Oxygen therapy , also known as supplemental oxygen , is the use of oxygen as a medical treatment. These can include low blood oxygen, carbon monoxide toxicity, cluster headache, and to maintain adequate oxygen when inhalation anesthesia is given. Long-term oxygen is often useful in people with chronic low oxygen such as from severe COPD or cystic fibrosis. Oxygen can be administered in several ways including the nasal cannula, face mask, and in the hyperbaric chamber.
Oxygen is required for normal cell metabolism. Excessively high concentrations may cause oxygen toxicity such as lung damage or cause respiratory failure in those with a tendency. Higher oxygen concentrations also increase the risk of fire, especially during smoking, and without humidification can also dry the nose. The recommended oxygen saturation target depends on the condition being treated. In most conditions, 94-96% saturation is recommended, whereas in those who are at risk of carbon dioxide retention saturation of 88-92% is preferred, and in those with carbon monoxide toxicity or cardiac arrest they should be as high as possible. Air is usually 21% oxygen by volume while oxygen therapy increases this to a certain extent up to 100%.
The use of oxygen in medicine became commonplace around 1917. This is the List of Essential Medicines of the World Health Organization, the most effective and safe medicines needed in the health system. The cost of oxygen at home is about 150 USD a month in Brazil and 400 USD a month in the United States. Home oxygen can be provided either by an oxygen tank or oxygen concentrator. Oxygen is believed to be the most common treatment given in hospitals in developed countries.
Video Oxygen therapy
Medical use
Oxygen is used as a medical treatment both in chronic and acute cases, and can be used in hospital, pre-hospital or fully out of hospital, depending on the patient's needs and their medical professional opinion.
Chronic condition
Common use of supplemental oxygen is in patients with chronic obstructive pulmonary disease (COPD), the occurrence of chronic bronchitis or emphysema, a common long-term smoking effect, which may require additional oxygen to breathe well during a temporary deteriorating condition of their condition. , or throughout the day and night. This is shown in COPD patients with partial oxygen partial pressure Pa O
2 <= 55 mmHg (7.3 kPa) or arterial oxygen saturation Sa O
2 <= 88% and has been shown to increase lifespan.
Oxygen is often prescribed for people with shortness of breath, in the setting of heart failure or late-stage breathing, advanced cancer or neurodegenerative diseases, despite having relatively normal blood oxygen levels. A 2010 trial of 239 subjects found no significant difference in reducing shortness of breath between oxygen and air delivered in the same way.
Acute conditions
Oxygen is widely used in emergency medicine, both in hospitals and by emergency medical services or those who provide first aid.
In prehospital settings, high flow oxygen is indicated for use in resuscitation, major trauma, anaphylaxis, major bleeding, shock, active seizures, and hypothermia.
It may also be indicated for others where their injury or illness has caused low oxygen levels, although in this case oxygen flow should be moderated to achieve oxygen saturation levels, based on pulse oximeter (with target levels of 94-96% in most, or 88- 92% in people with COPD). Excessive use of oxygen in those who are acutely ill but increases the risk of death.
For personal use, high-concentration oxygen is used as home therapy to abort cluster headache attacks, due to its vaso-constrictive effects.
People who receive oxygen therapy for low oxygen after acute illness or hospitalization should not routinely have prescribed updates for advanced oxygen therapy without a reexamination of the person's condition. If the person has recovered from his illness, then hypoxemia is expected to heal and additional treatment is not necessary and waste of resources.
Maps Oxygen therapy
Side effects
Many EMS protocols show that oxygen should not be withheld from any patient, while other protocols are more specific or cautious. However, there are certain situations where oxygen therapy is known to have a negative impact on the patient's condition.
Oxygen should not be given to patients suffering from paraquat poisoning unless they suffer from severe respiratory or respiratory arrest, as this may increase toxicity. (Paraquat poisoning is rare - for example 200 deaths globally from 1958 to 1978). Oxygen therapy is not recommended for patients suffering from pulmonary fibrosis or other lung damage resulting from bleomycin treatment.
High oxygen levels given to the baby cause blindness by promoting excessive growth of new blood vessels in the eye that prevents the eyesight. This is retinopathy prematurity (ROP).
