normal tidak
Beri
bantuan nafas
hipoventilasi
secara aktif
hiperventilasi
+ OKSIGEN
9
OKSIGEN DIPERLUKAN PADA PROSES METABOLISME
UNTUK PEMBENTUKAN ENERGI BIOLOGIS ( ATP )
4. TRANSPORT OKSIGEN
= PAO2 - PaO2
2. PaO2 / FiO2
Rumus Nunn-Freeman
Av. O2 = CO {(Hb x SaO2 x 1.34) + (pO2 x 0.003)}
Disederhanakan :
Av. O2 = CO x Hb x 1.34
Jika CO dapat naik sampai 2 x
Hb boleh tinggal ½ nya
Available O2 tidak berkurang !
Contoh :
Av.O2 = 50 x 15 x 1.34 = 1005
Av.O2 = 100 x 7.5 x 1.34 = 1005
Oxygen is a “DRUG”
TERAPI OKSIGEN
Assessing
Oxygen Levels
Pulse Oximetry
Non-invasive monitoring technique that
estimates the oxygen saturation of Hgb
(SaO2)
May be used continuously or intermittently
Must correlate values with physical
assessment findings
Normal SaO2 values – 95 to 100%
O2 Hemoglobin Saturation
PaO2 Levels
Levels
90 mm Hg 100 %
60 mm Hg 90 %
30 mm Hg 60 %
27 mm Hg 50 %
Oxygen saturation or O2 sat
Factors Affecting SaO2
Measurements
Low perfusion states
Motion artifact
Nail polish when using a finger probe
Intravascular dyes
Vasoconstrictor medications
Abnormal Hemoglobin
Too much light exposure
PaO2 at or below 55 mm Hg
Saturation O2 < 88% resting
PO2 <55 mm Hg or < 88% for 5 min (sleep)
A drop in PO2 10 mm Hg or 5% in O2 sat. during
sleep
Symptoms or signs of heart failure
(corpulmonale), pulmonary hypertension,
erythrocytosis, “P” pulmonale on EKG
PO2 <55 mm Hg or < 88% during exercise
PEDOMAN UMUM
TERAPI OKSIGEN
Bila :
Respiratory compromise
Cyanosis
Tachypnoea
Hypoxaemia
Partially obstructed airway
Indications for oxygen therapy
Cardiac compromise
Chest pain
Shock
Tachycardia
Arrhythmias
Neurological deficits
CVA
Spinal injuries
Coma
Long Term Sign
Clubbing
Aims of oxygen therapy
to increase PaO2 to acceptable level with
concentration of oxygen
to decrease respiratory rate and work of
breathing
Hypoxaemia with high PaCO2
24% initially
careful monitoring with regular ABG’s
Types of oxygen delivery
Nasal cannulae
Medium concentration mask
Fixed concentration mask
Non - rebreathe bag
Humidified circuits
High flow systems
Alat FiO2
NASAL PRONG 24 - 40 %
SIMPEL MASK 40 - 50 %
VENTURI - MASK 24 - 50 %
PARTIAL REBREATHING 60 - 80 %
NON REBREATHING - 90 %
CPAP - 100 %
VENTILATOR - 100 %
Nasal Cannulae
Flow rate up to 4l/min
Unable to determine exact concentration
Comfortable – allows patient to eat, drink talk
Can still be used if patient is
mouth breathing
Can use continuously with
meals and activity
Nasal prong
Keuntungan :
mudah penggunaan
ringan
ekonomis
disposable
nyaman,pasien bisa mobilisasi
Kerugian :
mudah lepas
maksimum FiO2 40 %
iritasi telinga
Tehnik lain dengan kateter :
