Difference between revisions of "Oxygen therapy"

(Created page with "{| class="wikitable" | align="center" style="background:#f0f0f0;"|'''Device''' | align="center" style="background:#f0f0f0;"|'''L/min''' | align="center" style="background:#f0f...")
 
(High-flow Nasal Cannula)
 
(7 intermediate revisions by 3 users not shown)
Line 1: Line 1:
 +
==Standard Administration Options==
 +
 
{| class="wikitable"
 
{| class="wikitable"
 
| align="center" style="background:#f0f0f0;"|'''Device'''
 
| align="center" style="background:#f0f0f0;"|'''Device'''
Line 21: Line 23:
 
| Oxygen tent||10-15||21-50%||Used mainly on children with croup or pneumonia
 
| Oxygen tent||10-15||21-50%||Used mainly on children with croup or pneumonia
 
|-
 
|-
| Simple mask||5-12||35-55%||Never used at flows less than 5 L/min to prevent rebreathing of CO2
+
| Simple mask||5-15||35-55%||Never used at flows less than 5 L/min to prevent rebreathing of CO2
 
|-
 
|-
 
| Trach mask||10-15||35-60%||Adequate flow shown by mist flowing out the exhalation port at all times
 
| Trach mask||10-15||35-60%||Adequate flow shown by mist flowing out the exhalation port at all times
Line 31: Line 33:
 
| Non-rebreathing mask||8-15 (or max)||60-99%||Flow rate must be sufficient to keep bag 1/3 to 1/2 inflated at all times
 
| Non-rebreathing mask||8-15 (or max)||60-99%||Flow rate must be sufficient to keep bag 1/3 to 1/2 inflated at all times
 
|}
 
|}
 +
 +
==High-flow Nasal Cannula==
 +
*Different Setup to low-flow O2 therapy
 +
*Good for hypoxemic respiratory failure
 +
*Every 10L/min is similar to 1mmHg PEEP
 +
*Set flow and FiO2%
 +
*Adults
 +
**Flow - start with 0.5 L/kg/min (Max 60L)
 +
**FiO2 - start with 100% and taper down from there
 +
*Pediatrics
 +
**FiO2 - Start 40% and titrate up
 +
**Flow - based on weight (table below) <ref>    Richards-Belle A, Davis P, Drikite L, et al    FIRST-line support for assistance in breathing in children (FIRST-ABC): a master protocol of two randomised trials to evaluate the non-inferiority of high-flow nasal cannula (HFNC) versus continuous positive airway pressure (CPAP) for non-invasive respiratory support in paediatric critical care    BMJ Open 2020;10:e038002. doi: 10.1136/bmjopen-2020-038002 PDF: https://bmjopen.bmj.com/content/bmjopen/10/8/e038002.full.pdf</ref>.
 +
{| class="wikitable"
 +
|-
 +
! Weight (kg) !! <=12!! 13-15!! 16-30!! 31-50 !! >50
 +
|-
 +
| Starting flow rate || 2 l/min/kg || 25-30 l/min || 35 l/min|| 40 l/min || 50 l/min
 +
|}
 +
 +
==Hyperbaric Oxygen (HBO)==
 +
*Two methods of administration<ref name="Bitterman">Bitterman H. Bench-to-bedside review: Oxygen as a drug. Critical Care. 2009;13(1):205. doi:10.1186/cc7151.</ref>
 +
*#Small, single-occupant chamber filled with 100% oxygen and pressurized to desired level
 +
*#Large, multi-occupant chamber filled with room air and pressurized to desired level - occupants breathe supplemental oxygen at ambient pressure via mask
 +
*Rationale for use<ref name="Bitterman" />
 +
**At normal pressures (even with supplemental oxygen administration), very little oxygen is dissolved in plasma
 +
**When oxygen provided at 3 ATA, there is enough oxygen dissolved in plasma to oxygenate all body tissues without resorting to hemoglobin-bound oxygen
  
 
==See Also==
 
==See Also==
 
*[[Oxygen toxicity]]
 
*[[Oxygen toxicity]]
 +
*[[High altitude medicine]]
  
 
==External Links==
 
==External Links==
Line 39: Line 68:
 
==References==
 
==References==
 
<references/>
 
<references/>
 +
 +
[[Category:Critical Care]]

Latest revision as of 11:26, 28 February 2021

Standard Administration Options

Device L/min % Oxygen Comments
Nasal Cannula 1 24%
2 28%
3 32%
4 36%
5 40%
6 44%
Venturi mask 24-50% Increasing flow will not alter FiO2
Oxygen tent 10-15 21-50% Used mainly on children with croup or pneumonia
Simple mask 5-15 35-55% Never used at flows less than 5 L/min to prevent rebreathing of CO2
Trach mask 10-15 35-60% Adequate flow shown by mist flowing out the exhalation port at all times
Partial rebreathing mask 8-15 35-60% Flow rate must be sufficient to keep bag 1/3 to 1/2 inflated at all times
Aerosol mask 8-15 21-99%
Non-rebreathing mask 8-15 (or max) 60-99% Flow rate must be sufficient to keep bag 1/3 to 1/2 inflated at all times

High-flow Nasal Cannula

  • Different Setup to low-flow O2 therapy
  • Good for hypoxemic respiratory failure
  • Every 10L/min is similar to 1mmHg PEEP
  • Set flow and FiO2%
  • Adults
    • Flow - start with 0.5 L/kg/min (Max 60L)
    • FiO2 - start with 100% and taper down from there
  • Pediatrics
    • FiO2 - Start 40% and titrate up
    • Flow - based on weight (table below) [1].
Weight (kg) <=12 13-15 16-30 31-50 >50
Starting flow rate 2 l/min/kg 25-30 l/min 35 l/min 40 l/min 50 l/min

Hyperbaric Oxygen (HBO)

  • Two methods of administration[2]
    1. Small, single-occupant chamber filled with 100% oxygen and pressurized to desired level
    2. Large, multi-occupant chamber filled with room air and pressurized to desired level - occupants breathe supplemental oxygen at ambient pressure via mask
  • Rationale for use[2]
    • At normal pressures (even with supplemental oxygen administration), very little oxygen is dissolved in plasma
    • When oxygen provided at 3 ATA, there is enough oxygen dissolved in plasma to oxygenate all body tissues without resorting to hemoglobin-bound oxygen

See Also

External Links

References

  1. Richards-Belle A, Davis P, Drikite L, et al FIRST-line support for assistance in breathing in children (FIRST-ABC): a master protocol of two randomised trials to evaluate the non-inferiority of high-flow nasal cannula (HFNC) versus continuous positive airway pressure (CPAP) for non-invasive respiratory support in paediatric critical care BMJ Open 2020;10:e038002. doi: 10.1136/bmjopen-2020-038002 PDF: https://bmjopen.bmj.com/content/bmjopen/10/8/e038002.full.pdf
  2. 2.0 2.1 Bitterman H. Bench-to-bedside review: Oxygen as a drug. Critical Care. 2009;13(1):205. doi:10.1186/cc7151.