Q: What are the indications of oxygen therapy?
Oxygen is rarely indicated for any other reason than Hypoxaemia.
• Hypoxaemia: Oxygen can be given in high or low concentration in all the
conditions associated with hypoxaemia. Hypoxaemia occurs frequently in
diseases like lower respiratory tract infection (severe pneumonia or
bronchiolitis), upper airway obstruction, severe asthma, common neonatal
conditions like birth asphyxia and in respiratory distress syndrome , severe
sepsis, heart failure, cardiac arrest, trauma, carbon monoxide poisoning, and
obstetric and perioperative emergencies.
Other indications include:
• Increased work of breathing.
• Increased myocardial work and/or Myocardial infarction.
• Pulmonary hypertension.
• Pre-oxygenation in induction and difficult intubation.
• Pre and post suctioning.
• Postoperative oxygenation especially in abdominal and chest surgeries.
• Hyperbaric oxygen therapy indicated in decompression sickness, gas
embolism, gas gangrene and carbon monoxide poisoning.
• Anaemic Hypoxia it’s benefits is limited due circulatory deficit.
• In arosal or drug delivery.
Q: What are the different types of oxygen therapy?
Types of Oxygen Equipment:
Additional Information:
Nasal-cannula (low-flow system)
Nasal cannula consists of a small bore tube connected to two short prongs that
are inserted into the nares to supply oxygen directly from a flow meter or
through humidified air to the patient. It is used for short- or long-term therapy
(i.e., COPD patients), and is best used with stable patients who require low
amounts of oxygen.
Advantages: Can provide 24% to 40% O2 (oxygen) concentration. Most
common type of oxygen equipment. Can deliver O2 at 1 to 6 litres per minute
(L/min). It is convenient as patient can talk and eat while receiving oxygen.
May be drying to nares if level is above 4 L/min. Easy to use, low cost, and
disposable.
Limitations: Easily dislodged, not as effective is a patient is a mouth breather or
has blocked nostrils or a deviated septum or polyps.
Applying a nasal cannula Nasal cannula
Simple face mask (low-flow system):
A mask fits over the mouth and nose of the patient and consists of exhalation
ports (holes on the side of the mask) through which the patient exhales CO2
(carbon dioxide). These holes should always remain open. The mask is held in
place by an elastic around the back of the head, and it has a metal piece to shape
over the nose to allow for a better mask fit for the patient. Humidified air may
be attached if concentrations are drying for the patient.
Advantages: Can provide 40% to 60% O2 concentration. Flow meter should be
set to deliver O2 at 6 to 10 L/min. Used to provide moderate oxygen
concentrations. Efficiency depends on how well mask fits and the patient’s
respiratory demands. Readily available on most hospital units. Provides higher
oxygen for patients.
Disadvantages: Difficult to eat with mask on. Mask may be confining for some
patients, who may feel claustrophobic with the mask on.
Simple face mask
Non re-breather mask (high-flow system):
Consists of a simple mask and a small reservoir bag attached to the oxygen
tubing connecting to the flow meter. With a re-breather mask, there is no re-
breathing of exhaled air. It has a series of one-way valves between the mask and
the bag and the covers on the exhalation ports. On inspiration, the patient only
breathes in from the reservoir bag; on exhalation, gases are prevented from
flowing into the reservoir bag and are directed out through the exhalation ports.
Advantages: With a good fit, the mask can deliver between 60% and 80% FiO2
(fraction of inspired oxygen). The flow meter should be set to deliver O2 at 10
to 15 L/min. Flow rate must be high enough to ensure that the reservoir bag
remains partially inflated during inspiration.
Disadvantages: These masks have a risk of suffocation if the gas flow is
interrupted. The bag should never totally deflate. The patient should never be
left alone unless the one-way valves on the exhalation ports are removed. This
equipment is used by respiratory therapists for specific short-term, high oxygen
requirements such as pre-intubation and patient transport. They are not available
on general wards due to: 1. the risk of suffocation, 2. the chance of hyper-
oxygenation, and 3. their possible lack of humidity. The mask also requires a
tight seal and may be hot and confining for the patient. The mask will interfere
with talking and eating.
Non re-breather mask:
Partial re-breather mask (high-flow system):
The bag should always remain partially inflated. The flow rate should be high
enough to keep the bag partially inflated.
Advantages: Can deliver 10 to 12 L/min for an O2 concentration of 80% to
90%. Used short term for patients who require high levels of oxygen.
Disadvantages: The partial re-breather bag has no one-way valves, so the
expired air mixes with the inhaled air. The mask may be hot and confining for
the patient and will interfere with eating and talking.
Partial re-breather mask:
Face tent (low-flow system):
The mask covers the nose and mouth and does not create a seal around the nose.
Advantages: Can provide 28% to 100% O2 Flow meter should be set to deliver
O2 at a minimum of 15 L/min. Face tents are used to provide a controlled
concentration of oxygen and increase moisture for patients who have facial burn
or a broken nose, or who are are claustrophobic.
Disadvantages: It is difficult to achieve high levels of oxygenation with this
mask.
Face tent:
Venturi mask (high-flow system):
High-flow system consisting of a bottle of sterile water, corrugated tubing, a
drainage bag, air/oxygen ratio nebulizer system, and a mask that works with the
corrugated tubing. The mask may be an aerosol face mask, tracheostomy mask,
a T-piece, or a face tent. The key is that the flow of oxygen exceeds the peak
inspiratory flow rate of the patient, and there is little possibility for the patient to
breathe in air from the room
Advantages: The system can provide 24% to 60% O2 at 4 to 12 L/min. Delivers
a more precise level of oxygen by controlling the specific amounts of oxygen
delivered. The port on the corrugated tubing (base of the mask) sets the oxygen
concentration. Delivers humidified oxygen for patient comfort. It does not dry
mucous membranes.
Disadvantages: The mask may be hot and confining for some patients, and it
interferes with talking and eating. Need a properly fitting mask. Nurses may be
asked to set up a high-flow system. In other instances, respiratory therapists
may be responsible for regulating and monitoring the high-flow systems.
Q: What are the different techniques of oxygen therapy?
Oxygen delivery method selected depends on:
• age of the patient
• oxygen requirements/therapeutic goals
• patient tolerance to selected interface
• humidification needs
LOW FLOW DELIVERY METHOD:
Low-flow systems include:
• Simple face mask
• Non re-breather face mask (mask with oxygen reservoir bag and one-way
valves which aims to prevent/reduce room air entrainment)
• Nasal prongs (low flow)
• Tracheostomy mask
• Tracheostomy HME connector
• Isolette - neonates
High flow delivery method
High flow systems include:
• Ventilators
• CPAP/BiPaP drivers
• Face mask or tracheostomy mask used in conjunction with an Airvo2
Humidifier
• High Flow Nasal Prong therapy (HFNPN)
• NB: There is separate CPG for HFNP use in the NICU
Q: Difference between BIPAP and CPAP?