Description
Oxygen therapy and non-invasive ventilation (NIV) are critical treatments for patients with respiratory issues. Oxygen therapy involves delivering supplemental oxygen to those with low blood oxygen levels due to conditions like COPD or pneumonia. Non-invasive ventilation, such as CPAP or BiPAP, supports breathing without the need for intubation, using a mask to provide pressurized air. NIV helps maintain airway pressure, improving oxygenation and reducing the work of breathing. Both therapies are less invasive options that can stabilize patients and improve outcomes, often preventing the need for more aggressive interventions like mechanical ventilation
Résumé
- The lecture focused on oxygen therapy and hypoxemia, highlighting that 21% of air is oxygen and supplemental therapy is needed if saturation can't be maintained. Nine steps of oxygen transport were reviewed, starting with the need for adequate partial pressure of oxygen. Altitude affects this, requiring acclimatization for the body to adapt and increase red blood cell production.
- Airway patency is essential, with obstructions, inflammation, or secretions causing hypoxemia. Decreasing the airway radius significantly increases resistance to airflow. Lung and chest wall abnormalities, such as pleural effusion or chest wall deformities, also lead to hypoxemia. Treatment includes chest physiotherapy and, in some cases, surgery.
- Diffusion, the movement of oxygen from alveoli to capillaries, can be impaired by secretions, leading to hypoxemia. Some diffusion defects are permanent (scarring) while others can be managed with therapies. Perfusion, or blood availability, is vital, and is impacted by conditions like anemia and shock, resulting in perfusion mismatch. Positioning can also influence perfusion.
- Hemoglobin's role as an oxygen carrier is critical; anemia can cause hypoxemia, needing blood transfusions or supplements. Myocardial function ensures oxygen-rich blood reaches vital organs; heart failure or cardiac arrest lead to circulatory hypoxemia. Peripheral circulation problems, such as thrombosis or arterial disease, also disrupt oxygen transport.
- Histotoxic hypoxemia occurs when tissues can't uptake oxygen, like in cyanide poisoning. Measuring oxygen levels is done via pulse oximetry or arterial blood gas analysis. Treatment involves maintaining patent airways, increasing inspired oxygen content, and improving diffusion capacity with positive pressure ventilation.
- Maintaining airway patency requires chest physiotherapy and using devices like spirometers. Supplemental oxygen is indicated for low PaO2 or saturation. Delivery devices are categorized into low flow (nasal cannula, simple face mask, partial rebreathing mask, non-rebreathing mask) and high flow (Venturi mask, high flow nasal cannula, oxygen hood).
- The nasal cannula delivers up to 44% FiO2 with a max 5 L/min, potentially causing mucosal drying. The simple face mask works between 6-10 L/min, achieving up to 60% FiO2, but may cause CO2 rebreathing if flow is too low. Partial and non-rebreathing masks provide 60-80% and 80-100% FiO2 respectively, but only the latter mask has a one-way valve.
- The Venturi mask delivers precise FiO2 values via color-coded attachments with specific flow rates. The oxygen hood, used mostly in pediatrics, requires high flow rates to prevent CO2 accumulation. The high-flow nasal cannula can provide up to 100% oxygen with flows up to 60 L/min, delivering pre-humidified and pre-warmed air.
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