Oxygen Therapy

Sukarmin,
KMB Department
Respiratory failure

Type 1 (hipoxemia)
Saturation < 90%. PaO2 <60 mm Hg

Type 2 (hipercapnia)
PCO2>50 mmHg, pH<7.35
Hypoxemia

Rendahnya tekanan oksigen pada

alveolus
(ambient, hypoventilation)
Gangguan ventilasi perfusi
Adanya lubang antara jantung kanan dan
kiri
Kegagalan difusi oksigen
Alveolar gases
V/Q mismatch

Ventilated but not perfused: increased

dead space ventilation, VT=VD+VA
VD= VD equipment + VD anatomic + VD physiologic
Perfused but not ventilated: shunt
>20% Shunt fraction, minimal
improvement with increased FiO2
Hypoxia

Hypoxemic Hypoxia
Anaemic Hypoxia
Stagnant Hypoxia ( distributive or low
CO)
Histotoxic Hypoxia

VDO2= CO x Hb x SAT/100 x 1.34ml/gHb+

(PaO2 x 0.003mlO2/100ml/mmHg)
Symptoms of Hypoxemia
and Hypoxia
Dyspnea, tachypnea. Hyperventilation
+/- Cyanosis ( Hb, perfusion) >15g/l
Impaired mental performance----coma
Seizures, permanent brain injury
Tachycardia/Hypertension
Hypotension/Bradycardia( 30 mmHg)
Lactic acidosis
Indications for Oxygen
therapy
Cardiac and respiratory arrest
Hypoxemia ( pO2 < 58.5 mmHg,
Sat<90%)
Hypotension ( Systolic BP < 100 mmHg)
Low Cardiac Output and Metabolic
Acidosis ( bicarbonate <18 mmol/l)
Respiratory distress ( RR>24/minute)
American College of Chest Physicians and NHLBI
Treatment I

Empiric oxygen treatment

Cardiac/ respiratory arrest
Hypotension
Respiratory Distress
Trauma
GCS decrease from any cause
Postoperative
Treatment II

Verify hypoxemia
Pulse oximetry
ABGs
Start Oxygen treatment.
Treatment goal ( sat level)
Administration mode, flow, when to stop
The oxyhaemoglobin dissociation curve showing the relation between partial pressure of oxygen
and haemoglobin saturation

Currie, G. P et al. BMJ 2006;333:34-36

Copyright 2006 BMJ Publishing Group Ltd.

 Charting Oxygen treatment

Dodd, M E et al. BMJ 2000;321:864-865

Copyright 2000 BMJ Publishing Group Ltd.

Bad medicine

To withhold Oxygen out of fear of

hypercarbic ventilatory failure is poor
practice
Identify patients at risk (COPD)
Use Venturi masks 0.24 -0.28 ---- FiO2.
ABGs/ O2-sat to direct therapy
Support ventilation (BiPAP, intubation)
Oxygen Hazards

Fire ( airway fires)

Tissue toxicity, pulmonary and retina
Decreased hypoxemic drive and
increased VD in COPD.
Seizures (hyperbaric)
Mucosal damage due to lack of humidity
Oxygen administration

Low flow systems

High Flow systems (HFOE)

Nasal Prongs
 Bateman, N T et al. BMJ 1998;317:798-801

Copyright 1998 BMJ Publishing Group Ltd.

Face Mask (Hudson)
Non-rebreather
Venturi Mask
Venturi valve
 Bateman, N T et al. BMJ 1998;317:798-801

Copyright 1998 BMJ Publishing Group Ltd.

 Long term oxygen therapy prolongs survival in hypoxaemic patients with COPD when used for
&ge;15 hours/day. (Results from the nocturnal oxygen therapy trial (NOTT) and the MRC trial)

Currie, G. P et al. BMJ 2006;333:34-36

Copyright 2006 BMJ Publishing Group Ltd.

Take home message
Acute empiric oxygen treatment is ok but hypoxemia
should be verified with pulse oximetry and /or ABGs
when situation more stable.
Oxygen is a drug and should be ordered as such:
mode of administration, flow rate, FiO2 (venturi),
treatment goal, monitoring, when to stop.
Never withhold oxygen out of fear of possible
hypercarbia
Avoid overzealous treatment- Adequate saturation for
the patient. COPD 88-90%