Oxygen therapy in pediatrics

Medicine
Pediatrics
pediatric
Oxygen
therapy
In
children

1. Oxygen Therapy in Pediatrics Prepared By : MS.Sabah Salim Under Supervision Of : Dr.Khalaf Hussein

2. Introduction on O2 Indications Detection Treatment & Methods

3. I ntroduction *Colorless, odorless, tasteless gas,Makes up 21% of room air ,It’s NOT flammable but does support combustion. *It’s Considered as a medical gas. *Stored in bottles in liquified Form *1L of liquified form = 860 L of Gaseous O2

4. For Mammalian to maintain their live ,depend on a continuous supply of O2 to sustain aerobic metabolism. The main purpose from O2 is ENERGY

5. ENERGY is provided by a series of biochemical oxidation/reduction reactions . energy is captured by certain molecules, such as (ATP), that then become reservoirs of ENERGY .

6. Tissues have no storage system for O2 . They rely on a continuous supply at a rate that precisely matches changing metabolic requirements. If supply fails, tissue hypoxaemia may develop resulting in anaerobic metabolism and production of lactate.

7. Hypoxemia decrease in the arterial O2 content in the blood   Hypoxia decreased O2 supply to the tissues. Hypoxemia (low oxygen in your blood ) can cause hypoxia (low oxygen in your tissues) when your blood doesn't carry enough oxygen to your tissues to meet your body's needs. The word hypoxia is sometimes used to describe both problems.

8. So….............Oxygen Therapy Refers to supplemental oxygen given to people who, aren’t able to get enough naturally largely due to breathing disorders.

9. I ndications: Pneumonia Asthma BPD underdeveloped lungs in newborns Heart Failure CF SA Trauma to the respiratory system

10. D etection C linical ev aluation P ulse oximetry A BG

11. C linical Evaluation

12. P ulse Oximetry Based on the R ed and I nfrared light absorption O xygenated hemoglobin absorbs more I nfrared light and allows more R ed light to pass through D eoxygenated (or reduced) hemoglobin absorbs more R ed light and allows more I nfrared light to pass through. Normal SpO2 values vary between 95 and 100%

13. A BG Blood gases are a measurement of how much O2 and CO2 are in your blood + pH Normal Values -PaO2 : 75 to 100 mm Hg (10.5 to 13.5 kPa) -PaCO2 : 38 to 42 mm Hg (5.1 to 5.6 kPa) -PH : 7.38 to 7.42 -SaO2 : 94% to 100% -HCO3 : 22 to 28 mEq/L

14. T reatment & M ethods Depends on: age of the patient oxygen requirements/therapeutic goals patient tolerance to selected interface humidification needs

15. Classification 1-Low-flow devices: Provide oxygen at flow rates that are lower than patients’ inspiratory demands When the total ventilation exceeds the capacity of the oxygen reservoir, room air is entrained 2-High-flow devices: Provide a constant FiO 2  by delivering the gas at flow rates that exceed the patient’s peak inspiratory flow rate and by using devices that entrain a fixed proportion of room air

16. 1-Low flow delivery M ethod *Simple face mask (without air entrainment device) *Non re-breather face mask (mask with oxygen reservoir bag and one-way valves which aims to prevent/reduce room air entrainment) *Nasal prongs (low flow) *Tracheostomy mask (without air entrainment device) *Face tent

17. Simple Oxygen Face Mask: A plastic oxygen mask that covers the nose and mouth and is utilized when delivering oxygen concentrations ranging from 30% - 60%. *Naturally occurring room air is 21% and a higher percentage is often essential for medical treatments. *Depending on the mask size, it offers a self-contained reservoir of 100 to 200 ml of additional gas and requires a flow of oxygen of 5 - 6L/min to avoid CO2 accumulation within the face mask. *The mask has exhalation ports to allow carbon dioxide to escape as well as mixing delivered oxygen with room air.

