Oxygen Therapy

Front 1

Common Medical Facts of Oxygen

Back 1

Atmosphere:
78% nitrogen
21% oxygen
1% trace gases (argon, krypton, xenon, etc…)


-first identified by Joseph Priestly in 1774, used therapeutically in 1800
-dry, colorless, tastless and odorless
-supports combustion
-liquid oxygen is traditionally converted to gas
-may be stored in cylinders (A – H)
-color coded cylinders (green), carbon dioxide (gray), helium (brown), nitrous oxide (light blue)
-requires a physician order
-requires humidification
-bulk oxygen (50 psig)

Front 2

Clinical indications of Oxygen:

Back 2

- reduce or correct arterial / tissue hypoxemia

- treatment of choice of carbon monoxide exposure

- decrease the work of breathing

- decrease myocardial work
Oxygen can be administered up to 100%

FIO2- fraction of inspired oxygen

Front 3

Traditional monitoring (SaO2):

Back 3

Saturation of oxygen in the arterial blood

- Normal: 97-99% (21-100%FIO2)

- Monitored with arterial blood gas analysis or pulse oximetry

- Pulse oximetry preferred: Non invasive, very convenient and accurate

- Location: finger, earlobe

- Nail polish interferes with accuracy

Front 4

Traditional monitoring (PaO2):

Back 4

partial pressure of oxygen in the arterial blood

- Normal: 80-100mmHg (21% FIO2)

- Monitored with arterial blood gas analysis

- Rule of thumb: FIO2 x 5 = PaO2

Example: FIO2 40% x 5 = 200mmHg


- A-a gradient – alveolar arterial gradient


- New technology: invasive continuous monitoring

Front 5

Oxygen Toxicity

Back 5

- atelectasis (lungs not fully inflated)

- oxygen toxicity

- hypoventilation

- retrolental fibroplasias (premature infants)

Front 6

Nasal Cannula

Back 6

- low-low system
- flowrate 0.5 – 6 L/min
- > 6L/min not recommended
- FIO2 24 – 44%
- variable FIO2 based upon patients RR, mouth breathing, etc..

Front 7

Simple Mask

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- low-flow system
- 5-8 L/min
- FIO2 40%
- used if patient not tolerating nasal cannula
- interferes with eating/drinking
- may feel “smothered”

Front 8

Venturi Mask

Back 8

- high-flow system
- variable
- FIO2 24, 28, 31, 35, 40, 50%
- precise FIO2 delivery
- never delivers more oxygen if flowrate accidently increased

Front 9

Partial Rebreather Mask

Back 9

- high-flow system
- 8-12 L/min
- FIO2 35-60%
- allows room air entrainment if oxygen source fails

Front 10

Non-Rebreather Mask

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- high flow system
- 15 L/M +
- FIO2 90-100%
- highest delivery of oxygen before mechanical ventilation required
- can be converted to partial rebreather mask
- no access to room air if oxygen source dissconnected

Front 11

Croupette

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- low-flow system
- used for children
- FIO2 21-100%
- 100% unlikely due to opening and closing for access to child
- high humidity aerosol promotes bacterial growth

Front 12

Isolete

Back 12

- low or high-flow systems
- used for infants
- FIO2 40 or 100%

Front 13

humidifiers/ nebulizers

Back 13

- can be used with various devices to provide high humidity aerosol

Front 14

Hyperbaric medicine

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(21 - 100% including increasing or decreasing in atmospheric pressure – 3 atmospheres – dissolves more oxygen in plasma)

Treatment – “bends”, skin ulcers, burn injury, osteomyelitis

Front 15

Patient counseling (Oxygen)

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- NO SMOKING!

- Avoid using oxygen near open flame or heat source

- Avoid dropping cylinders

- Check for leaks