Oxygen Therapy
Oxygen Therapy
Oxygen Therapy
Physiology of Oxygenation
Alveolar Gas Equation
PAO2=(PB-PH2O)FiO2 PaCO2(FiO2+1-FiO2) R Normal transit time for blood through pulmonary capillary is 0.3 to 0.7 sec Alveolar gas exchange is a major determinant of PAO2
Physiology of Oxygenation
Oxygen delivery to the periphery and its utilization depends on: 1. Oxygen content of arterial blood 2. Amount of blood i.e. cardiac output DO2 = CO X CaO2 X 10 CaO2 = (Hg X 1.34 X SaO2) + (PaO2X0.0031)
Oxygen Cascade
Dry air at sea level : 159 mmHg Trachea : 149 mmHg Alveolus : 101 mmHg Mitochondrion : 3.8 22.5 mmHg Mixed venous blood : 40 mmHg Oxygen consumption per minute at rest is 225 to 250 ml.
Causes of Hypoxia
A.Hypoxemic Decreased oxygen intake (high altitude) Ventilation-perfusion imbalance (high V/Q) (obstructive airways disease) Shunt (low V/Q) (ASD, pulmonary AV fistula) Diffusion defect (interstitial pneumonitis) Alveolar hypoventilation (COPD) Low mixed venous oxygen
Causes of Hypoxia
B.Impaired Delivery Circulatory (forward flow) (hypovolemia, heart-failure) Distributive (sepsis, arterial insufficiency) Defective blood oxygen transport (inherited abnormal hemoglobin, anemia and acquired abnormal hemoglobin e.g. carbon monoxide poisoning)
1. 2. 3. 4.
a) b)
c) d)
Polycythemia (hematocrit > 56%) Resting PaO2>59 mmHg or SaO2>89% justifying that more conservative therapy has failed
Degree of hypoxemia Requirement for precision of delivery Patient comfort Cost Rebreathing system Non-rebreathing system
Variable performance low flow system Fixed performance high flow system
Types of equipment
Gas flow is not sufficient to meet all inspiratory demands Does not provide consistent and predictable FiO2 Factors affecting FiO2 are:
ventilatory pattern of the patient size of available oxygen reservoir oxygen flow (liters per minute)
Nasal prongs
Oxygen Mask
30 =0.6:1 70 50
100
50
Enclosures
Oxygen Tents Oxyhoods
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Liquid oxygen
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Oxygen Concentrator
Advantages No waste or loss, low pressure system (15 psi), cost-effective when continuous supply of oxygen is needed, eliminates need for oxygen delivery Disadvantages Disruption in electrical service renders system inoperable, back-up oxygen is necessary, cannot operate ventilators or other high pressure devices, concentration of oxygen decreases with flow rate, electrical costs for operating system may be substantial
Oxygen Concentrator
Oxygen is addicting: in its grip are all mitochondria-rich eukaryocytes who learned to depend on it during the past 1.4 billion years. This, the first atmospheric pollutant, is the waste product of Stromatolytes (formation of algal plankton), which excreted it at least 2.3 billion years ago. Since then all sediments have been rusted or oxidised. Oxygen is toxic. It rusts a person in a century or less. With oxygen came the danger and blessing of fire. If introduced today, this gas might have difficulty in getting approved by the Food and Drug administration
Severinghaus JW, astrup PB. History of blood gas analysis; In: Leland Clarks electrode. J Clin Monit 1986;2;125-139
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