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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

Entrainment FiO2 Minimal flow Total flow


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

100

80

60
% Sat

40

20

0
0 20 40 60 80 100 120 140 160
PO2 mmHg
Resorption atelectasis
100% O2
nitrogen
oxygen

A B A B

After ~15 minutes,


B blood N2 is depleted.
A Poorly ventilated &
PO2 =673
PCO2 = 40
well perfused units (A)
PH2O = 47 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

 pH
60
% Sat

CO2
temp
40

20

0
0 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
System FiO2 ratio (O2/air) (L/min) (L/min)
Ventimasks 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
Aerosol 0.7 1-0.6 12 19
Estimating FiO2

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


Nasal cannula Oxygen mask Mask with reservoir
1 0.24 5-6 0.4 6 0.6
2 0.28 6-7 0.5 7 0.7
3 0.32 7-8 0.6 8 0.8
4 0.36 9 0.80+
5 0.4 10 0.80+
6 0.44
Simple mask

Exhalation  Open ports for


ports 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  O2 directed into


ports reservoir
 Insp: draw gas from
bag & ? room air
 Exp: first 1/3 of
exhaled gas goes into
O2
bag (dead space)
 Dead space gas
mixes with ‘new’ O2
going into bag
Reservoir  Deliver ~60% O2
Non-rebreathing mask

One-way valves
 Valve prevents
exhaled gas flow
into reservoir bag
 Valve over
exhalation ports
prevents air
O2 entrainment
 Delivers ~100% O2,
if bag does not
completely collapse
during inhalation
Reservoir