Methods of oxygen administration
Introduction
Oxygen administration is routinely used on most of the patients admitted to the intensive care unit or emergency rooms. These patients exhibit respiratory distress. Oxygen administration indications involve increased working of breathing, hypoxemia, and hypodynamic insufficiency. Generally, oxygen therapy is aimed at maintaining sufficient tissue oxygenation. It also, at the same time minimizing the cardiopulmonary work. Inadequate oxygenation may be characterized by signs such as accessory muscle work, tachypnea, cyanosis, dyspnea, hypertension, and tachycardia. Besides, oxygen administration can be used in chronic administration for patients that exhibit advanced cardiopulmonary illness. It can also be administered at the time of diagnosis evaluation.
Currently, there exists a wide array of oxygen delivery devices that the respiratory therapist can apply while administering patients. The selection of tools to be used in oxygen delivery is based on the patient’s oxygen requirement, reliability, the efficacy of the disease, patient acceptance, and ease of therapeutic use. Even though designs usually play an essential role while choosing the particular devices, clinical performance and assessment eventually determine how and which of the devices need to be chosen. The devices of oxygen delivery normally range from very inexpensive and simple designs through more costly and complex ones. The percentage of oxygen delivery can be precise or inconsistent based on the administration device type chosen. Oxygen delivery can potentially be administered through high-flow or low flow systems, with a reservoir or not and with humanity or not. Monitoring oxygen administration effectiveness involves analyses of arterial blood gas, clinical assessment, and oxygen saturation monitoring. This paper explores the concept of oxygen administration. The focus will include an understanding of oxygen delivery and who receives the therapy. Oxygen therapy has various methods that can be applied to patients in healthcare practice.
Methods of oxygen administration
Oxygen can be taken into consideration as toxic substances if the percentages are administered more than 60 percent. The chronic carbon dioxide retention population of the patient is likely to diminish ventilator dive and generate life-threatening hypercarbia. Besides, it can contribute to atelectasis absorption through the washing out of nitrogen gas when administered in high concentrations.
Devices of oxygen administration have historically been grouped into three primary types in terms of their design. These include low flow, reservoirs, and a high glow category. In regard to the range of inspiratory oxygen fraction (FiO2), systems of oxygen can be grouped into those that are indicated for low oxygen, which represents below 35%. The next group is the moderate delivery that ranges between 35-60%, or it may be categorized as high-delivery and above 60%. Some devices can potentially deliver oxygen percentages in broad ranges. The selection of a device to deliver oxygen requires the therapist to address two very crucial questions. One of the concerns includes the amount of oxygen delivered by the device. The next issue involves whether the Fi02 consistency of delivery or exhibits likely to vary considering the changing patterns of respiration. The different devices of oxygen delivery include the following:
Low flow delivery
Normal low-flow oxygen systems offer supplemental oxygen in most cases, less than the patient’s total minute ventilation. Since the minute ventilation of a patient exceeds the flow, the device’s administered oxygen will ultimately be diluted with ambient air (McDonald, 2014). Therefore, the inspired delivery of oxygen is less than it is required. Low flow systems of oxygen delivery are made up of nasal catheters, nasal cannula, and transtracheal catheters.
Nasal cannula, at its standard, delivers a Fi02 of between 20-44% at supply flows between 1-8 liters per minute (LPM). Some of the factors that influence Fi02 include tidal volume, breathe rate, and pathophysiology(McDonald, 2014). The slower the flow of respiration, the high the Fi02. On the contrary, the faster the flow of respiration, the lower the Fi02. Since the oxygen percentage delivered is found to be very inconsistent at the time of respiratory distress, it is not recommended to use a nasal cannula for severe acute hypoxemia. It may also be the case of patients that usually breathe on a hypoxic drive, where if the concretion of oxygen is too high, it may contribute to respiratory depression (McDonald, 2014). A nasal cannula makes use of no external oxygen reservoir. A device for humidification can be recommended for eh flows that are found to fall above 4 LPM. This provides that humidification of the dry inspired gas is attained—added flows ranging from 6-8 LPM. Even with humidity, it will contribute to nasal bleeding and dryness. One of the best clinical indicators for the nasal cannula is that they are allowed for patients exhibiting a relatively stable respiration pattern. It also includes patients who need a low percentage of oxygen or those in need of supplemental oxygen at the time of an operative or diagnostic mechanism, or for chronic home care.
