1. Cournand A. Circulation of the Blood, Men and Ideas. In: Fishman AP, Richards DW, editors. Air and blood. Bethesda: American Physiological Society; 1982. pp. 3–70. [Google Scholar] Show 2. Dwarkanath C. New Delhi: Central council for research in ayurveda and sidha; 1991. The development of Indian medicine: Sarangadhara's contribution. [Google Scholar] 3. Perkins JF., Jr . Historical development of respiratory physiology. In: Fenn WO, Rahn H, editors. Handbook of Physiology. Section 3: Respiration. Vol. 1. Bethesda: American Physiological Society; 1964. pp. 1–62. [Google Scholar] 4. Meakins J. Observations on the gases in human arterial blood in certain pathological pulmonary conditions and their treatment with oxygen. J Pathol Microbiol. 1921;24:79–90. [Google Scholar] 5. Crapo Robert O, Jensen Robert L, Hegewald Methew, Tashkin Donald P. Arterial blood gas references values for sea level and an altitude of 1,400 metres. Am J Respir Crit Care Med. 1999;160:1525–31. [PubMed] [Google Scholar] 6. Gries RE, Brooks LJ. Normal oxyhemoglobin saturation during sleep.How low does it go? Chest. 1996;110:1489–92. [PubMed] [Google Scholar] 7. Murphy R, Mackway-Jones K, Sammy I, Driscoll P, Gray A, O’Driscoll R, et al. Emergency oxygen therapy for the breathless patient.Guidelines prepared by North West Oxygen Group. Emerg Med J. 2001;18:421–3. [PMC free article] [PubMed] [Google Scholar] 8. Fairley HB. Oxygen therapy of surgical patients. Am Rev Respir Dis. 1980;122:37–44. [PubMed] [Google Scholar] 9. Strachan L, Noble DW. Hypoxia and surgical patients-prevention and treatment of an unnecessary cause of morbidity and mortality. J R Coll Surg Edinb. 2001;46:297–302. [PubMed] [Google Scholar] 10. Allen DB, Maguire JJ, Mahdavian M, Wicke C, Marcocci L, Scheuenstuhl H, et al. Wound hypoxia and acidosis limit neutrophil bacterial killing mechanisms. Arch Surg. 1997;132:991–6. [PubMed] [Google Scholar] 11. Hopf HW, Hunt TK, West JM, Blomquist P, Goodson WH, Jensen A, et al. Wound tissue oxygen tension predicts the risk of wound infection in surgical patients. Arch Surg. 1997;132:997–1005. [PubMed] [Google Scholar] 12. Greif R, Akça O, Horn EP, Kurz A, Sessler DI Outcomes Research Group. Supplemental peri-operative oxygen to reduce the incidence of surgical-wound infection. N Engl J Med. 2000;342:161–7. [PubMed] [Google Scholar] 13. Gibson GE, Pulsinelli W, Blass JP, Duffy TE. Brain dysfunction in mild to moderate hypoxia. Am J Med. 1981;79:1247–54. [PubMed] [Google Scholar] 14. Aakerland LP, Rosenberg J. Post-operative delerium: Treatment with supplementary oxygen. Br J Anaesth. 1994;72:286–90. [PubMed] [Google Scholar] 15. Greif R, Laciny S, Rapf B, Hickle RS, Sesslet DI. Supplemental oxygen reduces the incidence of postoperative nausea and vomiting. Anesthesiology. 1999;91:1246–52. [PubMed] [Google Scholar] 16. Denniston AK, O’Brien C, Stableforth D. The use of oxygen in acute exacerbations of chronic obstructive pulmonary disease: A prospective audit of pre-hospital and hospital emergency management. Clin Med. 2002;2:449–51. [PMC free article] [PubMed] [Google Scholar] 17. Piersen DJ. Translating new understanding into better care for the patient with chronic obstructive pulmonary disease. Respir Care. 2004;49:99–109. [PubMed] [Google Scholar] 18. Aubier M, Marviano D, Milic-Emil J. Effects of the administration of O2 on ventilation and blood gases in patients with chronic obstructive pulmonary disease during acute respiratory failure. Am Rev Respir Dis. 1988;138:535–9. [PubMed] [Google Scholar] 19. Cochrane GM. Management of adult asthma. In: Clark TJH, Godfrey S, Lee TH, editors. Asthma. London: Chapman and Hall; 1992. pp. 506–50. [Google Scholar] 20. Inwald D, Ronald M, Kuitert L, McKenzie SA, Petros A. Oxygen treatment for acute severse asthma. BMJ. 2001;323:98–100. [PMC free article] [PubMed] [Google Scholar] 21. Jenkinson SG. Oxygen toxicity. J Int Care Med. 1988;3:137–52. [Google Scholar] 22. Davis WB, Rennard SI, Bitterman PB, Crystal RG. Pulmonary oxygen toxicity. Early reversible changes in human alveolar structures induced by hyperoxia. N Engl J Med. 1983;309:878–83. [PubMed] [Google Scholar] 23. Cotes JE, Pisa Z, Thomas AJ. Effect of breathing O2 upon cardiac output, heart rate, ventilation, systemic and pulmonary blood pressures in patients with chronic lung disease. Clin Sci. 1963;25:305. [PubMed] [Google Scholar] 24. New A. Oxygen: Kill or use. Pre hospital hyperoxia in COPD patients? Emerg Med J. 2006;23:144–6. [PMC free article] [PubMed] [Google Scholar] Page 2Manifestations associated with hypoxia
