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Oxygen Therapy & O 2 Delivery Systems

Oxygen Therapy & O 2 Delivery Systems. Dr. J. S Dali MAMC. www.anaesthesia.co.in anaesthesia.co.in@gmail.com. Oxygen Therapy. ?. Oxygen Therapy. Partial Pr of O 2 in insp. gas (P i o 2 ). Oxygen Therapy. Partial Pr of O 2 in insp. gas (P i o 2 ). Conc. of O 2 (Fi o 2 )

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Oxygen Therapy & O 2 Delivery Systems

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  1. Oxygen Therapy & O2 Delivery Systems Dr. J. S Dali MAMC www.anaesthesia.co.inanaesthesia.co.in@gmail.com

  2. Oxygen Therapy ?

  3. Oxygen Therapy Partial Pr of O2 in insp. gas (Pi o2)

  4. Oxygen Therapy Partial Pr of O2 in insp. gas (Pi o2) Conc. of O2 (Fi o2) (Orthobaric) Total Pressure (Hyperbaric)

  5. Father of modern O2 Therapy ?

  6. Father of modern O2 Therapy O2 lack not only stops the machine, but totally ruins the supposed machinery J.S Haldane-1917

  7. Aim of O2 Therapy ?

  8. Aim of O2 Therapy To restore tissue O2 towards normal

  9. O2 Cascade Air mitochondria

  10. O2 Cascade 159mm Hg (20.95 % of 760) Atm. Air (dry) ? Lower Resp. Tract (moist 37oc) 149mm Hg (20.95 % of 713)

  11. O2 Cascade 159mm Hg (20.95 % of 760) Atm. Air (dry) Humidification 6 Vol % (47mm Hg) Lower Resp. Tract (moist 37oc) 149mm Hg 20.95 % of 713 (760-47)

  12. O2 Cascade Lower Resp. Tract (moist 37oc) 149mm Hg (20.95 % of 713) ? ? 101mm Hg (14 % of 713) or (15 % of 673) 673 = 760 – 47 – 40 Alveolar air PA O2 = FI O2 (Pb – 47) – PaCo2 x F = PI O2 –PaCo2 = PI O2 – PaCo2 if breathing 100% O2 R.Q

  13. O2 Cascade Lower Resp. Tract (moist 37oc) 149mm Hg (20.95 % of 713) O2 consumption Alv. ventilation 101mm Hg (14 % of 713) or (15 % of 673) 673 = 760 – 47 – 40 Alveolar air PA O2 = FI O2 (Pb – 47) – PaCo2 x F = PI O2 –PaCo2 = PI O2 – PaCo2 if breathing 100% O2 R.Q

  14. O2 Cascade 101mm Hg (14 % of 713) or (15 % of 673) 673 = 760 – 47 – 40 Alveolar air ? Arterial blood 97mm Hg Pa O2 = 100 – 0.3 x age (years) mm Hg A – a = 4 – 25 mmHg

  15. O2 Cascade 101mm Hg (14 % of 713) or (15 % of 673) 673 = 760 – 47 – 40 Alveolar air Venous admixture Arterial blood 97mm Hg Pa O2 = 100 – 0.3 x age (years) mm Hg A – a = 4 – 25 mmHg

  16. O2 Cascade Venous admixture(physiological shunt) Low VA/Q Normal True shunt (normal anatomical shunt)

  17. O2 Cascade Venous admixture(physiological shunt) Low VA/Q Normal True shunt (normal anatomical shunt) Pulmonary (Bronchial veins) Extra Pulm. (Thebesian veins)

  18. O2 Cascade Venous admixture(physiological shunt) Low VA/Q Normal True shunt (normal anatomical shunt) Pulmonary (Bronchial veins) Extra Pulm. (Thebesian veins) Normal = upto 5 % of cardiac output

  19. O2 Cascade PA O2 = 101mm Hg (14 % of 713) or (15 % of 673) 673 = 760 – 47 – 40 Alveolar air ? Venous admixture ? Arterial blood Pa O2 = 97mm Hg Pa O2 = 100 – 0.3 x age (years) mm Hg A – a = 4 – 25 mmHg