Oxygen has a vasoconstrictive effect on the circulatory system, reducing peripheral circulation and was once thought to potentially increase the stroke effect. However, when additional oxygen is given to the patient, additional oxygen is dissolved in the plasma according to Henry's Law. This allows the change of compensation and dissolved oxygen in the plasma to support shameful (oxygen-starved) neurons, reduce post-stroke cerebral inflammation and edema. Since 1990, hyperbaric oxygen therapy has been used in stroke care worldwide. In rare cases, hyperbaric oxygen therapy patients experience seizures. However, because of the existing Henry Law effect of dissolved oxygen available to neurons, there is usually no negative sequel to the event. Such seizures are generally the result of oxygen toxicity, although hypoglycemia may be a contributing factor, but the latter risk can be eradicated or reduced by carefully monitoring the patient's nutritional intake before oxygen treatment.
The first aid of oxygen has been used as an emergency treatment for diving injuries for years. Recompressions in hyperbaric chambers with 100% oxygen patient breathing are standard hospitals and military medical responses to decompression diseases. The success of the recompression therapy as well as the decline in the number of required recompression treatments has been shown if first aid oxygen is given within four hours of surfacing. It has been suggested that oxygen delivery may not be the most effective measure for the treatment of decompression diseases and that heliox may be a better alternative.
Chronic obstructive pulmonary disease
Treatment is necessary in patients with chronic obstructive pulmonary disease, such as emphysema, especially in those known to maintain carbon dioxide (respiratory failure type II). Such patients can further collect carbon dioxide and decrease pH (hypercapnation) if given additional oxygen, possibly endangering their lives. This is primarily as a result of ventilation-perfusion imbalance (see Effect of oxygen on chronic obstructive pulmonary disease). In the worst case, high levels of oxygen in patients with severe emphysema and high blood carbon dioxide can reduce respiratory impulse to the point of respiratory failure, with an observed mortality increase compared to those receiving titration oxygen therapy. However, the risk of loss of respiratory impulse is much greater than the risk of withstanding oxygen, and therefore emergency oxygen delivery is never contraindicated. Transfers from field care to definitive care, in which the use of oxygen can be carefully calibrated, usually occur well before significant reductions to the respiratory drive.
A 2010 study has shown that titration oxygen therapy (oxygen-controlled administration) is less harmful to COPD patients and other non-COPD patients, possibly also, in some cases, more favorably than titration therapy.
Fire risks
A highly concentrated source of oxygen enhances rapid combustion. Oxygen itself is not flammable, but the addition of concentrated oxygen to the fire greatly increases its intensity, and can help the combustion of a relatively inert material (like metal) under normal conditions. Fire and explosion hazards occur when concentrated oxidants and fuels are brought close; However, ignition events, such as heat or sparks, are required to trigger burning. A notable example of accidental fires is accelerated by pure oxygen occurring in the Apollo 1 spacecraft in January 1967 during a ground test; it killed all three astronauts. A similar accident killed Soviet cosmonaut Valentin Bondarenko in 1961.
Burning hazards also apply to oxygen compounds with high oxidative potentials, such as peroxides, chlorates, nitrates, perchlorates, and dichromates because they can contribute oxygen to the fire.
O
2 will enable burning takes place quickly and energetically. Steel pipes and storage vessels used to store and transmit oxygen in the form of gases and liquids will act as fuel; and therefore the design and manufacture of O
2 system requires special training to ensure that ignition sources are minimized. Highly concentrated oxygen in high pressure environments can spontaneously ignite hydrocarbons such as oils and fats, which produce fire or explosion. Heat caused by rapid pressure serves as a source of ignition. For this reason, storage vessels, regulators, pipes and other equipment used with highly concentrated oxygen must be "clean-oxygen" before use, to ensure the absence of potential fuel. This applies not only to pure oxygen; A much higher concentration of the atmosphere (about 21%) carries a potential risk.
Hospitals in some jurisdictions, such as the UK, now operate a "no smoking" policy, which, although introduced for other reasons, support the goal of safeguarding the ignition source of medical oxygen pipe. Medically determined oxygen ignition sources include wax, aromatherapy, medical equipment, cooking, and unfortunately, deliberate vandalism. Smoking pipes, cigars and cigarettes are of special concern. This policy does not completely eliminate the risk of injury with a portable oxygen system, especially if its adherence is poor.
