Download O2-12

O2 Therapy & Air way management
techniques
Abdualrahman ALshehri
Lecturer
King Saud University
Riyadh Community College
RN, MSN
Respiratory Anatomy
Nose and mouth (warms, moistens, and
filters air).
Pharynx
–Oropharynx
–Nasopharynx
Epiglottis
Trachea (windpipe)
Respiratory Anatomy
Cricoid cartilage (adams apple).
Larynx (voice box).
Bronchi
Lungs
–Visceral pleura (surface of lungs)
–Parietal pleura (internal chest wall)
–Interpleural space (potential space)
Respiratory Anatomy
Diaphragm
Inhalation (active process)
–Diaphragm and intercostal muscles contract,
increasing the size of the thoracic cavity.
–Diaphragm moves slightly downward, ribs move
upward and outward.
Air flows into the lungs creating a negative
pressure in the chest cavity.
Respiratory Anatomy
Exhalation (passive process)
Diaphragm and intercostal muscles relax
decreasing the size of the thoracic cavity.
–Diaphragm moves upward, ribs move downward
and inward.
Air flows out of the lungs creating a positive
pressure inside the chest cavity.
Respiratory Physiology
 Oxygenation - blood and the cells become saturated
with oxygen
 Hypoxia - inadequate oxygen being delivered to the
cells
 Signs of Hypoxia
– Increased or decreased heart rate
– Altered mental status (early sign)
– Agitation
– Initial elevation of B.P. followed by a decrease
– Cyanosis (often a late sign)
Alveolar/Capillary Exchange
Oxygen-rich air enters the alveoli during each
inspiration.
Oxygen-poor blood in the capillaries passes
into the alveoli.
Oxygen enters the capillaries as carbon
dioxide enters the alveoli.
Capillary/Cellular Exchange
Cells give up carbon dioxide to the
capillaries.
Capillaries give up oxygen to the cells.
Functions of the Respiratory System: Overview
Exchange O2
–Air to blood
–Blood to cells
Exchange CO2
–Cells to blood
–Blood to air
Regulate blood pH
Vocalizations
Protect alveoli
Factors Affecting Ventilation
 Airway Resistance
 Diameter
 Mucous blockage
 Bronchoconstriction
 Bronchodilation
 Alveolar compliance
1. Surfactants
2. Surface tension
 Alveolar elasticity
Gas Exchange in the Alveoli
Thin cells: exchange
Surfactant cells
Elastic fibers
– Recoil
– Push air out
Thin basement membrane
Capillaries cover 90% of surface
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Gas Exchange in the Alveoli
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Oxygen movement
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Oxygen movement
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Oxygen movement
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Oxygen Therapy
For over 200 years oxygen therapy has
often been used and sometimes misused
(Hough 2001)
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Oxygen Therapy
Should be prescribed
Acute and chronic respiratory conditions
Personnel should be trained in its use
Protocols
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Oxygen Therapy - Indications
 Hypoxaemia (PaO2<8KPA, O2sats<90%)
 Acute or chronic respiratory condition
 Pre and post suction
 Routinely post operatively
 Optimise oxygen delivery
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Oxygen therapy - limitations
Giving oxygen does not guarantee it’s arrival at the
mitochondria
Oxygen does not improve ventilation directly
(Hough 2001)
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Oxygen therapy – complications/cautions
Respiratory depression if hypoxic drive
Pulmonary oxygen toxicity
Tracheobronchitis
Absorption atelectasis
Fire
Variable delivery
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Oxygen Therapy - Monitoring
Oxygen saturations continuous/intermittent
Arterial blood gases
Observation
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Oxygen therapy – delivery devices
Low Flow masks (variable performance)
High flow masks (fixed flow)/venturi
Nasal cannulae
Mask and reservoir bag
Tracheal mask/t-piece
Tracheal speaking valves
Mechanical ventilator
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Oxygen Therapy - low flow masks
Commonly used
Variable performance
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Oxygen therapy – high flow masks
Guaranteed percentage of oxygen
Venturi system
More expensive
Up to 60%
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Nasal cannulae
1l/min
24% oxygen
2l/min
28% oxygen
3l/min
32% oxygen
4l/min
36% oxygen
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Oxygen therapy – bag and mask
High concentrations of oxygen
Mask and reservoir bag
55-90%
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Oxygen Therapy tracheostomy
T-piece
Mask
Swedish nose
Speaking valve
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Long term oxygen therapy
Chronic hypoxaemia
Increases survival
Aim to raise PaO2 to >8Kpa
Worn as much as possible >15hours
Cylinders/concentrators/liquid
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Humidification
Mucocillary escalator
Adequate hydration is vital
Bacterial contamination!!!
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Humidification - indications
URT bypassed
Thick retained secretions
High flow oxygen/non-invasive mechanical aids
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Humidification - Cautions
Hyper-reactive airways - bronchospasm
Infection
Burns
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Humidification - Types
Nebulisers Large/Small/Ultrasonic
Steam
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Humidification - Humidifiers
Hot
 - Increases moisture content
 - Increases risk of infection
Cold
 - Poor moisture content
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Non-invasive ventilation
BiPAP
CPAP
IPPB
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