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Oxygen Delivery Devices

theyre 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
Entrainment ratio 1/25 1/10 1/7 1/5 1/3 1/1.7 1/1 1/0.6 FiO2 0.24 0.28 0.31 0.35 0.40 0.50 0.60 0.70 Minimal flow to operate 4 4 6 8 8 12 12 12 Total flow (L/min) 104 44 48 48 32 32 24 19

Delivered FiO2 with low-flow

Whats 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


100 80
% Sat

60 40 20 0

20

40

60

80

100

120

140

160

PO2 mmHg

Resorption atelectasis
100% O2
oxygen nitrogen

B
PO2 =673 PCO2 = 40 PH2O = 47

After ~15 minutes, blood N2 is depleted. Poorly ventilated & well perfused units (A) become atelectactic.

Non-rebreathing system
Room air Gas source

Expiratory gas

Reservoir

To patient
One way valves

Air entrainment devices


exhaled gas oxygen

room air

O2Hgb dissociation curve shift


100 80
% Sat

60 40 20 0

pH

CO2 temp

20

40

60

80

100

120

140

160

PO2 mmHg

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
Flow Total Entrainment rate flow FiO2 ratio (O2/air) (L/min) (L/min) 0.24 1-25 4 104 0.28 1-10 4 44 0.31 1-7 6 48 0.35 1-5 8 48 0.4 1-3 8 32 0.5 1-1.7 12 32 0.6 1-1 12 24 0.7 1-0.6 12 19

System Ventimasks

Aerosol

Estimating FiO2
O2 Flow rate FiO2 O2 Flow rate FiO2 O2 Flow rate FiO2

Nasal cannula 1 0.24 2 0.28 3 0.32 4 0.36 5 0.4 6 0.44

Oxygen mask 5-6 0.4 6-7 0.5 7-8 0.6

Mask with reservoir 6 0.6 7 0.7 8 0.8 9 0.80+ 10 0.80+

Simple mask
Exhalation ports

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

O2 inlet

Partial rebreather mask


Exhalation ports

O2

Reservoir

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
One-way valves

O2

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
Reservoir