Alternative medicine
Some alternative medicine practitioners have promoted "oxygen therapy" as a cure for many human diseases including AIDS, Alzheimer's disease and cancer. This procedure may include injecting hydrogen peroxide, blood oxygenation, or oxygen delivery under pressure to the rectum, vagina, or other body opening. According to the American Cancer Society, "the available scientific evidence does not support the claim that incorporating chemicals that release oxygen into one's body is effective in treating cancer", and some of these treatments can be harmful.
Storage and source
Oxygen can be separated by a number of methods, including chemical reactions and fractional distillation, and then either used immediately or stored for future use. The main types of sources for oxygen therapy are: Liquid storage - Liquid oxygen is stored in a cold tank until necessary, and then allowed to boil (at 90.188 K (-182.96 ° C) to release oxygen as a gas. These are widely used in hospitals due to their high usage requirements, but can also be used in other settings. See Isolated Vacuum Evaporator for more information on this storage method.
Shipping
Various devices are used for oxygen administration. In most cases, oxygen will first pass through the pressure regulator, which is used to control the high pressure oxygen sent from the cylinder (or other source) to a lower pressure. This lower pressure is then controlled by a flowmeter, which can be adjusted or selected, and this controls the flow in sizes such as liters per minute (lpm). The typical flowmeter range for medical oxygen is between 0 and 15 lpm with some units able to obtain up to 25 liters per minute. Many wall flowmeters using Thorpe tube designs can be called for "flush" which is useful in emergency situations.
Low dose oxygen
Many people just need a little increase in oxygen in the air they breathe, rather than pure or almost pure oxygen. These can be delivered via a number of devices depending on the situation, the required flow and in some instances of patient preference.
A nasal cannula (NC) is a thin tube with two small nozzles protruding into the patient's nostrils. It can only comfortably provide oxygen at a low flow rate of 2-6 liters per minute (LPM), giving a concentration of 24-40%.
There are also a number of facial mask options, such as simple face masks, often used between 5 and 8 LPM, with an oxygen concentration to patients between 28% and 50%. This is closely related to a more controllable air-controlled mask, also known as the Venturi mask, which can accurately assign a predetermined oxygen concentration to the trachea by up to 40%.
In some cases, partial rebreathing masks may be used, based on a simple mask, but display a reservoir bag, which increases the oxygen concentration provided to 40-70% oxygen at 5-15 LPM.
The non-rebreather mask draws oxygen from the inherent reservoir pouch, with a one-way valve that blows air out of the mask immediately. When installed properly and used at 8-10 LPM flow rates or higher, they deliver nearly 100% oxygen. This type of mask is indicated for acute medical emergencies.
The demand for oxygen delivery system (DODS) or oxygen resuscitation only provides oxygen when a person inhales, or, in the case of a person who is not breathing, the caregiver presses a button on the mask. This system greatly saves oxygen compared to a steady-flow mask, which is useful in emergency situations when limited oxygen supply is available and there is a delay in transporting patients to higher treatments. They are very useful in performing CPR, because caregivers can provide a rescue breath composed of 100% oxygen at the push of a button. Care should be taken not to over-expand the patient's lungs, and some systems use safety valves to help prevent this. This system may not be appropriate for the unconscious patient or those who have respiratory problems, because of the effort required to breathe from them.
High flow oxygen delivery
In cases where patients require high concentrations of up to 100% oxygen, a number of devices are available, with the most common non-rebreather masks (or reservoir masks), which are similar to partial rebreathing masks except for a series of one-way valves that prevent exhaled air in order do not go back to the bag. There should be a minimum flow of 10 L/min. The oxygen inhalation fraction of the system is 60-80%, depending on the oxygen flow and the respiratory pattern. Another type of tool is a moist high nasal nasal cannula that allows flow beyond the inspiratory flow of inspiratory inspiration to be sent through the nasal cannula, thus providing F < to 100% because there is no room air entrainment, even with open mouth. It also allows the patient to continue talking, eating and drinking while still receiving therapy. This type of shipping method is associated with greater overall comfort, and increased oxygenation and respiratory rates compared to oxygen facial masks.
In specialist applications such as aviation, a tight fitting mask can be used, and it also has applications in anesthesia, carbon monoxide poisoning treatments and hyperbaric oxygen therapy
Positive pressure delivery
Patients who can not breathe on their own will require positive pressure to transfer oxygen to their lungs for gas exchange to occur. The system for delivering this varies in complexity (and cost), starting with an additional base mask that can be used by the first aider trained to manually provide artificial respiration with additional oxygen sent through ports in the mask.
