Oxygen Delivery Devices.ppt

Oxygen Delivery Devices they’re not what you think Indications for oxygen use Low ambient O2 Hypoxemia Suspected hypoxemia Increased work-of-breathing Flaring Tachypnea Increased myocardial work Acute head injury 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 Delivered FiO2 with low-flow What’s my PaO2? a: On room air? b: On 0.50 FiO2? c: On 0.80 FiO2? 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 O2Hgb dissociation curve Resorption atelectasis Non-rebreathing system Air entrainment devices O2Hgb dissociation curve shift 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 DO2 = 1.38(hgb X sat X CI) + (pO2 X 0.003) Entrainment ratios Estimating FiO2 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 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 Non-rebreathing mask 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 % Sat PO2 mmHg 100% O2 oxygen nitrogen PO2 =673 PCO2 = 40 PH2O = 47 A B After ~15 minutes, blood N2 is depleted. Poorly ventilated well perfused units (A) become atelectactic. Reservoir Gas source Room air Expiratory gas To patient One way valves oxygen room air exhaled gas % Sat PO2 mmHg ˉ p