  20. O2 Cascade PA O2 = 101mm Hg (14 % of 713) or (15 % of 673) 673 = 760 – 47 – 40 Alveolar air PI O2 Venous admixture PV O2 Arterial blood Pa O2 = 97mm Hg Pa O2 = 100 – 0.3 x age (years) mm Hg A – a = 4 – 25 mmHg

  21. O2 Cascade Pa O2 = 97mm Hg (Sat. > 95 %) Arterial blood Utilization by tissue Cell Mitochondria PO2 7 – 37 mmHg Mixed Venous blood PV O2 = 40mm Hg Sat. 75% – The critical level for aerobic metab. to continue

  22. O2 Cascade Pa O2 = 97mm Hg (Sat. > 95 %) Arterial blood Utilization by tissue Cell Mitochondria PO2 7 – 37 mmHg Mixed Venous blood PV O2 = 40mm Hg Sat. 75% Pasteur point – The critical level for aerobic metab. to continue (1 – 2 mmHg PO2 in mitochondria)

  23. Which patient is better placed – ? AB Hb 14gm (normal) 7gm (Anaemic) C.O. 5 L (normal) 4 L (Low) PaO2 23 mm 60 mm O2 Flux 375ml 350ml

  24. Which patient is better placed – ? AB Hb 14gm (normal) 7gm (Anaemic) C.O. 5 L (normal) 4 L (Low) SPO2 40 % 90 % PaO2 23 mm 60 mm O2 Flux 375ml 350ml Min. gradient for O2 transfer from cap. to cell (app. 20 mm Hg) = sat. 20 – 30% = 200 – 300ml O2 flux Critical Level for O2 delivery / critical O2 flux

  25. O2 Cascade Pa O2 = 97mm Hg (Sat. > 95 %) Arterial blood Utilization by tissue Cell Mitochondria PO2 7 – 37 mmHg Mixed Venous blood PV O2 = 40mm Hg Sat. 75% Pasteur point – The critical level for aerobic metab. to continue (PO2 1-2 mmHgin mitochondria, 22mmHg in capillary)

  26. O2 Cascade Pa O2 = 97mm Hg (Sat. > 95 %) Arterial blood ? Utilization by tissue ? Cell Mitochondria PO2 7 – 37 mmHg Mixed Venous blood PV O2 = 40mm Hg Sat. 75% Pasteur point – The critical level for aerobic metab. to continue (PO2 1-2 mmHgin mitochondria, 22mmHg in capillary)

  27. O2 Cascade Pa O2 = 97mm Hg (Sat. > 95 %) Arterial blood Perfusion Utilization by tissue O2 content (Hb Conc.) Cell Mitochondria PO2 7 – 37 mmHg Mixed Venous blood PV O2 = 40mm Hg Sat. 75% Pasteur point – The critical level for aerobic metab. to continue (PO2 1-2 mmHgin mitochondria, 22mmHg in capillary)

  28. O2 contentPer 100 ml Art. blood 14g x 1.39 x 100% = 20 ml Ven. blood 14g x 1.39 x 75% = 15ml Tissue extraction 25% = 5ml

  29. O2 contentPer 100 ml Art. blood 14g x 1.39 x 100% = 20 ml Ven. blood 14g x 1.39 x 75% = 15ml Tissue extraction 25% = 5ml 1% = 0.2ml Art. blood 7g x 1.39 x 100% = 10 ml Ven. blood 7g x 1.39 x 50% = 5ml Tissue extraction 50% = 5ml 1% = 0.1ml

  30. PO2O2 contentPer 100 ml97mm Art. blood 14g x 1.39 x 100% = 20 ml 40mm Ven. blood 14g x 1.39 x 75% = 15ml Tissue extraction 25% = 5ml 1% = 0.2ml 97mm Art. blood 7g x 1.39 x 100% = 10 ml ? Ven. blood 7g x 1.39 x 50% = 5ml Tissue extraction 50% = 5ml 1% = 0.1ml

  31. PO2O2 contentPer 100 ml97mm Art. blood 14g x 1.39 x 100% = 20 ml 40mm Ven. blood 14g x 1.39 x 75% = 15ml Tissue extraction 25% = 5ml 1% = 0.2ml 97mm Art. blood 7g x 1.39 x 100% = 10 ml 27mm Ven. blood 7g x 1.39 x 50% = 5ml Tissue extraction 50% = 5ml 1% = 0.1ml