Many emergency medical services and first aid personnel, as well as hospitals, will use bag-valve-mask (BVM), which is a soft pouch attached to a facial mask (or invasive airway such as endotracheal tubes or laryngeal mask breathing channels), usually with an installed reservoir bag, which is manually manipulated by a health care professional to push oxygen (or air) into the lungs. This is the only procedure allowed for the initial treatment of cyanide poisoning in the British workplace.
The automated version of the BVM system, known as resuscitator or pneupac can also provide a measurable and timed dose of oxygen directly to the patient through a facial or airway enclosure. This system is associated with an anesthetic machine used in operations under general anesthesia which allows a number of oxygen variables to be delivered, along with other gases including air, nitrous oxide and inhalation anesthetics.
As a drug delivery route
Oxygen and other compressed gases are used in conjunction with the nebulizer to enable delivery of the drug to the upper and/or lower airways. Nebulizers use compressed gas to drive liquid medicine into the aerosol, with special droplets of therapeutic size, for deposition on appropriate and desirable airway portions. The typical compressed gas flow rate of 8-10 L/min is used for drug, salt, sterile, or mixed nebulosity of the drug, which has previously become therapeutic aerosol for inhalation. In the air the airborne clinical setting (ambient mixture of some gases), molecular oxygen, and Heliox are the most common gases used for bolus nebulation or the continuous volume of therapeutic aerosols.
Exhalation filter for oxygen mask
The filtered oxygen mask has the ability to prevent transmitted, potentially infectious particles released into the surrounding environment. Mask-mask is usually a closed design so that leakage is minimized and air respiration is controlled through a series of one-way valves. The exhaled breathing is done either by placing a filter on the respiratory port, or through an integral filter that is part of the mask itself. The mask was first popular in the Toronto (Canada) health care community during the 2003 SARS Crisis. SARS was identified as breathing based on and determined that conventional oxygen therapy devices were not designed for containment of exhaled particles. The common practices of patients suspected of wearing a surgical mask are confused by the use of standard oxygen therapy equipment. In 2003, the oxygen mask HiOx 80 was released for sale. HiOx mask 80 is a closed design mask that allows filters to be placed on the respiratory port. Several new designs have emerged in the global health community for containment and screening of potentially infectious particles. Other designs include ISO- O 2 oxygen mask, Flo 2 Max oxygen mask, and O-Mask. The use of an oxygen mask capable of gradually filtering out particles into a recommended practice for the preparation of a pandemic in many jurisdictions.
The typical oxygen mask allows the patient to breathe in the air of the room apart from their therapeutic oxygen, but because the filtered oxygen mask uses a sealed design that minimizes or eliminates the patient's contact with and the ability to breathe room air, giving the oxygen concentration to the patient has been found to be higher, 99% use sufficient oxygen flow. As all the exhaled particles are in the mask, the nepulised drugs are also prevented from releasing into the surrounding atmosphere, thereby reducing occupational exposure to health care staff and other patients.
Planes
In the United States, most airlines limit the permitted devices on airplanes. As a result, passengers are limited on what devices they can use. Some airlines will provide cylinders for passengers with related costs. Other airlines allow passengers to carry approved portable concentrators. But the list of approved devices varies by airline so passengers need to check with any airline they plan to fly. Passengers are generally not allowed to carry their own cylinders. In all cases, passengers need to notify airlines in advance about their equipment.
Effective May 13, 2009, the Department of Transportation and FAA decided that a certain number of portable oxygen concentrators were approved for use on all commercial flights. FAA regulations require larger aircraft to carry D-cylinders of oxygen for use in emergencies.
See also
- Respiratory Gas
- Nebulizer
- Mechanical Ventilation
- Hyperbaric oxygen therapy
- Oxygen bar
- Emergency Medical Services
- Respiratory Therapist
- Oxygen tents
- Oxygen combustion torch
References
Further reading
- Kallstrom, TJ (June 2002). "American Association for Respiratory Care Clinical Practice Guideline: Oxygen therapy for adults at acute care facility - 2002 Revised & Update". Respir Treatment . 47 (6): 717-20. PMID 12078655.
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Cahill Lambert AE (November 2005). "Adult domiciliary oxygen therapy: patient perspective". The Medical Journal of Australia . 183 (9): 472-3. PMID 27 16274348.
Source of the article : Wikipedia
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