Oxygen is considered a medication and requires a practitioner’s order; administer it cautiously and observe the patient closely for adverse reactions. Assess the patient’s need for oxygen and recognize the signs and symptoms of hypoxemia. Use caution in the presence of oxygen. Oxygen is a fire hazard because it lowers the temperature at which materials catch fire in the presence of an ignition source, such as a spark or heat from a light source. Respiratory depression can develop in a very small percentage of patients who are chronically hypercapnic when breathing moderate to high oxygen concentrations.undefined#ref1">1 OVERVIEWThe goal of oxygen therapy is to maintain adequate levels of oxygen to manage suspected or confirmed hypoxemia. Selection of the type of oxygen therapy is based on the patient’s need, the severity of hypoxemia, and the disease process. Signs and symptoms of mild hypoxemia include restlessness, anxiety, disorientation, confusion, listlessness, and headaches (Box 1). The two types of oxygen delivery devices are high flow and low flow. High-flow devices discourage entraining of room air, which dilutes the fraction of inspired oxygen (FIO2). The target peripheral oxygen saturation (SpO2) for most acutely ill patients is 94% to 98%.2 Patients with chronic obstructive pulmonary disease should have a target of 88% to 92%.2 Oxygen TherapyDevices that deliver oxygen therapy include a nasal cannula, various types of face masks, and oxygen tents and hoods (Table 1). A nasal cannula is a simple, effective, comfortable device for delivering low-flow oxygen (Figure 1).1 It consists of two prongs protruding from the center of a disposable tube and inserted into the nostrils. The nasal cannula allows breathing through the mouth or nose, is available for all age groups, and is adequate for short- or long-term use. Compared with other oxygen delivery systems, a nasal cannula decreases a patient’s feeling of claustrophobia, but it may not be suitable for mouth breathers. Cannulas are inexpensive, disposable, and easily accepted by most patients. When cannulas are used at higher flow rates, the airway mucosa may dry. A humidifier should be used to help prevent drying of the nasal and oral mucous membranes if the flow rate is greater than 4 L/min.1 Approximate FIO2 is estimated by the flow rate. The delivered oxygen percentage varies, depending on the rate and depth of the patient’s breathing.1 A simple face mask is for short-term, low-flow oxygen therapy (Figure 2).1 A clear plastic mask is placed on the patient’s face with an elastic strap to secure it. The body of the mask stores oxygen between the patient’s breaths. Side port openings located on either side of the mask allow room air to mix with delivered oxygen and allow exhaled air to escape. The percentage of delivered oxygen varies, depending on the rate and depth of the patient’s breathing.1 Some patients find the face mask uncomfortable, and it must be removed for eating. A partial rebreathing mask is a face mask with a reservoir bag that delivers moderate to higher concentrations of oxygen (Figure 3A).1 Frequent inspection of the reservoir bag is required to ensure that it remains inflated; if it is deflated, exhaled air collects in it, which results in the patient rebreathing large amounts of exhaled carbon dioxide. Side port openings on either side of the mask vent exhaled air on expiration and allow room air to enter the mask on inspiration. The delivered oxygen percentage varies, depending on the rate and depth of the patient’s breathing.1 A nonrebreathing mask is a face mask with a reservoir bag that delivers high concentrations of oxygen (Figure 3B).1 A one-way inspiratory valve sits on top of the reservoir bag, and a one-way expiratory valve covers one of the side ports on the mask. During inhalation the expiratory valve over the side port closes, preventing air from entering the mask while the inspiratory valve on top of the reservoir bag opens, providing oxygen to the patient. During exhalation, the expiratory valve opens allowing exhaled air to vent out of the mask while the inspiratory valve closes preventing exhaled air from entering the reservoir bag. The open exhalation port is a safety feature designed to allow air to enter the mask if the oxygen source fails. However, this feature can result in dilution of the inspired oxygen. The delivered oxygen percentage varies, depending on the rate and depth of the patient’s breathing.1 A Venturi mask is a cone-shaped device with entrainment ports of various sizes at its base (Figure 4).1 The entrainment ports adjust to deliver various oxygen concentrations. This mask is useful because it delivers a more precise concentration of oxygen to the patient. A face tent is a shield-like device that fits under the patient’s chin and encircles the face (Figure 5). It is used primarily for humidification and for oxygen only when the patient cannot or will not tolerate a tight-fitting mask. Because it is so close to the patient’s face, there is no way to estimate how much oxygen is delivered to the patient. High-Flow Oxygen TherapyHigh-flow nasal oxygen therapy is a method of providing warmed, humidified oxygen at higher concentrations via specialized nasal cannula (Figure 6). Conventional nasal cannula devices can deliver flows of only 1 to 6 L/min, whereas high-flow nasal oxygen therapy delivers flows from 1 L/min to 60 L/min, depending on the device.1 High-flow oxygen therapy allows for more effective secretion clearance, decreases atelectasis, and prevents dehydration of the airway mucosa. EDUCATION
ASSESSMENT AND PREPARATIONAssessment
Preparation
PROCEDUREOxygen Therapy
High-Flow Oxygen Therapy
MONITORING AND CARE
EXPECTED OUTCOMES
UNEXPECTED OUTCOMES
DOCUMENTATION
PEDIATRIC CONSIDERATIONS
OLDER ADULT CONSIDERATIONS
HOME CARE CONSIDERATIONS
REFERENCES
ADDITIONAL READINGSAshraf-Kashani, N., Kumar, R. (2017). High-flow nasal oxygen therapy. BJA Education, 17(2), 63-67. doi:10.1093/bjaed/mkw041 Adapted from Perry, A.G. and others (Eds.). (2022). Clinical nursing skills & techniques (10th ed.). St. Louis: Elsevier. Elsevier Skills Levels of Evidence
|