  32. Oxygen Therapy Indications

  33. Oxygen Therapy Indications FIO2 Barometric Pressure PIO2

  34. Oxygen Therapy Indications FIO2 -FIO2 during anaes. - Rebreathing Barometric Pressure - High altitude PIO2

  35. Oxygen Therapy Indications FIO2 -FIO2 during anaes. - Rebreathing Barometric Pressure - High altitude PIO2 • O2 Consumption Alveolar Ventilation PAO2

  36. Oxygen Therapy Indications FIO2 -FIO2 during anaes. - Rebreathing Barometric Pressure - High altitude PIO2 • O2 Consumption • convulsions • thyrotoxicosis • -shivering • -pyrexia • Alveolar Ventilation • resp. depression • Resp. muscle paresis • resp.effort (trauma) • airway obstruction PAO2

  37. Oxygen Therapy Indications FIO2 -FIO2 during anaes. - Rebreathing Barometric Pressure - High altitude PIO2 • O2 Consumption • convulsions • thyrotoxicosis • -shivering • -pyrexia • (7 % / o C) • Alveolar Ventilation • resp. depression • Resp. muscle paresis • resp.effort (trauma) • airway obstruction PAO2

  38. Oxygen Therapy Indications Low VA/Q Normal Anat. shunt PaO2

  39. Oxygen Therapy Indications • Low VA/Q • Abn. Pulmonary shunt • - pneumonia • lobar atelectasis • ARDS • Normal Anat. shunt • Abn.extra Pulm. Shunt • cong. heart disease • (R L ) PaO2

  40. Oxygen Therapy Indications • Low VA/Q • Abn. Pulmonary shunt • - pneumonia • lobar atelectasis • ARDS • Normal Anat. shunt • Abn.extra Pulm. Shunt • cong. heart disease • (R L ) PaO2 Hypoxic hypoxia

  41. Simple Rule Hypoxia due to hypoventilation Slight increase in O2 conc. (Thus the importance of ventimask) Higher O2 conc.

  42. Simple Rule Hypoxia due to hypoventilation Slight increase in O2 conc. (Thus the importance of ventimask) Higher O2 conc. • hypercapnoea • absence of cynosis

  43. Oxygen Therapy Indications • Low VA/Q • Abn. Pulmonary shunt • - pneumonia • lobar atelectasis • ARDS • Normal Anat. shunt • Abn.extra Pulm. Shunt • cong. heart disease • (R L ) PaO2 Perfusion Hb concentration Cell PO2

  44. Oxygen Therapy Indications • Low VA/Q • Abn. Pulmonary shunt • - pneumonia • lobar atelectasis • ARDS • Normal Anat. shunt • Abn.extra Pulm. Shunt • cong. heart disease • (R L ) PaO2 Perfusion local - PVD, thrombosis gen – shock, Hypovol., card. Failure cardiac arrest • Hb concentration • Anaemia • CO poisoning Cell PO2

  45. Which patient is better placed – ? AB Anaemic patient Patient with Hb 14gm% Hb = 7gm % Normal Hb 7gm% Hb Co 7gm%

  46. Which patient is better placed – ? AB Anaemic patient Patient with Hb 14gm% Hb = 7gm % Normal Hb 7gm% Hb Co 7gm% 2,3 DPG Shift to R Shift to L unloading of O2 unloading of O2 (blood tissue) (blood tissue) PVO2 – ? PVO2 – ?

  47. Which patient is better placed – ? AB Anaemic patient Patient with Hb 14gm% Hb = 7gm % Normal Hb 7gm% Hb Co 7gm% 2,3 DPG Shift to R Shift to L unloading of O2 unloading of O2 (blood tissue) (blood tissue) PVO2 – 27 mm Hg PVO2 – ?

  48. Which patient is better placed – ? AB Anaemic patient Patient with Hb 14gm% Hb = 7gm % Normal Hb 7gm% Hb Co 7gm% 2,3 DPG Shift to R Shift to L unloading of O2 unloading of O2 (blood tissue) (blood tissue) PVO2 – 27 mm Hg PVO2 – 14mmHg

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