Hazards of Oxygen Therapy First year Respiratory Therapy MJC

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Hazards of Oxygen Therapy

• First year Respiratory Therapy
• MJC 220

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Oxygen Therapy

• The RCP is the primary member of the healthcare
  team responsible for oxygen administration.
• RCP must be well-versed in its goals and
  objectives

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Oxygen is a DRUG

• Must be considered as a drug
• TOO MUCH of a drug can cause overdosing problems
• TOO LITTLE isnt enough to treat the symptoms

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Goals of Oxygen Therapy

• Correct hypoxemia
• Decrease symptoms associated with hypoxemia
• Decrease workload on cardiopulmonary system

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Indications for Oxygen

• Documented hypoxemia
• PaO2 less than 60 torr or SaO2 less than 90 in
  adults and infants older than 28 days while
  breathing room air
• Acute care situation where hypoxemia is suspected
• Severe trauma
• Acute myocardial infarction
• Short term therapy i.e. Post-op anesthesia

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Monitoring the Patient

• Clinical assessment including but not limited to
  cardiac, pulmonary, and neurological status
• Assessment of physiologic parameters measurement
  of oxygen tensions or saturation in any patient
  treated with oxygen

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Clinical Signs of Hypoxia

• Respiratory
• Increased respiratory rate (Tachypnea), dyspnea,
  cyanosis, acc muscle use
• Cardiac
• Increased heart rate (Tachycardia), hypertension
• Neurological
• Confusion or panic
• Cyanosis
• Diaphoresis
• Somnolence, confusion, blurred vision, loss of
  coordination, impaired judgment

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Long Term Sign

• Clubbing

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Precautions of Supplemental Oxygen

• 1. Oxygen toxicity
• 2. Depression of ventilation
• 3. Retinopathy of Prematurity
• 4. Absorption atelectasis
• 5. Bacterial infection with humidifiers

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Oxygen Toxicity

• Patients exposed to high oxygen levels for a
  prolonged period of time have lung damage.
• First damage is capillary epithelium, leading to
  edema, thickened membranes and finally to
  pulmonary fibrosis and hypertension.

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A Vicious Cycle
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Depression of Ventilation

• COPD patients with CO2 retention have blunted
  stimuli to breathing
• Hypoxic drive theory
• They have a different stimulus to breathe then
  normal
• GOLDEN RULE You should never stop giving oxygen
  to a patient in need.

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Retinopathy of Prematurity

• Is an abnormal eye condition in some premature
  infants who receive high FIO2s
• Retinal arteries hemorrhage and scaring cause
  retinal detachment and blindness.

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Absorption Atelectasis

• The alveoli in the lungs collapse and cause
  shunting in the capillary lung fields.
• Loss of nitrogen in the blood causes less total
  venous pressure. This leads to the collapse of of
  the alveolus.

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Pressure gradients that cause absorption
atelectasis
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Infection Control

• Therapist must use an aseptic technique when
  handling supplemental oxygen and humidity
  equipment
• Never drain water from the tubing back into the
  heated humidifier
• Always date the opened container
• Only use sterile liquids in reservoirs

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Oxygen a fire hazard

• NEVER smoke while using supplemental oxygen
• Severe facial burns can and do happen

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Clinical Guidelines

• Consider Oxygen as a drug
• Use the lowest FIO2 .
• Use it for the shortest possible time
• Keep oxygen below 50 if
• If you have to - accept lower saturations than
  normal in some situations
• Check equipment regularly for contaminants

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Thats all folks!

• Any questions?

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Typical Question

• Administration of high oxygen concentrations to a
  neonate for prolonged periods of time may result
  in which of the following
• Atelectasis
• CO2 retention
• Retinopathy of Prematurity
• Pneumothorax

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Another?

• Typically, which are the precautions of
  administering oxygen to patients in the hospital
  EXCEPT
• Retinopathy of Prematurity
• Oxygen narcosis
• Absorption atelectasis
• Depression of ventilation