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Module 103, Theme 4: Physiology of the lungs and gaseous exchange. Pulmonary disorders and principles of their treatment. > Sleep apnoea and oxygen therapy. > Flashcards

Sleep apnoea and oxygen therapy. Flashcards

1
Q

Sources of oxygen

A

Oxygen cylinder

Wall supply

Oxygen concentrators

Liquid oxygen

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2
Q

Oxygen cylinders

A

Supplies 100%.

Comes in various sizes and only gives O2 for a limited length of time.

Used for treatments that last for a short duration.

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3
Q

Wall supply of O2

A

Only available in the hospital

Supplies 100%.

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4
Q

Oxygen concentrators

A

Machine that has a molecular sleeve to remove nitrogen.

Concentration >90%.

Mobile use of oxygen

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5
Q

Liquid oxygen

A

Highly compressed oxygen that allows larger volume of O2.

Not in the UK.

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6
Q

Nasal cannulae

A

Delivers O2- 24-40%.

Flow rate: 1-4L/min

Uses: mild hypoxaemia

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7
Q

Indication for nasal cannulae

A

Mild hypoxaemia.

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8
Q

Uncontrolled re-breathe masks

  • Example
  • Concentration
  • Flow
A

Example- Hudson mask.

Delivers 30-60%

Flow rate: 5-10L/min

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9
Q

Uncontrolled non-rebreathe masks

  • Concentration
  • Flow rate
  • Indication
A

85-90%

15L/min

Indication- acutely unwell patients.

One way valve prevents room air mixing with O2 supplied.

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10
Q

Venturi masks

A

Supplies a fixed concentration of O2.

Blue- 24%, 2-4L
White- 28% 4-6L
Yellow- 35% 8-10L
Red- 40% 10-12 L
Green- 60% 12-15L
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11
Q

Oxygen concentrations supplied by venturi

A

24% (blue)

28% (white)

35% (yellow)

40% (red)

60% (green)

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12
Q

4 main clinical indications for O2

A
  1. Acutely hypoxaemic patients.
  2. Chronically hypoxaemic with acute exacerbation.
  3. Chronically hypoxaemic who are stable.
  4. Palliative use in cancer.
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13
Q

O2 sat targets in those at risk of hypercapnic patients

A

88-92%

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14
Q

O2 target for normal adults and most patients

A

Normal:

96-98%

Patients- 94-98%

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15
Q

Acute hypoxaemia examples

A

Acute pulmonary oedema.

Acute pneumonia

Acute pneumothorax

Acute asthma

MI

Sepsis

CO poisoning

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16
Q

Acute breathlessness with hypoxaemia

  • Risk
  • O2 Treatment
  • Non-O2 treatment
A

Risk: acute cardiac arrhythmia and organ failure.

Treatment:
Max O2- high uncontrolled.
Target SpO2- 94-98%

Non-O2:

  • Secure airway patency
  • Avoid respiratory depressants
  • Treat established reason for hypoxaemia
  • Possible ventilation (IPPV)
17
Q

Chronically hypoxaemic with COPD + acute exacerbation.

  • Example of exacerbation.
  • Treatment
A

Example:
Bacterial infection
Heart failure episode

Treatment:

  • Fixed O2, venturi 24%
  • Target SpO2 at 88-92%
  • pH kept >7.35
18
Q

Chronically hypoxaemic with COPD + acute exacerbation.

  • Example of exacerbation.
  • Treatment
A

Example:
Bacterial infection
Heart failure episode

Treatment:

  • Fixed O2, venturi 24%
  • Target SpO2 at 88-92%
  • pH kept >7.35
  • CO2<6
  • pO2 <10
19
Q

Chronically hypoxaemic patients that are stable:

  • Problems if not treated
  • O2 therapy
A

Used in COPD and some bronchiectasis.

Problems caused if not treated:

  • Pulmonary artery hypertension.
  • RV hypertrophy
  • Cor pulmonale.

O2:
LTOT

20
Q

LTOT

A

Long term O2 treatment.

Given to some patients with stable COPD.

21
Q

Areas of the pharynx

A

Nasopharynx

Oropharynx

Laryngopharynx

22
Q

What happens to the pharynx during sleep apnoea

A

The tendency of the pharynx to collapse increases due to the following factors:

  • Decrease in the neuromuscular tone of the upper airway (UA).
  • Decrease in the caliber of the UA.
  • Increase in resistance of the UA.
  • Increase in pharyngeal compliance
23
Q

Sleep apnoea cycle

A
  1. Sleep.
  2. Relaxation of the muscles and tissues surrounding the pharyngeal airway.
  3. Collapse and obstruction of the airway= snoring.
  4. Apnoea
  5. Arousal
  6. Return of muscular tone
  7. Resumption of breathing.
24
Q

CPAP

A

Continuous positive airway pressure

Used to treat sleep apnoea.

The device generates airflow by delivering positive pressure via a mask.

Keeps the pharynx open by making the intraluminal pharyngeal pressure> surrounding pressure.

25
Q

Benefits of CPAP

A

Resolves symptoms

Decreases :

  • Apnoea
  • Daytime sleepiness
  • Risk of road accidents.

Increases quality of life

26
Q

Problems of CPAP

A

Mask problems: leaks and discomfort.

Life long

Can cause airway drying and irritation.

Difficult to adhere to

27
Q

Behavioural changes to manage sleep apnoea

A

Weight loss

Avoid sleeping supine

Avoiding alcohol

28
Q

Mandibular advancement devices

A

Equipment used to treat sleep apnoea.

Holds the soft tissue of the oropharynx forward.

Used for mild-moderate sleep apnoea.

29
Q

Consequences of obstructive sleep apnoea

A

Increased risk of road accidents.

Associated with many conditions:
T2 diabetes
Hypertension
IHD
Heart failure
Stroke
Arrythmias
Death

Module 103, Theme 4: Physiology of the lungs and gaseous exchange. Pulmonary disorders and principles of their treatment. (16 decks)

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