OXYGEN THERAPY

‫العالج باألوكسجين‬

Presented by :
Salim Shehab Ahmed
Master Degree in Nursing
Nov. 2018
 Introduction ‫المقدمة‬
 As there is a fixed amount of haemoglobin
circulating in the blood, the amount of oxygen
carried in the blood is often expressed in terms
of how saturated ‫ مشبع‬with oxygen. This is what
is meant by ‘oxygen saturation level ‫مستوى تشبع‬
‫’ االوكسجين‬. If this is measured directly from an
arterial blood sample it is termed SaO2. If it is
measured from a pulse oximeter it is termed
SpO2.
 SpO2 the 5th vital signs = O2 saturation by
pulse. ‫تسمى العالمة الحيوية الخامسة‬
 Purpose of using o2 therapy
‫الغرض من استخدام العالج باألوكسجين‬

 Documented hypoxemia In adults, children, and

infants, oxygen saturation (spO2) of < 90%
 ‫قلة في تجهيز االوكسجين الى اجهزة الجسم‬
 PRACTICAL USES OF OXYGEN THERAPY
‫االستخدامات العملية لالوكسجين‬
 Pre-oxygenation: Pre-oxygenation means
breathing 100% oxygen for 3- 5 minutes
through an anaesthetic circuit with a face mask
firmly applied to the face. If the patient is
breathing room air, the oxygen store in
functional residual capacit ‫السعة الوضيفية لوضيفة الرئة‬
(FRC) is approximately 450 ml and it can be
increased to 3000 ml with breathing 100%
oxygen. As a result, there will be a rapid fall in
oxygen saturation during apnea (e.g. following
induction of anaesthesia) if breathing room air.
 PRACTICAL USES OF OXYGEN
THERAPY
‫االستخدامات العملية لالوكسجين‬
Postoperative oxygen: Additional oxygen 
should be given to all patients for the first 10
min after general anaesthesia, as a result of
hypoxaemia during the early recovery period.
Postoperative hypoventilation is common due
to the residual effect of anaesthesia, opioid
analgesia, pain or airway obstruction.
Prolonged oxygen therapy is required after
operation in certain conditions such as
hypotension, ischaemic heart disease,
anaemia, and obesity.
 PRACTICAL USES OF OXYGEN
THERAPY
‫االستخدامات العملية لالوكسجين‬
 Hyperbaric oxygen therapy:
 ‫العالج باالوكسجين عالي الضغط‬
 It is indicated in decompression
sickness, gas embolism, gas
gangrene and carbon monoxide
poisoning
PRACTICAL USES OF OXYGEN THERAPY
‫االستخدامات العملية لالوكسجين‬
 Hypoxaemia is deficiency of oxygen in arterial
blood (PaO2 < 60 mmHg) hypoxaemia can
also be measured in relation to
oxyhaemoglobin ‫االوكسجين المرتبط‬saturation
SaO2<90%.
 Hypoxia: is a deficiency of oxygen at the
tissue level.
 Hypoxia: occurs when oxygen supplies are
insufficient to reach to, alveolar or tissue
hypoxia.
 INDICATIONS
‫الحاالت التي يستخدم فيها العالج باالوكسجين‬
1 Cardiac arrest and other conditions requiring CPR
2 Critically ill patients including major trauma, shock and
major sepsis
3 Drowning ‫غريق‬
4 Anaphylaxis 10–15 L/min
5 Major pulmonary haemorrhage or massive haemoptysis
6 Epileptic fits As this is a life-threatening patient may
suffer from cerebral hypoxia (and oximetry may not be
possible), patients with status epilepticus should be
treated in accordance with (reservoir mask until
clinically stabilised).
7 Major head injury
 Forms of oxygen
‫اشكال االوكسجين‬

1 Cylinders (compressed gas) Oxygen can be stored

under pressure in cylinders
2 Liquid oxygen is contained in pressure tanks and is
obtained from atmospheric oxygen by distillation ‫التقطير‬
 Forms of oxygen
‫اشكال االوكسجين‬

 2 Oxygen concentrators: It is a device which extracts

oxygen from atmospheric air by using
zeolite molecular sieve ‫ منخل الزيوليت الجزيئي‬.
Small or large concentrators are available.
 devices used ‫االدوات المستعملة‬

