1. Understanding Oxygen Therapy in less than an Hour
Respiratory Therapy 101
Understanding Oxygen Therapy in less than an Hour

2. Oxygen Cannula Can safely be used at flow rates of 1-6 LPM
Flow should not be turned above 6 LPM
Produces 24% to 44% oxygen to patient

3. Oxygen Cannula
Liter Flow
% Oxygen 1 2 3 4 5 6
24% 28% 32% 36% 40% 44%

4. Oxygen Humidifiers Used with oxygen cannulas to prevent nasal drying
May not be used at flow rates less than 3LPM (need to bubble to be effective)
Check water level and change as needed

5. Oxygen Humidifiers

6. Reservoir Cannulas
Stores oxygen in a reservoir on exhalation so the patient has more oxygen available on inhalation
Capable of providing higher oxygen percentage at a lower flow rate

7. Two styles of Reservoir Cannulas

8. Simple Oxygen Mask Flow rate should be from 5 to 10 LPM
Flow rate should NOT be Less than 5 LPM
Oxygen delivery is approximately 35% to 50%
Short term use only
No Humidity

9. Simple Mask

10. 100% Non-Rebreather Mask
Set oxygen flow to a setting that does not allow the reservoir bag to collapse with the patient’s inspiration (10 – 15 LPM)
If tight fitting to patient’s face, 100% oxygen can be given
Usual oxygen percentage is 60% to 80%
USED BY EMS

11. Non-rebreather Masks

12. High Flow Systems Air Entrainment Mask (Venturi)
Percent of oxygen delivered depends on the LPM flow, the size of the jet, and the size of the entrainment port
Delivers a precise oxygen percentage
Entrainment ports must be kept open
Most accurate way to deliver O2
Ideal for CO2 retainers

13. High Flow System Air Entrainment Mask

14. High Flow System Air Entrainment Mask
The flow of 100% oxygen through the mask and draws in a controlled amount of room air (21 per cent oxygen).
Commonly available masks deliver 24, 28, 31, 35, or 40 per cent oxygen. At concentrations above 24 per cent, humidification may be required. (Color coded – depending on manufacturer)

15. High Flow System Air Entrainment Mask

16. Oxygen Blender
Controls precisely the percent of oxygen the patient is receiving
High flow meter is required for use

17. Oxygen Blender

18. How do I know if my Patient is Oxygen Deprived???

19. Clinical Respiratory Signs of Hypoxia
MILD to MODERATE
SEVERE
Tachypnea
Dyspnea
Paleness
Tachypnea
Dyspnea
Cyanosis

20. Cardiovascular Signs of Hypoxia
MILD to MODERATE
SEVERE
Tachycardia
Mild Hypertension
Peripheral Vasoconstriction
Tachycardia, eventual bradycardia, arrhythmia
Hypertension and eventual hypotension

21. Neurologic Signs of Hypoxia
MILD to MODERATE
SEVERE
Restlessness
Disorientation
Headaches
Lassitude
Somnolence
Confusion
Distressed appearance
Blurred Vision
Loss of Coordination
Impaired judgment
Slow reaction time
Manic-Depressive activity
Coma

22. Monitoring Oxygen with an Oximeter
Monitors the adequacy of arterial oxyhemoglobin saturation
Usually maintained at values above 90%
Only provides valuable data when patient has normal hemoglobin
Light and nail polish can alter saturation readings

23. ETCO2 Monitoring
Used with post surgical patients on PCA pumps, Epidurals and Mechanically Vented patients
ETCO2 – measures ventilation, not saturation (end product of breathing is CO2)
(See pamphlet)

24. Monitoring Oxygen with ABG’s
Pa02 reflects oxygenation levels
Normal Pa02 is mmHg (<60 mmHg-needs intervention).
Pa02 Values below 55 mmHg are Critical
Normal Pa02 values decrease
with age
Hypoxemia – low PaO2 <80

25. ABG Review pH = 7.35 to 7.45 <7.35 Acidic and > 7.45 Alkalotic
PaC02 = 35 to 45
HC03 = (28)
Cost of ABG ($800-$1500/draw)
Invasive Procedure
ROME = Respiratory – Opposite direction
Metalbolic – Equal (same) direction

26. What is CPAP??? Continuous Positive Airway Pressure
Application of positive pressure to a patient’s airway throughout the respiratory cycle
Increases the patient’s FRC (functional residual capacity)
Improves oxygenation
Also, used to prevent airway collapse in treatment of obstructive sleep apnea

27. What is BiPAP?? Non-Invasive Positive Pressure Ventilation (NIPPV)
Provides two levels of pressure to the patient
One pressure on the inspiration (IPAP)
One pressure on the expiration (EPAP)
May be used in patients with acute, short-term respiratory problems to avoid intubation and invasive mechanical ventilation
Improves the ability to remove CO2 and provide O2

