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Oxygen Delivery Devices

Oxygen Delivery Devices. they’re not what you think. Indications for oxygen use. Low ambient O 2 Hypoxemia Suspected hypoxemia Increased work-of-breathing Flaring Tachypnea Increased myocardial work Acute head injury. O 2 delivery systems. High-flow

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Oxygen Delivery Devices

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  1. Oxygen Delivery Devices they’re not what you think

  2. Indications for oxygen use • Low ambient O2 • Hypoxemia • Suspected hypoxemia • Increased work-of-breathing • Flaring • Tachypnea • Increased myocardial work • Acute head injury

  3. 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

  4. Entrainment ratios

  5. Delivered FiO2 with low-flow

  6. What’s my PaO2? • a: On room air? • b: On 0.50 FiO2? • c: On 0.80 FiO2?

  7. 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

  8. O2Hgb dissociation curve % Sat PO2 mmHg

  9. Resorption atelectasis 100% O2 nitrogen oxygen After ~15 minutes, blood N2 is depleted. Poorly ventilated & well perfused units (A) become atelectactic. B A PO2 =673 PCO2 = 40 PH2O = 47

  10. Non-rebreathing system Room air Gas source Expiratory gas Reservoir To patient One way valves

  11. exhaled gas oxygen room air Air entrainment devices

  12. O2Hgb dissociation curve shift ¯pH ­ CO2 ­ temp % Sat PO2 mmHg

  13. What happens to your pO2 and sats when your pH changes? ph = 7.4, pO2 = 100, sat 96% ph = 7.0, pO2 = ?, sat = ?

  14. Oxygen delivery = # trucks X how full they are loaded Xhow fast they go DO2 = 1.38(hgb X sat X CI) + (pO2 X 0.003)

  15. Entrainment ratios

  16. Estimating FiO2

  17. 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 Exhalation ports O2inlet

  18. 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 Exhalation ports O2 Reservoir

  19. Non-rebreathing mask One-way valves • 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 O2 Reservoir

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