EXPENSIVE, UNCOMFORTABLE
VENTURY MASK
 HIGH FLOW OXYGEN DELIVARY DEVICE
 DESIGNED WITH WIDE BORE TUBING AND VARIOUS COLOUR CODED JET
ADAPTERS
 BASED ON BERNOULLI PRINCIPLE -A RAPID VELOCITY OF GAS EXITING
FROM A RESTRICTED ORIFICE WILL CREATE SUB ATMOSPERIC
PRESSURE,RESULTING IN AIR BEING ENTRAINED INTO THE MAINSTREAM
 EACH COLOUR CODE CORRESPONDS TO A PRECISE OXYGEN
CONCENTRATION AND A SPECIFIC LITER FLOW
COLOUR FLOW RATE FIO2
BLUE 02 24%
WHITE 04 28%
ORANGE 06 31%
YELLOW 08 35%
RED 10 40%
GREEN 15 60%
 MERITS--DELIVERS MOST PRECISE OXYGEN CONCENTRATION, DOES
NOT DRY MUCOUS MEMBRANE
 DEMERITS---UNCOMFORTABLE, RISK OF SKIN IRRITATION
OXYGEN HOOD :
PLASTIC DOME OR BOX WITH WARM,MOIST OXYGEN PLACED OVER BABIES
HEAD FOR EXTRA OXYGEN
OXYGEN TENT :
TYPICALLY MADE OF SEE THROUGH PLASTIC MATERIAL ENVELOP PATIENTS
BED OFTEN HAS A SIDE OPENING WITH A ZIPPER
TRACHEOSTOMY COLLAR/MASK
*INSERTED DIRECTED INTO TRACHEA
*INDICATED FOR CHRONIC THERAPY
*FLOW RATE 8 TO 10 LITER
*ACCURATE,COMFORTABLE WITH GOOD HUMIDITY
T-PIECE
*USED ON END OF ET TUBE WHEN WEANING FROM VENTILATOR
*PROVIDES ACCURATE FIO2
SELECTION OF DEVICES
 OXYGEN CONC REQUIRED FOR THE

PATIENT
 OXYGENCONC ACHIEVED BY THE

DELIVERY DEVICE
 IMPORTANCE OF ACCURACY OF THE

DEVICE
 PATIENT COMFORT AND MOBILITY

SYSTEM REQUIREMENT
1.SOURCE OF OXYGEN
 OXYGEN CYLINDERS
 A CENTRAL PIPELINE OUTLET SUPPLIED BY BULK CYLINDERS IN MANIFOLD ROOM
 OXYGEN CONCENTRATOR USING ZEOLITE SIEVE THAT TRAPS ALLNITROGEN FROM THE
AIR AND DELIVERS >90% PURE OXYGEN.
 2.FLOW METER
 3.OXYGEN TUBING
 4.HUMIDIFIER
 5.DELIVARY DEVICE
COMPLICATIONS OF OXYGEN THERAPY
 OXYGEN TOXICITY
 HYPOVENTILATION
 RETINOPATHY OF PREMATURITY
 ABSORPTION ATELECTASIS
 FIRE HAZARDS
OXIGEN TOXICITY--------
RESPIRATORY (LORRAIN SMITHS EFFECT)
LOSS OF SURFACTANT
ATELECTASIS
CNS (PAUL BERT EFFECT)
CONVULSION
HYPOVENTILATION
COPD PATIENT WITH CHRONIC CO2 RETENTION
ALTERED RESPIRATORY DRIVE DEPENDENT ON RELATIVE HYPOXEMIA
CORRECTION LEADS TO LOSS OF RESPIRATORY DRIVE
ULTIMATELY RESPIRATORY FAILURE
SPO2 GOAL 90 TO 92 %
RETINOPATHY OF PREMATURITY (ROP)

SUPPLEMENTORY OXYGEN INCREASE PaO2
INCREASE RETINAL VASCULARITY
NECROSIS OF BLOOD VESSEL
NEW VASCULARISATION
HAEMORRHAGE-RETINAL DETACHMENT -BLINDNESS

GOAL PaO2 <80 MMHG
 ABSORPTION ATELECTASIS
LARGE VOLUME OF NITROGEN IN ALVEOLI REPLACED WITH OXYGEN
OXYGEN SUBSEQUENTLY ABSORBED INTO BLOOD
EFFECT IS REDUCTION OF VOLUME OF ALVEOLI
COLLAPSE ALVEOLI - ABSORPTION ATELECTASIS
 FIRE HAZARD
RISK OF FIRE DUE TO
IMPROPER USE OF OXYGEN
INCORRECT DESIGN OF OXYGEN SYSTEM
INCORRECT OPERATION AND MAINTENANCE
HOW MUCH OXYGEN IS SAFE ??
 100% NOT MORE THAN 12 HRS

HYPERBARIC OXYGEN THERAPY:
 DELIVERING THE OXYGEN ABOVE ATMOSPHERIC PRESSURE IN A SPECIAL
EXPENSIVE HYPERBARIC CHAMBER.
INDICATIONS:
 POISONING ----CARBON MONOXIDE (HALF LIFE OF CO AT 1 ATM IS 214 MINUTES
THAT CAN BE REDUCED TO 19 MINUTES AT 2.5 ATM )
 INFECTIONS—CLOSTRIDIAL ,MUCORMYCOSIS
 ACUTE ISCHEMIA---CRUSH INJURY
 CHRONIC ISCHEMIA ---RADIATION NECROSIS
 ISCHEMIC ULCER –DIABETIC ULCER
TOXICITY OF HBO DEPENDS ON