Reservoir systems
Reservoir systems integrate procedure for assembling and storing oxygen at the time of inspiration and during exhalation. Patients usually draw from the reservoir of oxygen anytime the patient’s minute ventilation goes past the delivery flow of the device—the types of reservoir devices in masks and cannula. Reservoir cannulas usually serve the role of improving oxygen delivery efficiency (Miller, 2015). Normally, the devices are designed to ensure that oxygen is conserved. Therefore, patients are likely to be well oxygenated during the lower flows. Liter flows especially ranging up to 8 LPM, have been identified to attain adequate oxygenation towards patients who have high low needs. Generally, the reservoir offers practical oxygen delivery to patients. The supply flows are significantly less than the nasal cannula. The location of the reservoir can be under the nasal cannula. It may also hang in the form of a pendant around the neck of a patient. The reservoir is aesthetically acceptable to the patients. The device’s widespread use across patients who require chronic oxygen treatment could lead to substantial financial savings. The devices are similar to transtracheal oxygen, and it is best used on chronic oxygen users. They wish to have more significant mobility extend than what is provided by traditional oxygen systems.
Increasing the delivered oxygen concentration in most cases, a mask reservoir is used. The facemask’s volume is about 100-300 cm3 based on the size. The mask has the potential of delivering a Fi02 of between 40-60 percent. Tidal volume, breath rate, and pathology usually influence the Fi02. Further, the mask is also depicted on patients with epistaxis or nasal irritation. Besides, it can be applied for patients identified as strictly mouth breathers. Generally, the reservoir is used for operative procedures, short-run emergencies, or the lack of an appropriate nasal canal for the patients.
High flow delivery
The systems of high flow delivery usually supply particularly the concentration of oxygen at a flow that equals or exceeds the inspiratory flow demand of a patient. In most cases, a blending system or an air-entrainment is applied (Roca et al., 2010). As long as the delivered flow is more than the patient’s total flow, it is possible to achieve an exact delivered Fi02. Oxygen is mixed with room air using a venturi mask, where it allows the creation of high flow enriched air of a specific concentration. The mask offers a constant and accurate Fi02 regardless of the distinct rates of respiration and the tidal volumes. The delivery settings of Fi02 are usually set at 24%, 28%, 31%, 35%, and 40% based on oxygen (Roca et al., 2010). The venturi mask is, in most cases, used when the clinician expresses concern about carbon dioxide retention. It may also be used when there is inconsistent respiratory drive. Humidification addition is not essential in the case of high flow delivery. In most cases, the venturi mask is used in the COPD patient population, where the threat of knocking the hypoxic drive of a patient is of concern.
Conclusion
In conclusion, oxygen delivery is a well-known clinical intervention, especially for patients that exhibit respiratory distress. Outcome optimization, in most cases, is based on selecting the appropriate oxygen delivery device. Devices of oxygen administration have historically been grouped into three primary types in terms of their design. These include low flow, reservoirs, and a high glow category. A respiratory therapist needs to involve certain recommendations when selecting a device for oxygen delivery. These include the patent’s etiology and condition, the goal of oxygen delivery, and the selected device’s performance. The selection of oxygen administration devices is based on the patient’s physiological response and clinical pathophysiology. It is essential to include clinical monitoring and assessment as they ensure patient safety. They also assist in attaining desired clinical results when delivering oxygen.
References
McDonald, C. F. (2014). Low‐flow oxygen: How much is your patient really getting?. Respirology, 19(4), 469-470. https://doi.org/10.1111/resp.12290
Miller, K. (2015). Oxygen administration: what is the best choice? Although design plays an important role in selection of oxygen delivery devices, clinical assessment and performance ultimately determine which device should be selected. RT for Decision Makers in Respiratory Care, 28(10), 28-31.
Roca, O., Riera, J., Torres, F., & Masclans, J. R. (2010). High-flow oxygen therapy in acute respiratory failure. Respiratory care, 55(4), 408-413.