Oxygen delivery devices
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Oxygen Delivery Devices. they’re not what you think. Indications for oxygen use. Low ambient O 2 Hypoxemia Suspected hypoxemia Increased work-of-breathing Flaring Tachypnea Increased myocardial work Acute head injury. O 2 delivery systems. High-flow

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Oxygen Delivery Devices

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Oxygen delivery devices

Oxygen Delivery Devices

they’re not what you think


Indications for oxygen use

Indications for oxygen use

  • Low ambient O2

  • Hypoxemia

  • Suspected hypoxemia

    • Increased work-of-breathing

    • Flaring

    • Tachypnea

  • Increased myocardial work

  • Acute head injury


O 2 delivery systems

O2 delivery systems

  • High-flow

    • Venti-masks (air entrainment masks)

    • Mechanical aerosol systems

    • High-flow humidifier systems

  • Low-flow

    • Nasal cannula

    • Simple masks

    • Partial rebreathing masks

    • Non-rebreathing masks


Entrainment ratios

Entrainment ratios


Delivered fio 2 with low flow

Delivered FiO2 with low-flow


What s my pao 2

What’s my PaO2?

  • a: On room air?

  • b: On 0.50 FiO2?

  • c: On 0.80 FiO2?


The answers

The answers:

PaO2 = FiO2 x (barometric pressure - water vapor pressure) - PaCO2/RQ

PaO2 = FiO2 X (760 - 43) - PaCO2/0.8

a: PaO2 = .21 X 713 - 40/0.8 = 100

b: PaO2 = .50 X 713 - 40/0.8 = 306

c: PaO2 = .80 X 713 - 40/0.8 = 520


O 2 hgb dissociation curve

O2Hgb dissociation curve

% Sat

PO2 mmHg


Resorption atelectasis

Resorption atelectasis

100% O2

nitrogen

oxygen

After ~15 minutes,

blood N2 is depleted.

Poorly ventilated &

well perfused units (A)

become atelectactic.

B

A

PO2 =673

PCO2 = 40

PH2O = 47


Non rebreathing system

Non-rebreathing system

Room air

Gas source

Expiratory

gas

Reservoir

To patient

One way valves


Air entrainment devices

exhaled gas

oxygen

room air

Air entrainment devices


O 2 hgb dissociation curve shift

O2Hgb dissociation curve shift

¯pH

­ CO2

­ temp

% Sat

PO2 mmHg


What happens to your po 2 and sats when your ph changes

What happens to your pO2 and sats when your pH changes?

ph = 7.4, pO2 = 100, sat 96%

ph = 7.0, pO2 = ?, sat = ?


Oxygen delivery trucks x how full they are loaded x how fast they go

Oxygen delivery = # trucks X how full they are loaded Xhow fast they go

DO2 = 1.38(hgb X sat X CI)

+ (pO2 X 0.003)


Entrainment ratios1

Entrainment ratios


Estimating fio 2

Estimating FiO2


Simple mask

Simple mask

  • Open ports for exhaled gas

  • Air entrained through ports if O2 flow through does not meet peak insp flow

  • 35-55% O2 at 6-10 L/min

Exhalation

ports

O2inlet


Partial rebreather mask

Partial rebreather mask

  • O2 directed into reservoir

  • Insp: draw gas from bag & ? room air

  • Exp: first 1/3 of exhaled gas goes into bag (dead space)

  • Dead space gas mixes with ‘new’ O2 going into bag

  • Deliver ~60% O2

Exhalation

ports

O2

Reservoir


Non rebreathing mask

Non-rebreathing mask

One-way valves

  • Valve prevents exhaled gas flow into reservoir bag

  • Valve over exhalation ports prevents air entrainment

  • Delivers ~100% O2, if bag does not completely collapse during inhalation

O2

Reservoir


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