Oxygen Therapy
·
Ensure PO2 is on
plateau of O2 saturation curve (ie PaO2 > 70 mmHg)
·
Shunt is resistant to O2
therapy, whereas a diffusion abnormality and V/Q mismatch respond well
·
Complications:
o Reduced respiratory drive in CORD. Consider if PCO2
but pH not as low as you‟d expect. Don‟t give too much O2 otherwise ¯respiratory
drive ® CO2. Aim for saturation of ~ 90%
o Loss of nitrogen splint, etc
·
Levels of O2 therapy:
o 21%: Room air
o 24%: nasal prongs at 1 litre
o 28%: nasal prongs at 2 litres
o 32%: nasal prongs at 3 litres
o 35%: Hudson mask at 6LO2/min
o 40%: Hudson mask at 8LO2/min. Maximum level obtainable with a mask (inspiratory flow > flow from wall)
o 50%: Hudson mask with rebreather bag
·
Types of ventilation:
o CPAP: Continuous positive airways pressure – splints airways open at end
of respiration
o BiPAP: Positive pressure for inspiration only. Good if CO2
retention – makes it easier to blow off CO2
o IPPV = intermittent positive pressure ventilation: complete control
o PEEP = positive end expiratory pressure ventilation: splints collapsed
or fluid filled alveoli
o Complications of ventilation:
§ Application of pressure to lungs ® rupture, thoracic
pressure ® ¯venous return
§ Artificial airway ® obstruction, trauma to teeth, pharynx, cilial damage, infection
§ Ventilation mismanagement ® inappropriate ventilation,
hypoxic gas mixture, equipment failure
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