28. Facial and Nasal Masks

29. Non-Invasive Positive Pressure Ventilator Support

30. FiO2 Fractional concentrated of inspired oxygen delivered
Percentage of Oxygen delivered or participating in gas exchange
in the alveoli (0.21 to 1.0)
Expressed in %. (0.35 is 35%).
In percentages its 21% to 100%

31. Oh my GOD!! My patient is on a ventilator!

32. Drager Ventilator

34. BASIC VENTIALTOR MODES
VOLUME CONTROLLED –
tidal volume (volume of air inhaled)
PRESSURE CONTROLLED –
PIP (positive inspiratory pressure)

35. Basic Ventilator Parameters Breath Rate (f)
Number of times per minute that inspiration is initiated (controlled by ventilator, patient or combination of both).
Two things to know:
Ventilator Setting (rate) (f)
Patient Rate (BPM)
Rate (f) setting and Patient breathing rate are not the same thing

36. Basic Ventilator Parameters Tidal Volume (vT)
Amount of gas delivered during an inspiration in ml or liters
Average adult tidal volume is
ml or L
Setting in volume control modes
Not a setting but volume
readings are measured in
pressure control modes

37. Basic Ventilator Parameters Peak Inspiratory Pressure (PIP)
Maximum pressure reached in the ventilator system during inspiration
Set parameter in pressure setting modes (Pressure Controlled Ventilation - PCV)

38. PEEP Positive End Expiratory Pressure
Application of a constant, positive pressure such that at the end of exhalation, airway pressure does not return to zero
Improves oxygenation

39. Basic Ventilator Parameters Breath Types
Mandatory – ventilator controls all parts of breathing
Spontaneous – patient controls all parts of breathing
Assisted Breaths – patient controls breathing rate, breaths are assisted with a set Vt (tidal volume)

40. Basic Ventilator Parameters Common Modes of Ventilation
CMV
A/C VC
SIMV
SIMV + PS
PSV

41. CMV Mode (volume) most common type used is Assist Control (A/C)
Continuous mandatory ventilation
Continuous mechanical ventilation
Every breath is mandatory or assisted
Set minimum breath rate
CMV – patient does not determine breathing rate.
A/C – patient determines breathing rate.
Patient does not work
Delivery of a mandatory or assisted breath at a set rate

42. SIMV Mode (volume , sometimes pressure)
A minimum number of breaths delivered with a tidal volume (assisted) is set on the ventilator.
Respiratory rate and tidal volumes are set
Patient may breath spontaneously between the number of set assisted breaths
Weaning mode (usually)
Set PEEP and sometimes
pressure support is set

43. Pressure Controlled Ventilation (pressure)
Delivers breaths at a preset pressure limit (equal to PIP).
When ventilator delivers a breath, it continues delivering the volume until the pre-set pressure limit is reached, then it stops delivering the breath.
Settings: Pressure limit (PIP) and I:E ratio but not the tidal volume (tidal volume will vary).
IMPORTANT NOTE: “unnatural feeling of breathing” – NEEDS SEDATION!
With control modes – increases mean airway and intrathoracic pressures rise, may decrease Cardiac Output, very important to monitor hemodynamics (BP, HR, CVP)

44. Pressure Support Ventilation PSV (pressure)
Augments or assists spontaneous breathing efforts by delivering a high flow air to a selected pressure level early in inspiration and maintains that level throughout the inspiratory phase.
When PSV is used as a stand-alone mode the pressure support level is adjusted to achieve the targeted tidal volume and respiratory rate. (Vt and f are not set - patient determines own respiratory rate and tidal volume
Reduces the work of breathing for the patient by reducing the resistance of breathing through an ET tube and circuit tubing.
A lot of time this mode is combined with SIMV and CPAP mode.
At High pressures PSV can provide nearly total ventilator support.
Because level of pressure can be gradually decreased, endurance conditioning is enhanced in PSV modes. Great for weaning!

45. CPAP Mode (pressure) Not the same as CPAP by mask at home or is it????
Supplies pressure throughout the respiratory cycle, helping to improve oxygenation in spontaneously breathing patients.
No setting on ventilator for rate or tidal volumes (patient determines own rate and their own tidal volume).
FiO2, PEEP, PS (pressure support) can be set.
Should not over sedate people on this mode.
Monitor breathing rate, apnea alarms!!
May be used on intubated or non-intubated patients via mask.

46. Alarms High inspiratory pressure or pressure limit
Low inspiratory pressure
Low exhaled tidal volume
High or low minute volume
Apnea
High rate or frequency
Low PEEP/CPAP

47. High Inspiratory Pressure Alarm
Coughing
Secretions in the airway
Biting on the ET tube
Bronchospasm
Patient Ventilator asynchrony
Kinking of ventilator circuit

48. Low Inspiratory Pressure
Low exhaled volume
Patient Disconnected
Circuit Leaks
Airway leaks

49. When in Doubt Always Ask!! Your Respiratory Therapist Is Your Friend!!!!!!!
And to keep your patients breathing forever!
They are here to help!