Oxygen therapy is the administration of O2 as an intervention, and can be used either in chronic or acute Pt care.
What is oxygen therapy?
It's where we give oxygen as an intervention. It can be given in the long term, or in the short term.
Oxygen is essential for cell metabolism, and thus tissue oxygenation is essential for normal physiological function
However, high blood/tissue levels of O2 can be damaging (not only helpful), depending on circumstances
The purpose of O2 therapy is to increase the supply of O2 to the lungs, and thus increasing the availability of O2 to the body tissues, especially when the Pt is suffering from hypoxia and/or hypxemia
Sources of oxygen include:
Liquid oxygen, stored in chilled tanks until required, and then allowed to boil at -183 degrees C, to release oxygen as a gas. This is widely used at hospitals due to their high usage requirements
Compressed gas storage, where oxygen gas is compressed in a gas cylinder, providing convenient storage, without the requirement for refrigeration found w/ liquid storage
Instant usage, involving use of an electrically powered oxygen concentrator, which can create sufficient oxygen for a Pt to use immediately. Their advantage is continuous supply w/o the need for deliveries of bulky cylinders
Oxygen passes through a pressure regulator, which controls the high pressure of oxygen delivered from a cylinder to a lower pressure. This lower pressure is controlled by a flowmeter, which is controlled by liters per minute, ranging from 0-15
Delivery of oxygen, can include, noting FiO2 (fraction of inspired oxygen) is the fraction/percentage f oxygen in the space being measured. We try to keep FiO2<0.5 even with mechanical ventilatoin, to avoid oxygen toxicity. It includes:
[Room oxygen, has FiO2 21%]
Supplemental oxygen, which is in addition to the room air they are breathing. This can be delivered by:
Nasal cannula (aka nasal prong, NP), a thin tube w/ 2 small nozzles that protrude into the Pt's nostrils. It can deliver 1-3L/min, which is an FiO2 of 24-32%
Simple face mask, which can deliver oxygen at 5-8L/min, which is an FiO2 of 40-60%
Partial rebreathing mask, which is a simple mask, plus a reservoir bag, which delivers oxygen at 8-12L/min, which is an FiO2 of 40-70% oxygen
High flow oxygen, where the Pt requires high concentrations of oxygen, all delivering oxygen at 10-15L/min, which is an FiO2 at 80-90%, including:
Non-rebreather mask, which is similar to the partial rebreathing mask, except it has a series of 1-way valves preventing exhaled air from returning to the bag. It is indicated for acute medical emergencies
Infant head box
Humidified high flow nasal cannula/prong, which enables flow exceeding a Pt's peak inspiratory flow demand, thus delivering high oxygen, because there is no entrainment of room air, even w/ the mouth open. This also allows the Pt to talk, eat and drink, whilst receiving therapy
Positive pressure delivery, for Pt's who are unable to breathe on their own, who require positive pressure to move oxygen into their lungs for gaseous exchange to take place
How can we give oxygen?
There's supplemental oxygen, high flow oxygen, and positive pressure delivery. Supplemental oxygen is just given in addition to room air they are breathing, which can be through a nasal cannula that goes into the patient's nose, a face mask, or even a rebreather mask to increase the oxygen provided. High flow oxygen is where we give concentrations up to 100%, and it includes the non-breather mask which prevents air breathed out from being returned, and high flow nasal cannula. PPV is where positive pressure is used to move oxygen into the lungs, by pushing air into the lungs.
Paperwork for Acute pediatric oxygen therapy chart includes:
Affix Pt label
A table, with various columns, for the rows Date, Time, Staff initials, Mode, O2 L/M and Air L/M (which are filled into a subdivided box), Prong size, Max flow limit, Activity, Color, Tracheal tug, Nasal flaring, Headbobbing, Recessino, Grunting, Humidifier temp, Suction, SPOC criteria
Mode of delivery, includes RA Room air, NP Nasal prongs, HM Hudson mask, HNP Humidified nasal prongs, HFNP High flow nasal prongs, HA Humidifed air
Color, including P Pale, D Dusky, C Cyanotic, J Jaundice, M Mottled
Recession including IC Intercostal, SC Subcostal, TT Tracheal tug
SPOC criteria is divided into the determinants on the rows, Airway, behavior & feeding, Respiratory rate, Accessory muscle use, Apneic episodes, Oxygen. The columns include Mild, Moderate, Severe. For Mild, is Stridor on exertion; Normal, Age appropriate vocalization; Mildly increased; None/minimal; None; No oxygen required. For Moderate, is Stridor at rest, partial airway obstruction; Some/intermittent irritability, difficulty talking ot crying, difficulty feeding or crying; Respiratory rate in yellow zone; Moderate recession, tracheal tug, nasal flaring; Abnormal pauses in breathing; Mild hypoxemia, corrected by oxygen, Increasing oxygen requirement. For Severe, New onset of stridor, Imminent airway obstruction; Agitated/confused, drowsy, unable to talk or cry, unable to feed or eat; Respiratory rate in red zone, decreasing (exhaustion); Severe recession, gasping, grunting, extreme pallor, cyanosis, absent breath sounds; Apneic episodes; Hypoxemia may not be corrected by oxygen