1. Nasal kateter
2. Transtracheal kateter.
Medium concentration mask
‘Hudson’/ MC mask
Flow rate must be at least 5 l/min
Exact concentration of oxygen depends on
patient’s respiratory pattern
Poor humidification
Useful post-operatively
Masker oksigen
Konsentrasi O2 bervariasi antara 24 - 100 %
Kerugian :
1. Tidak nyaman,
2. Iritasi kulit akibat pemakaian masker ketat
3. Kontrol FiO2 sukar,( kecuali dengan sistim venturi )
4. Kalau pasien makan harus dilepas
2. Partial rebreathing
( 35 - 60 % dengan flow 6 - 10 L )
3. Non rebreathing
( 90 % , bila tidak ada kebocoran )
Partial Rebreather Mask
Consists of mask with exhalation
ports and reservoir bag
Reservoir bag must remain inflated
O2 flow rate - 8 to 10L
Client can inhale gas from mask,
bag, exhalation ports
Poorly fitting; must remove to eat
Non-rebreather Mask
Consists of mask, reservoir
bag, 2 one-way valves at
exhalation ports and bag
Client can only inhale from
reservoir bag
Bag must remain inflated at
all times
O2 flow rate- 10 to 15L
Poorly fitting; must remove to
eat
Fixed concentration
‘Venturi’ masks
Deliver a fixed concentration of oxygen
Must be set at minimum flow rate as shown on
barrel
FiO2 0.24 – 0.6
Able to increase flow rate
without altering concentration
Bernouilli principle
Venturi Mask
Most reliable and accurate method
for delivering a precise O2
concentration
Consists of a mask with a jet
Excess gas leaves by exhalation
ports
O2 flow rate- 4 to 15L
Can cause skin breakdown; must
remove to eat
Non Rebreathe bags
Reservoir bags’
Deliver FiO2 0.6 – 0.8
Flow rate must be set to 15 L/min
Fill reservoir 2 thirds before applying
Useful in acute situation
Should not be worn >24hrs
Alat Terapi Oksigen
I . FIXED SYSTEM ( FiO2 TIDAK DIPENGARUHI FAKTOR
PASIEN )
1. SISTIM VENTURI - HIGH FLOW
2. LOW FLOW BREATHING CIRCUITS ( CPAP,
BAG-MASK,JAKSON-REES ,MESIN ANESTESI )
Simple mask
Salter Oxy-Frame
Oxymizer Pendant
T-piece
Used on end of ET
tube when weaning from
ventilator
Provides accurate
FiO2
Provides good humidity
Konsentrasi Oksigen
yang dihasilkan tergantung pada :
1. Alat
2. Cara pemberian
3. Pasien kooperatif atau tidak
4. Pola napas pasien.
Respiratory Non-respiratory
distress distress
Minute vol 30 l/min 5 l/min
(RR x TV) (40bpm x 750ml) (10bpm x 500ml)
Bronchoconstriction
Flowmeter + humidifier
Flowmeter pengatur
aliran oksigen
Humidifier, pelembab
Sebaiknya dikosongkan saja
(mudah jadi sarang kuman)
66
Precautions of Supplemental
Oxygen
1. Oxygen toxicity
2. Depression of ventilation
3. Retinopathy of Prematurity
4. Absorption atelectasis
5. Bacterial infection with humidifiers
Oxygen Toxicity
Patients exposed to high oxygen levels for a
prolonged period of time have lung damage.
First damage is capillary epithelium,
leading to edema, thickened membranes
and finally to pulmonary fibrosis and
hypertension.
A Vicious Cycle
Depression of
Ventilation
COPD patients with CO retention have
2
blunted stimuli to breathing
– Hypoxic drive theory
• They have a different stimulus to breathe then
normal
GOLDEN RULE:
You should never stop giving oxygen to a patient in
need.
Retinopathy of
Prematurity
• Is an abnormal eye condition in some
premature infants who receive high FIO 2
– Retinal arteries hemorrhage and scaring
cause retinal detachment and blindness.
Absorption
• The alveoliAtelectasis
in the lungs collapse and cause
shunting in the capillary lung fields.
– Loss of nitrogen in the blood causes less
total venous pressure. This leads to the
collapse of of the alveolus.
Pressure gradients that cause absorption
atelectasis
Infection Control
Therapist must use an aseptic technique when
handling supplemental oxygen and humidity
equipment
Never drain water from the tubing back into
the heated humidifier
Always date the opened container
Only use sterile liquids in reservoirs
Oxygen: a fire hazard