1. O2 Therapy & Air way management techniques Abdualrahman ALshehri Lecturer King Saud University Riyadh Community College RN, MSN

2. Respiratory Anatomy  Nose and mouth (warms, moistens, and filters air).  Pharynx –Oropharynx –Nasopharynx  Epiglottis  Trachea (windpipe)

3. Respiratory Anatomy  Cricoid cartilage (adams apple).  Larynx (voice box).  Bronchi  Lungs –Visceral pleura (surface of lungs) –Parietal pleura (internal chest wall) –Interpleural space (potential space)

4. Respiratory Anatomy  Diaphragm  Inhalation (active process) –Diaphragm and intercostal muscles contract, increasing the size of the thoracic cavity. –Diaphragm moves slightly downward, ribs move upward and outward.  Air flows into the lungs creating a negative pressure in the chest cavity.

5. Respiratory Anatomy  Exhalation (passive process)  Diaphragm and intercostal muscles relax decreasing the size of the thoracic cavity. –Diaphragm moves upward, ribs move downward and inward.  Air flows out of the lungs creating a positive pressure inside the chest cavity.

6. Respiratory Physiology  Oxygenation - blood and the cells become saturated with oxygen  Hypoxia - inadequate oxygen being delivered to the cells  Signs of Hypoxia –Increased or decreased heart rate –Altered mental status (early sign) –Agitation –Initial elevation of B.P. followed by a decrease –Cyanosis (often a late sign)

7. Alveolar/Capillary Exchange Oxygen-rich air enters the alveoli during each inspiration. Oxygen-poor blood in the capillaries passes into the alveoli. Oxygen enters the capillaries as carbon dioxide enters the alveoli.

8. Capillary/Cellular Exchange Cells give up carbon dioxide to the capillaries. Capillaries give up oxygen to the cells.

9. Functions of the Respiratory System: Overview  Exchange O 2 –Air to blood –Blood to cells  Exchange CO 2 –Cells to blood –Blood to air  Regulate blood pH  Vocalizations  Protect alveoli

10. Factors Affecting Ventilation  Airway Resistance  Diameter  Mucous blockage  Bronchoconstriction  Bronchodilation  Alveolar compliance 1.Surfactants 2. Surface tension  Alveolar elasticity

11. Page  11 Gas Exchange in the Alveoli  Thin cells: exchange  Surfactant cells  Elastic fibers –Recoil –Push air out  Thin basement membrane  Capillaries cover 90% of surface

12. Page  12 Gas Exchange in the Alveoli

13. Page  13 Oxygen movement

14. Page  14 Oxygen movement

15. Page  15 Oxygen movement

16. Page  16 Oxygen Therapy For over 200 years oxygen therapy has often been used and sometimes misused (Hough 2001)

17. Page  17 Oxygen Therapy  Should be prescribed  Acute and chronic respiratory conditions  Personnel should be trained in its use  Protocols

18. Page  18 Oxygen Therapy - Indications  Hypoxaemia (PaO2<8KPA, O2sats<90%)  Acute or chronic respiratory condition  Pre and post suction  Routinely post operatively  Optimise oxygen delivery

19. Page  19 Oxygen therapy - limitations  Giving oxygen does not guarantee it’s arrival at the mitochondria  Oxygen does not improve ventilation directly (Hough 2001)

20. Page  20 Oxygen therapy – complications/cautions  Respiratory depression if hypoxic drive  Pulmonary oxygen toxicity  Tracheobronchitis  Absorption atelectasis  Fire  Variable delivery

21. Page  21 Oxygen Therapy - Monitoring  Oxygen saturations continuous/intermittent  Arterial blood gases  Observation

22. Page  22 Oxygen therapy – delivery devices  Low Flow masks (variable performance)  High flow masks (fixed flow)/venturi  Nasal cannulae  Mask and reservoir bag  Tracheal mask/t-piece  Tracheal speaking valves  Mechanical ventilator

23. Page  23 Oxygen Therapy - low flow masks  Commonly used  Variable performance

24. Page  24 Oxygen therapy – high flow masks  Guaranteed percentage of oxygen  Venturi system  More expensive  Up to 60%

25. Page  25 Nasal cannulae  1l/min 24% oxygen  2l/min28% oxygen  3l/min32% oxygen  4l/min36% oxygen

26. Page  26 Oxygen therapy – bag and mask  High concentrations of oxygen  Mask and reservoir bag  55-90%

27. Page  27 Oxygen Therapy tracheostomy  T-piece  Mask  Swedish nose  Speaking valve

28. Page  28 Long term oxygen therapy  Chronic hypoxaemia  Increases survival  Aim to raise PaO2 to >8Kpa  Worn as much as possible >15hours  Cylinders/concentrators/liquid

29. Page  29 Humidification  Mucocillary escalator  Adequate hydration is vital  Bacterial contamination!!!

30. Page  30 Humidification - indications  URT bypassed  Thick retained secretions  High flow oxygen/non-invasive mechanical aids

31. Page  31 Humidification - Cautions  Hyper-reactive airways - bronchospasm  Infection  Burns

32. Page  32 Humidification - Types  Nebulisers Large/Small/Ultrasonic  Steam

33. Page  33 Humidification - Humidifiers Hot  - Increases moisture content  - Increases risk of infection Cold  - Poor moisture content

34. Page  34 Non-invasive ventilation  BiPAP  CPAP  IPPB

35. Page  35