BASIC

OF
OXYGEN THERAPY

RITA ROGAYAH
DEPT. PULMONOLOGY AND RESPIRATORY MEDICINE
MEDICAL FACULTY OF UNIVERSITY INDONESIA/
PERSAHABATAN HOSPITAL
Oxygen :
Pharmacologic agent, a colorless, odorless,
tasteless, use for combustion process (oxidative
process).

Oxygen was originally discovered by Joseph

Priestley in Wiltshire, in 1774 and named by
Antoine Lavoisier in 1777
•Beddoes (1800) : use O2 for
medical purpose
•Barach (1920) : O2 therapy
for
hypoxemic patient
•Cherniack (1967) : O2 therapy
through nasal cannula, low flow
rate  good result, without CO2
 THE KEY OF OXYGEN
ADMINISTRATION

• For whom

• How to administer

• How to follow-up/monitoring
 Goals of Oxygen Therapy

• To increase oxygen content within the arterial

blood  deliver into tissue  to facilitate an
aerobe metabolism
 Goals of Oxygen therapy
• Maintain PaO2 < 60 mmHg or SaO2 <
90% 
– To prevent hypoxia of cell and tissue
– To reduce work of breathing
– To reduce myocardial work
Oxygen administration = drug  can give
advantages  - indication
- oxygen dose
- complication
 HYPOXEMIA

• Decreasing of partial oxygen pressure

(PaO2) in the arterial blood
• Neonatal  PaO2 < 50 mmHg or SaO2 <
88%
• Adult, children, baby  PaO2 < 60
mmHg or SaO2 < 90%
PaO2 and SaO2 value in adult

PaO2 SaO2 (%)

Normal 97 97
Normal range  80  95
Hypoxemia < 80 < 95
Mild 60 –79 90 – 94

Moderate 40 – 59 75 – 89
Severe <40 < 75
 INDICATION OF OXYGEN THERAPY

• Hypoxemia  PaO2  or Sp O2 
• Suspected hypoxemia  ex. shock, CO
toxicity
• Decreasing of work of breathing  post
anesthesia recovery
• Decreasing of myocardial work  myocardial
infarction
• Severe trauma
 MECHANISM OF HYPOXEMIA

• V/Q mismatch  COPD, sputum retention,

cardiovascular disease
• Alveolar hypoventilation  COPD
exacerbation, sleep apnea, drug overdose
• Shunt  pneumonia, ARDS, atelectasis,
cardiogenic pulmonary edema, pulmonary
embolism
 MECHANISM OF HYPOXEMIA

• Impairment of diffusion  interstitial fibrosis,

interstitial edema, sarcoidosis, asbestosis,
colagen vascular disease (SLE, granulomatosis
wagener)
• Decreasing of inspire oxygen pressure  high
altitude, anemia, bleeding
TISSUE HYPOXIA CAUSED BY HYPOXEMIA

1. Hyposic hypoxemia  reduce O2 content in

inspire gas/blood (V/Q mismatch, impaired
diffusion, alveolar hypoventilation)
2. Anoxia hypoxia  reduce capacity of O2
transport due to anemia, CO2 toxicity, sickle
cell anemia, other Hb abnormality
3. Stagnant Hypoxia  due to poor tissue
perfusion, reduce blood flow (heart failure,
shock, cardiac arrest)
4. Histotoxic hypoxia  inability to use O2 in
the tissue level (cyanide toxicity, alcohol)
 DETECTION OF HYPOXEMIA

A. Symptoms
B. Blood gas analysis
C. Pulse oxymetri
D. Transcutaneous partial pressure of oxygen
(Ptc O2)
 A. SYMPTOMS

1. Dyspnea
2. Rapid and shallow of breath
3. Respiratory rate 35x/min
4. Nose tip respiration
5. Retraction of intercostal space
6. Cyanosis (advance stage)
Fatique, disorientation, tachycardia,bradycardia,
arrythmia, hypertension, hypotension, etc.
 B. BLOOD GAS ANALYSIS

• Gold standard  hypoxemia

• PaO2 and SaO2
• Sat O2  amount of O2 that bound to Hb
• Saturation level is depend on oxyhemoglo-
bin dissociation
 C.Pulse oxymetri
Good accurate if SaO2 < 80%

D.Transcutaneous partial
pressure of oxygen (Ptc O2)
 Detection of hypoxemia

• Physical examination
- PaCO2  < 45 mmHg  alveoli hypoventilation
- Chest X-ray and laboratory finding
- Count of alveolar-arterial oxygen gradient (AaDO2) :
 < 20 mmHg normal
 20-40 mmHg V/Q mismatch
 40-60 mmHg shunt
 < 60 mmHg impairment of diffusion
 The use of Oxygen therapy :

1. O2 supplement  acute condition < 30 days

(ex. : pneumonia, asthma exacerbation)
2. Therapy
Short-term oxygen therapy  O2 therapy for 30
- 90 days (ex. : heart failure)
Long-term oxygen therapy  O2 therapy for <
90 days (ex. : COPD)
 METHODE OXYGEN ADMINISTRATION

• O2  giving O2 in a simple way

• FiO2 as low as possible  to maintain

PaO2< 60 mmHg and SaO2 < 90%

 O2 administration is depend on :
a.The need of FiO2

b.Patient convenience

c.Level of humidity

d.The need of nebulizer therapy

 DETERMINE OF OXYGEN DOSE (A)
1. PAO2=(PB-PH2O)xFIO2 – (PaCO2 x1.25)
= (760-47)xFIO2-(PaCO2 x1.25)

