Oxygen Therapy in pediatric patients 2022.pptx

Oxygen therapy in pediatrics is hot topic and essential in health care of pediatrics

1. Oxygen Therapy P r e pared by A b dulghani Jaafar

2. Oxygen Oxygen is essential for aerobic metabolism and survival. Any decrease in oxygen delivery can cause end-organ damage and death. Rapid and effective oxygen delivery is an essential component of the care of critically ill patients.

3. Definitions Hypoxemia – a decrease in PO2 in arterial blood Hypoxia – a decrease in PO2 in the peripheral tissues

4. Arterial Blood Gas An arterial blood gas (ABG) accurately assesses the presence of hypoxemia (SaO2 < 90%) ABG’s require an arterial puncture for collection and specialized laboratory machinery for analysis

5. Pulse Oximetry Transcutaneous pulse oximetry estimates O2 saturation (SpO2) of capillary blood based on the absorption of light from light-emitting diodes positioned in a finger clip or adhesive strip probe. The estimates are generally very accurate and correlate to within 5% of measured O2 saturation (SaO2)

6. Pulse Oximetry Results may be less accurate in patients wearing nail polish, and those with arrhythmias, shock or hypotension Pulse oximetry is only able to detect oxyhemoglobin. Nevertheless, other types of Hb (carboxyhemoglobin, methemoglobin) may falsely elevate the SpO2 measurement.

7. Oxygen Delivery Systems Nasal cannulas (nasal prongs) Oxygen mask Ambu bag (Anesthesia Bag)

8. Nasal Cannulas Nasal cannulas have 2 hollow plastic prongs attached to a longer flexible plastic tube. Oxygen is delivered to the nostrils through the tubing. Oxygen is run through a bubbled humidifier (if needed) at a flow rate of 0.5 to 4 L/min. The oxygen concentration delivered is between 25%-40%.

9. Nasal Cannulas Most pediatric patients require approximately ½ to 2 L/min O2. Flow rates greater than 2 L/min are not recommended before the age of 2 years. Older children might require up to 4 L/min O2

10. Nasal Cannulas (prongs)

11. Oxygen Masks Simple masks fit loosely over the nose and mouth. They can provide oxygen concentrations between 35%-50% but require oxygen flow rates of 6-10 L/min. Using oxygen flow rates of < 5 L/min can lead to carbon dioxide (CO2) rebreathing. There is a higher risk of aspiration after vomiting due vomitus collecting in the mask.

12. Oxygen Masks

13. Anesthesia Bag Anesthesia bags (Ambu-bag) are used to mechanically ventilate a patient who cannot oxygenate and ventilate independently. Oxygen should always be administered via the anesthesia bag when a patient is being mechanically ventilated. The oxygen flow rate should be set to maximum and the oxygen source should not be shared.

14. Anesthesia Bag Self-inflating anesthesia bags should never be used to give blow by oxygen to a child because they contain one-way valves which restrict the flow of oxygen. The one-way valve also poses a risk of suffocation if the mask is sealed against the child’s face.

15. Humidification Is it really needed??

16. Humidification Not very often. It is needed only if we give more than 2L/min to a child under 2 years for more than 2 hours, OR if we give more than 4L/min to a child above 2 years for more than 2 hours.

17. Humidification And:

18. Oxygen Therapy Oxygen therapy should be guided by pulse oximetry. Oxygen therapy should be given to children with SpO2 < 93%. In neonates , oxygen therapy is only needed if the SpO2 goes below 90%.

19. Oxygen Therapy If pulse oximetry is not available, the need for oxygen therapy needs to be guided by clinical signs which are less reliable. If the SpO2 is not able to be obtained or is unavailable, symptomatic patients should be placed on oxygen therapy (cyanosis, chest indrawing, respiratory rate ≥ 70), grunting, head nodding).

20. Oxygen Therapy The patient should be connected to the oxygen source with the shortest length oxygen tubing possible. You may need to move the patient or the oxygen concentrator. No more than 2 children should share one oxygen concentrator (Above all if we don’t have oxygen distributors) If an oxygen source is shared, the tubing going to each patient should be of equal length.

21. Oxygen Therapy Patients requiring O2 therapy should have they SpO2 checked shortly after beginning oxygen therapy and O2 flow adjusted according to pulse oximetry values. Patients requiring O2 therapy should have their SpO2 checked at least once a day to assess whether oxygen therapy is still required or if it can, at least, be reduced.

22. Oxygen Therapy The target SpO2 for children after the first month of life who are receiving oxygen should be 95 – 98% . The target SpO2 for neonates <2000gr who are receiving oxygen is 90- 95%. The target SpO2 for neonates >2000gr who are receiving oxygen is 95-98%.

23. Conclusions Oxygen is a valuable drug. In general, when pulse oximetry is available, oxygen should only be given to patients who are hypoxic. Use the shortest length oxygen tubing possible. Placing too many patients on oxygen who do not require it takes away valuable oxygen from those that actually need it.

24. Exceptions? Shock? Convulsions? Pain crisis in a sickle cell disease affected patient? Severe Anaemia? Coma?

25. T h ank you