Description
Oxygen therapy is a medical intervention that involves the administration of oxygen at a higher concentration than what is present in ambient air to patients with respiratory or cardiovascular conditions. It is delivered through various methods, including nasal cannulas, oxygen masks, or ventilators, to improve oxygen saturation in the blood. Oxygen therapy is crucial in managing conditions like chronic obstructive pulmonary disease (COPD), pneumonia, and severe respiratory distress, helping patients breathe more comfortably and ensuring adequate oxygen supply to vital organs. Treatment duration and oxygen flow rates are tailored to individual patient needs, and close monitoring is essential to optimize therapy effectiveness while avoiding potential complications associated with excessive oxygen levels.
Résumé
- Oxygen therapy involves supplementing room air with additional oxygen. It's crucial to differentiate between hypoxemia (decreased partial pressure of oxygen in arterial blood) and hypoxia (insufficient oxygen supply to meet tissue demands), with hypoxemia being a type of hypoxia. Long-term oxygen therapy is defined as requiring oxygen for at least 15 hours daily in chronically hypoxemic patients.
- Oxygen transport occurs in three steps: oxygen uptake, oxygen transport in the blood, and diffusion to cells. Atmospheric air contains approximately 21% oxygen, but the partial pressure of oxygen gradually decreases as it moves from the trachea to the alveoli to the arterial blood. The alveolar gas equation is vital for determining the partial pressure of oxygen in the alveoli.
- Arterial hypoxemia can be caused by decreased oxygen intake, alveolar hypoventilation, ventilation-perfusion mismatch, diffusion defect, or shunting. Oxygen delivery depends on the oxygen content of the blood and blood flow. It is important to differentiate between PAO2 (arterial partial pressure), SPO2 (pulse oximetry saturation), and SCAO2 (arterial oxygen content). A PAO2 of 60 corresponds roughly to an SPO2 of 90.
- A bedside approach to hypoxemia involves clinical examination, chest X-ray, and arterial blood gas analysis. It is essential to evaluate the PCO2 and the A-a gradient to determine the underlying cause of hypoxemia. Goals of oxygen therapy include increasing alveolar oxygen tension, decreasing the work of breathing, decreasing myocardial work, and correcting hypoxemia.
- Oxygen delivery devices are classified as low-flow (variable FIO2) or high-flow (fixed FIO2). Low-flow devices include nasal cannula, simple face mask, and reservoir bags. High-flow devices include Venturi mask and HFNC. It is important to prescribe oxygen with specified delivery device, flow rate, target saturation, duration, and monitoring instructions.
- Complications of oxygen therapy include absorption atelectasis, hypercapnic respiratory failure, acute respiratory distress syndrome (ARDS), and bronchopulmonary dysplasia in newborns. There is no specific treatment for oxygen toxicity; prevention is key by using the lowest possible FIO2. Oxygen therapy should be avoided if not required as it could harm the patient.
Exemple de certificat
À propos des intervenants
Dr Kishan Srikanth Juvva
Consultant principal - Pneumologie interventionnelle et médecine du sommeil, hôpitaux STAR, Hyderabad.
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