O2 Therapy Flashcards
O2 therapy is:
the administration of oxygen at concentrations greater than those found in ambient air in order to treat or prevent hypoxaemia. When used as a medical treatment, oxygen is regarded as a drug and must be prescribed according to a target saturation range
The patient is monitored to:
ensure that the oxygen therapy administered keeps them within the target saturation range. For most patients, a target of 94-98% is appropriate. For those at risk of carbon dioxide retention (hypercapnia), a target of 88-92% ensures safe levels of oxygenation and minimises risk of respiratory acidosis
O2 therapy will improve:
oxygenation but it does not treat the underlying cause of hypoxaemia which must be diagnosed and treated as a matter of urgency
Indications for O2 Therapy:
- Documented hypoxemia as evidenced by: 1) PaO2 < 8Kpa or SaO2 < 90-92% on room air 2) PaO2 or SaO2 below desirable range for a specific clinical situation
- Acute care situations in which hypoxaemia is suspected
- Severe trauma
- Acute myocardial infarction
- Short term therapy (Post anaesthesia recovery)
- Decrease the symptoms associated with chronic hypoxaemia in pts who are not CO2 retainers
- Decrease the workload hypoxaemia imposes on the cardiopulmonary system, i.e. increased CO and redistribution to vital organs
Strong indicator for oxygen therapy is:
PaO2 < 9 kPa is a strong indicator for oxygen therapy
Early signs of hypoxemia include:
PaO2 8-10 kPa: Cold, clammy extremities/restless
Late signs of hypoxemia include:
Symptoms if PaO2 <8 kPa: Cyanosis (peripheral and central), tachycardia (increased HR), dyspnoea (SOB)
Symptoms of PaO2 <6kPa: Mental deficiency, memory loss, arrhythmia, confusion, loss of co-ordination (ataxic)
Symptoms of PaO2 <4kPa: Bradycardia (reduced HR), cardiac arrest, hypotension
Complications of O2 therapy are:
- Oxygen toxicity: increased free radicals results in fibrotic changes. Occurs from prolonged exposure. Seen as tremors, twitching, convulsions
- Depression of ventilation: Those with hypoxic drive are at risk of slowing RR leading to cardiac arrest. Require Non-Invasive Ventilator (NIV) to blow off CO2
- Retinopathy of Prematurity: premature babies ocular system affected results in visual changes
- Absorption atelectasis: increased O2 concentration levels at detriment of normal N2 levels in lungs that maintain alveoli to stay open thus alveoli will begin to collapse
- Fire hazard: smoking
Guidelines procedure in starting and monitoring O2 therapy include:
Oxygen should be prescribed prior to administration (except in an emergency)
Oxygen therapy is started using an appropriate delivery system and flow rate
Oxygen saturations should be observed for first 5 mins after a change to oxygen therapy
Oxygen therapy is titrated to maintain target saturation
Patients requiring >28% oxygen for more than 24 hours can have oxygen delivered via a humidification system for comfort and to avoid the drying of secretions
Oxygen saturation is documented with the oxygen device, FiO2 (concentration) and flow rate
Signs of Respiratory Deterioration:
Increased RR (especially if >30)
Decreased SpO2
Increase in O2 dose needed to keep SpO2 in target range
Increase in NEWS score
Patients require prompt medical review and further assessment including monitoring of arterial blood gas
Signs of CO2 retention:
Drowsiness, headache, flushed face, flapping tremor
Those at risk of hypercapnia are:
Chronic obstructive pulmonary disease (emphysema); Neuromuscular and chest wall disorders; Cystic fibrosis; Morbid obesity.
Assessment techniques for suitability of O2 therapy include:
Pulse Oximetry: 1st port of call, Non-invasive, Measures SpO2 and HR only (no information on pH, PaCO2, haemoglobin levels)
Arterial Blood Gases: ‘Gold Standard Test’ for assessing respiratory failure, Measures PaO2, pH, PaCO2, HCO3, SaO2, Invasive
Oxygen Delivery Methods include:
Variable-Performance Devices (estimated oxygen delivery): Nasal Cannula (Reservoir Cannula), Simple Face Mask, Reservoir Mask (Partial re-breath mask, Non-rebreathe)
Fixed-Performance Devices: Venturi Mask (fixed FiO2 model, variable FiO2 model)
Other: Nasal Catheter, Transtracheal Catheter, Oxygen tent, Hyperbaric chamber
Indications for nasal cannula
Low to mod O2 requirement: 2-4 l min-1 (28-36%); < 2 L/min(child)
No or mild respiratory distress: Mild hypoxaemia on air (9-10 Kpa)
Long term O2 therapy