Oxygen Toxicity: How much is too much? R.J. YANGER RRT, BS Disclosure

I Have nothing to disclose Objectives

 Define Oxygen Toxicity  Review indications for Oxygen Therapy  Overview of oxygen administration devices and application to critically sick patients Oxygen Toxicity? Whats That?

 Condition that worsens with high Fractions of Inspired Oxygen (FiO2) over prolonged period  2 types  CNS Toxicity(Bert Effect)  Pulmonary Toxicity (Smith Effect) Exposure over time What happens to the alveoli The Vicious cycle of oxygen toxicity Oxygen the Gas  Oxygen is a gas that makes up 20.95% of Atmospheric Room Air  The other parts of Atmospheric Room Air are Nitrogen (78.09%), Argon (0.93%), Carbon Dioxide (0.04%)  At Seal level barometric pressure is 760 mmHG  At Lubbock level 756 mmHg Clinical indications: Respiratory Signs

 Tachypnea

 Dyspnea

 Cyanosis Clinical Indications: Cardiovascular Signs

 Tachycardia and Eventual Bradycardia,

 Arrhythmia

 Hypertension and eventual hypo tension Clinical Indications Neurological Signs

 Somnolence

 Confusion

 Distressed appearance

 Blurred vision

 Tunnel vision Acute Care situations in which Hypoxemia is suspected

Acute myocardial infarction Indications according to Severe Trauma the AARC Short term therapy or surgical intervention

Any evident Hypoxemia with PaO2 less than 60mmHg or an SpO2 less than 90% on Room Air Contraindications according to the AARC

 No specific contraindications to O2 therapy exist when the indications are present

 Specific devices are contraindicated, such as Nasal cannulas and nasopharyngeal catheters in pediatric and neonatal patients with nasal obstruction. Arterial Blood Gasses Oxygen Devices

 Nasal Cannula

 FiO2 range 22%-40%

 Variable FiO2 stability Oxygen Devices

 Simple Mask

 FiO2 Range 35%-50%

 Variable FiO2 stability

 Must always run at 6 L/min to allow for CO2 washout Oxygen devices

 Venturi Mask

 FiO2 range 24%-50%

 Fixed FiO2 Stability Oxygen Devices

 Non rebreather

 FiO2 Range 60%-100%

 Variable FiO2 Stability

 Must be run at 10L/min to prevent bag from collapsing

 Potential suffocation hazard High Velocity Nasal Insuflation (HiVNI)

 Vapotherm: Precision Flow Plus Non-invasive Ventilator

 Phillips Respironics V60  Assists with Oxygenation and Ventilation Mechanical Ventilation

 The Hamilton G5

 Provides oxygenation and ventilatory support to patients that are intubated Oxygen Toxicity

Indications for Oxygen Recap Therapy

Devices that we use to provide therapy Sources Cited

 Kacmarek, R., Stoller, J., Heuer, A., Chatburn, R. and Kallet, R. (n.d.). Egan's fundamentals of respiratory care. 10th ed. St Louis: Elsevier, pp.909-944.

 http://www.rtmagazine.com/2013/06/the-abcs-of-abgs-blood-gas-analysis/

 https://www.usa.philips.com/healthcare/product/HCNOCTN96/respironics-v60-ventilator

 https://www.usa.philips.com/healthcare/product/HC1120925/respironics-af541-noninvasive- ventilation-niv-mask

 https://www.usa.philips.com/healthcare/product/HCNOCTN111/respironics-performax-full- face-mask

 https://www.philips.co.in/healthcare/philipshealthcareathome/blog/benefits-of-niv-therapy

 http://www.ncbi.nlm.nih.gov/pubmed/8636522?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pub med.Pubmed_Re

 http://onlinelibrary.wiley.com/doi/10.1002/ppul.23022/abstract;jsessionid=D24BEA9A8BAF0747E 5051F535307D3FC.f01t02

 https://humanbodyanatomy.co/anatomy-of-the-airway/anatomy-of-the-airway-chapter-6- essential-anatomy-of-the-airway-emergency-medicine/