 1 Nasal cannula Flow from 1-6 LPM of O2 It is ideal for long

term oxygen therapy. It does not increase dead space and there is no rebreathing.
Flow rate of 2-4 L/min is recommended as higher flow rate (>5L/min) can result in
discomfort of the patient. Advantage
 1. Easy to use
 2. Low-flow oxygen administration
 3. Less restrictive than face mask
 4. No increase in dead space
 5. More tolerable than oxygen mask
 6. Allow speech and eating/drinking

Disadvantages
 1. Drying and irritation of nasal mucosa
 2. Chance of nasal bleeding
 3. Sores around the external nares in longterm use
 devices used ‫االدوات المستعملة‬
 2 Simple face mask . 5 – 10 liters per minute < 5 liters will not flush CO2
from mask. Body of the mask serves as a reservoir for both oxygen and expired CO2.
It has a small dead space and can result in a small amount of rebreathing. Various
sizes are available from pediatric to adult. It is indicated for patients who require
higher levels of oxygen than cannulas eg. during medical transport, post anesthesia
care unit and emergency department
 Disadvantages
 - Patient complains of feeling of suffocation ‫ الخنق‬and poorly tolerated.
 - Speech is muffled ‫مكتوم‬, eating and drinking are difficult.
 The face mask is indicated in patients with nasal irritation or epistaxis ‫الرعاف‬.
 devices used ‫االدوات المستعملة‬

 3 High-concentration oxygen reservoir:

from reservoir mask (15 L/min). It is a standard face
mask with addition of reservoir bag to increase the
capacity of O2 reservoir by 600 ml expiration returns to
the reservoir bag and non-rebreathing systems where
one-way valve is incorporated to prevent any exhaled
gas from returning to the reservoir bag.
 devices used ‫االدوات المستعملة‬
4 Venturi mask ‫بخاخ‬
 High flow O2 delivery system
 Red 40% 10 L/min
 Yellow 35% 8 L/min
 Orange 31% 6 L/min
Venturi mask
 White 28% 4 L/min
 Blue 24% 2 L/min

5 Face tent ‫خيمة‬

7 Tracheostomy collar ‫طوق‬
 RISKS OF OXYGEN TREATMENT
‫مخاطر استخدام االوكسجين‬
1 Fire hazard: Oxygen supports combustion ‫ احتراق‬of
other fuels ‫انواع الوقود االخرى‬.
2 Absorption atelectasis ‫انكماش الرئة‬: Absorption
Atelectasis Refers to the condition where the reduction
of nitrogen concentration in the lungs causes a collapse.
High concentrations of oxygen can cause atelectasis of
the lungs .
3 Retinopathy of prematurity ‫( الطفل الخديج‬ROP):
resolved in 80% of cases without visual loss.
 RISKS OF OXYGEN TREATMENT
‫مخاطر استخدام االوكسجين‬
4 Pulmonary toxicity: Oxygen Toxicity Patients exposed to high oxygen
levels for a prolonged period of time have lung damage , may occur after
exposure to high concentration of oxygen for a week. Oxygen concentration
greater than 50%over 24 to 48 hours can cause pathological changes in the
lungs. More evident in infants especially prematurely delivered. (retinopathy of
prematurity and in some fibrotic lung.

5 Depression of ventilation: It is seen in COPD patients with

chronic CO2 retention who have hypoxic respiratory drive to
breath.

6 Hyperbaric oxygen toxicity: Prolonged exposure of

hyperbaric O2 therapy can lead to pulmonary, optic and central
nervous system toxicity. Symptoms of pulmonary toxicity include
retrosternal burning, cough and chest tightness. It can cause
narrowing of the visual fields in adults.
 Signs and symptoms of oxygen toxicity
‫اعراض وعالمات التسمم باالوكسجين‬
 Non-productive cough
 -Nausea vomiting and Fatigue
 -Substernal chest pain
 -Nasal stuffiness ‫اختناق‬
 -Headache
 -Sore throat
 -Hypoventilation ‫نقص التهوية‬
 -Nasal congestion
 -Dyspnea
 -Inspiration pain
Thanks for listening