2. PAO2=713xFIO2-1.25xPaCO2

3. PaO2 = desired PaO2

Measured PAO2 new PAO2

4. If we already got the result of new PAO2, then we

must count the new FIO2 by using formula (1)
 DETERMINE OF OXYGEN DOSE (B)

150 + AaDO2
FiO2 = x 100% = ….%
760

AaDO2 = PA O2 - PaO2

PA O2 : oxygen pressure in the alveoli

PaO2 : based on BGA result
PA O2 = (Patm - PH2O) xFiO2 - PaCO2 x 1.25
=(760 - 47) xFiO2-PaCO2 x 1.25
= 713 x FiO2 – PaCO2 x1,25

PaCO2  based on BGA result

FiO2  oxygen fraction  when the BGA was taken,
if patient didn’t use oxygen  FiO2 : 21% (0,21)
 OXYGEN DELIVERY METHOD

Device classification  FDO2 dan FiO2 :

1.Variable performance devices
(low-flow devices)
2. Fixed performance devices
(high-flow devices)

(FDO2 = O2 concentration entering airway, FiO2 =

actual O2 concentration in alveoli/lung)
 VARIABLE PERFORMANCE DEVICES
(LOW-FLOW DEVICES)
• Gas entering airway < compared to gas inspired
by patient
• FiO2 < FDO2  variable according to the gas
from device and patient's respiration pattern
(tidal volume, RR, I:E ratio, inspiratory flow rate)
• example:
- nasal cannula
- Oxygen face mask (simple face mask,
rebreathing mask and non-rebreathing mask)
 FIXED PERFORMANCE DEVICES
(HIGH-FLOW DEVICES)

• Gas entering the airway is stabil and all is

inspired by the patient (FiO2 = FDO2)
• Example:
- Jet-mixing (venturi) mask
- CPAP / BiPAP
 Nasal cannula
- Cannula is connected to a small pipe and
linked to a humidifier
- O2 flow rate 2-6 L/’, FiO2 0,28 – 0,4
- Every 1 L/’ O2  O2 concentration added
is 4% Example: flow rate 1 L/minute =
24%, 2 liter/minute = 28% dst, maximal 6
L/’.
 Advantage
– Oxygen delivery is stable with regular tidal volume
and respiration rate
– Well tolerated for long term use
– Patient may move freely
– Efficient and comfortable

Disadvantages
– Nasal irritation, the back of the ears as the place of
binasal strap
– FiO2 will decrease if the patient is mouth-breathing
 Mask

A. If O2 level given is higher than nasal cannule  use mask

covering nose and mouth  tight (mask should be placed
tightly in patient's face to avoid leakage)
B. Humid
C. Patient cannot eat, drink, or talk freely
D. Risk of aspiration if the patient vomits, especially in
unconscious patients
E. Consist of:
1. Simple mask
2. Reservoir mask
• Rebreathing mask
• Nonrebreathing mask
 Simple mask

• O2 flow rate is variable 5-7

litres/minute, FiO2 0,3-0,6 O2
concentration reaches 60%.
• Low-flow system uses nasopharynx
and oropharynx as anatomical
reservoir
 RESERVOIR MASK

2 types of reservoir masks:

- Rebreathing
- Non breathing
Mask  light  transparant plastic with
reservoir bag beneath the chin
Flow rate of 4-10 L/minute
- Difference of the two masks  with/without
valve between mask and reservoir

- Rebreathing mask valve  air exits during

expiration  holes beside the valve and the
reservoir bag  only O2 from reservoir bag
inhaled during inspiration
Without valve

Without valve
 Masker

Valve 2 Mask
Klep 2

Valve 1

Reservoir bag
O2 hose
 HIGH FLOW

Venturi mask
• Oxygen concentration  air within the mask
 Oxygen is given with fix flow rate
• Nonaerosol device is used  fixed
percentage (24%, 28%, 31%, 36%, 40%, 50%)
OXYGEN CONCENTRATION BASED ON
DELIVERY DEVICE USED
Device used O2 (l/mnt) FiO2

Nasal cannule 1 0,21 – 0,24

2 0,23 – 0,28
3 0,27 – 0,34
4 0,31 – 0,38
5-6 0,32 – 0,44

Venturi 4-6 0,24 – 0,28

8-10 0,35 – 0,40
8-12 0,50

Simple mask 5-6 0,30 – 0,45

7-8 0,40 – 0,60

Rebreathing 7 0,35 – 0,75

10 0,65 – 1,00

Non rebreathing 4-10 0,40 - 1,00

Continuous Positive Airway Pressure
(CPAP)
Method  giving constant positive
pressure to the airway during inspiration
and expiration
Assist ventilation  giving air pressure 
fix pressure  airway  increasing
transpulmonary pressure  lung
inflation
Connector  nasal mask, oronasal or
mouthpiece
 OXYGEN SOURCE

1. Cylinder

2. Liquid oxygen system (portable)

3. Concentrator
 CYLINDER

 Large size, 240-622 l  2 – 5,5 hours (flow

rate 2 l/minute)

 Patient is immobile

 Relatively cheap

 Reffilable
 OXYGEN LIQUID SYSTEM

 Lightweight  7 days (flow rate 2 l/min)

 Can be hand-carried while walking
 Refiillable
 More expensive
 CONCENTRATOR

 Takes up room air

 Has filtration system (large particles, non-
oxygen gas O2)
 Uses electricity
 No refill needed