*PRESSURE *TIME OF EXPOSURE *OXYGEN CONCENTRATION
THE EXACT SAFE LEVEL ARE NOT DEFINED BUT NOT MORE THAN 2.8 ATM
SHOULD BE USED WITH 100% O2 BUT WITH 21% UPTO 6 HRS CAN BE USED
SAFELY.ONE SCHEDULE SHOULD BE LESS THAN 2 HRS
SUMMARY
 OXYGEN THERAPY IS ADMINISTRATION OF OXYGEN
IN CONCENTRATION MORE THAN THAT OF AMBIENT
AIR (21%).
 IT IS CRUCIAL TO CHOOSE OXYGEN DELIVARY

DEVICES FOR FIO2 APPROPRIATE FOR THE PATIENT.
 OXYGEN IN CONCENTRATION HIGHER THAN

REQUIRED TO MAINTAIN NORMAL PaO2 IS
ASSOCIATED WITH TOXICITY.
 GOAL SHOULD BE TO USE LOWEST POSSIBLE FIO2

COMPATABLE WITH ADEQUATE TISSUE
OXYGENATION KNOWN AS EFFECTIVE OXYGEN
THERAPY .
CONCLUSION
 OXYGEN IS CONSIDERED A LIFE SAVING PRESCRIPTION DRUG
 JUDICIOUS USE WITH PROPER DOCUMENTATION IS MUST
*DATE AND TIME OF STARTING THE THERAPY
*FLOW RATE (DOSE)
*DELIVERY DEVICE (ROUTE )
*DURATION (HOW LONG )
*INSTRUCTION OF MONITORING
*FULL SIGNATURE OF CONCERNED DOCTOR

THANK YOU

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OXYGEN THERAPY

DR. ANUPAM CHAKRABARTI

 DEFINITION OF OXYGEN THERAPY

 TYPES OF OXYGEN THERAPY

 GOALS OF OXYGEN THERAPY

 INDICATIONS OF OXYGEN THERAPY

 METHODS OF OXYGEN THERAPY

 COMPLICATIONS OF OXYGEN THERAPY

AEROBIC METABOLISM (OXIDATIVE PHOSPHORYLATION)

GLUCOSE-----------CO2 +H2O + 38 ATP

GLUCOSE -----------LACTIC ACID + 2ATP

METABOLIC FAILURE AND METABOLIC

 HYPOXIA ----LACK OF OXYGEN

 HYPOXEMIA ----LACK OF OXYGEN IN BLOOD

ANEMIC HYPOXIA ………..DECREASE O₂ CONTENT

1.DECREASED INSPIRED CONCENTRATION (FIO₂)

2.HYPOVENTILATION DUE TO ANAESTHETICS OVERDOSE OR POST OP PAIN

3.DEFFUSION HYPOXIA (FINK EFFECT )

4.SHUNT -SEPTAL DEFECTS

5.DEFFUSION DEFECTS -PNEUMONIA,PULMONARY EDEMA ETC

3.CARBON MONOXIDE POISIONING

STAGNANT HYPOXIA CAUSES ARE

ELECTRON TRANSPORT SYSTEM OF CYTOCHROME OXIDASE IS PARALYSED

HYPOXIC HYPOXIA ++++

INVASIVE ---ARTERIAL BLOOD GAS ANALYSIS

 WHAT ARE THE PURPOSE OF THERAPY ?

HIGH FLOW /FIXED PERFORMANCE DEVICES:

3.SIMPLE FACE MASK (MARY CARTERALL MASK ),

4.MASK WITH RESERVOIR (PARTIAL REBREATHING AND NON REBREATHING

5.OXYGEN HOOD AND TENT,

 ANAESTHESIA BAG AND MASK

 HIGH FLOW NASAL CANNULA OXYGINATION (HFNOC)

 USED FOR LOW -MEDIUM CONCENTRATIONS OF OXYGEN

 FLOW RATE (LITRE/MIN) FIO2

 HELD TO THE HEAD WITH ELASTIC BANDS

 DELIVERS 35 TO 60% OXYGEN AT A FLOW RATE 6 TO 8 LITRE/MIN

 MERITS--- -INCREASED DELIVERY FOR SHORT PERIOD

 MASK WITH A RESERVOIR BAG THAT MUST REMAIN INFLATED DURING

 MERITS-- DELIVERS THE HIGHEST POSSIBLE OXYGEN CONCENTRATION

 DEMERITS- -IMPRACTICAL FOR LONG TERM THERAPY, SUFFOCATION,

 OXYGEN CONC REQUIRED FOR THE

 OXYGENCONC ACHIEVED BY THE

 IMPORTANCE OF ACCURACY OF THE

 PATIENT COMFORT AND MOBILITY

 A CENTRAL PIPELINE OUTLET SUPPLIED BY BULK CYLINDERS IN MANIFOLD ROOM

ALTERED RESPIRATORY DRIVE DEPENDENT ON RELATIVE HYPOXEMIA

CORRECTION LEADS TO LOSS OF RESPIRATORY DRIVE

ULTIMATELY RESPIRATORY FAILURE

RETINOPATHY OF PREMATURITY (ROP)

INCREASE RETINAL VASCULARITY

NECROSIS OF BLOOD VESSEL

HAEMORRHAGE-RETINAL DETACHMENT -BLINDNESS

OXYGEN SUBSEQUENTLY ABSORBED INTO BLOOD

EFFECT IS REDUCTION OF VOLUME OF ALVEOLI

COLLAPSE ALVEOLI - ABSORPTION ATELECTASIS

 80% NOT MORE THAN 24 HRS

 60% NOT MORE THAN 36 HRS

 ACUTE ISCHEMIA---CRUSH INJURY

 CHRONIC ISCHEMIA ---RADIATION NECROSIS