18. Indications: Medium flow oxygen desired, mild to moderate respiratory distress When increased oxygen delivery for short period (<12 hrs) Advantage: Less expensive (Rs 80/-) Can be used in mouth breathers Contraindications: Poor respiratory efforts, apnea , severe hypoxia Disadvantage Uncomfortable Require tight seal Donot deliver high FiO2 FiO2 varies with breathing efforts Interfere with eating, drinking, communication Difficult to keep in position for long Skin breakdown

19. Non rebreather mask Has one way valve Can deliver 100% Fio2

20. Contraindications: Poor respiratory efforts, apnea, severe hypoxia Disadvantage Expensive (Rs 250/-) Require tight seal, Uncomfortable Interfere with eating and drinking Not suitable for long term use Malfunction can cause CO2 buildup, suffocation Disadvantage Expensive (Rs 250/-) Require tight seal, Uncomfortable Interfere with eating and drinking Not suitable for long term use Malfunction can cause CO2 buildup, suffocation Indications: High FiO2 requirement >40% Advantage: Highest possible FiO2 without intubation Suitable for spontaneously breathing patients with severe hypoxia

21. Nasal Cannula two-pronged tube device that delivers a low flow rate of oxygen that distributes oxygen concentrations of 24% to 44%, *appropriate for individuals requiring long-term oxygen use, or for those with minimal respiratory distress. *The two prongs sit at the entrance of the nostrils with the long, thin oxygen delivering tube anchoring over the ears to help hold the nasal cannula in place. ***better for feeding

22. Indications Low to moderate oxygen requirement No or mild respiratory distress Long term oxygen therapy Advantages Less expensive (Rs 70/-) Comfortable, well tolerated Able to talk and eat Contraindications Poor efforts, apnea, severe hypoxia Mouth breathing Disadvantages Doesnot deliver high FiO2 Irritation and nasal obstruction Less FiO2 in nasal obstruction FiO2 varies with breathing efforts

23. Tracheostomy Mask A tracheostomy mask, sometimes referred to as a tracheostomy collar, is a small mask that fits over the patient’s tracheostomy site. An adjustable elastic strap that fits around the patient’s neck holds it in place. The mask has an exhalation port that remains patent at all times and a port that connects to the oxygen source with large-bore tubing. The flow rate is usually set at 10 L/min, with a nebulizer set at the appropriate oxygen concentration.

24. Oxygen tent Clear plastic sheet that cover child’s upper body FiO2 50% Not reliable Limit access to patient Not useful in emergency situations

25. Face tent/face shield High flow soft plastic bucket Well tolerated by children than face mask 10-15 L/min, 40% FiO2 Access for suctioning without need for interrupting oxygen

26. 2-High flow delivery M ethod *CPAP/BiPaP drivers *Face mask or tracheostomy mask used in conjunction with an entrainment device *High flow nasal prongs (HFNP)

27. CPAP and BiPAp Noninvasive ventilation, an alternative to mechanical ventilation, is used to maintain positive airway pressure and to improve alveolar ventilation without the need for an artificial airway. It is commonly used for patients who have congestive heart failure, sleep disorders, and pulmonary diseases to improve oxygenation, reduce and reverse atelectasis, reduce pulmonary edema, and improve cardiac function. The two types of noninvasive ventilation are CPAP and BiPAP. Continuous positive pressure ventilation (CPAP) provides a set positive airway pressure throughout the patient’s breathing cycle. It is commonly used for patients who experience sleep apnea because the continuous positive pressure keeps the airway open and prevents the upper airway from collapsing. The usual CPAP pressure is between 5 and 20 cm of water. Bilevel positive airway pressure (BiPAP) provides assistance during inspiration and keeps the airway from closing during expiration. The benefits of BiPAP include an increase in the amount of air in the lungs at the end of expiration, reduced airway closure, and improved oxygenation.

28. Continuous positive airway pressure By applying underwater expiratory resistance Indicated When oxygen requirement >60% with a PaO2 of <60 mmHg CPAP reduce work of breathing, increases FRC and helps maintain it, recruit alveoli, increase static compliance, and improve ventilation perfusion ratio

29. Used in Early ARDS, acute bronchiolitis, pneumonia It should be tried in spontaneously breathing child who does not require emergency intubation prior to conventional ventilation

30. Venturi Mask: Often used when a clinician has a concern about CO2 retention,

31. Contraindications Poor respiratory efforts, apnea, severe hypoxia Disadvantage Uncomfortable Expensive (Rs 150/-) Cannot deliver high FiO2 Interfere with eating and drinking indications: Desire to deliver exact amount of FiO2 Advantage: Fine control of FiO2 at fixed flow Fixed, reliable, and precise FiO2 Doesnot dry mucus membranes High flow comes from the air, saving the oxygen cost Can be used for low FiO2 also Helps in deciding whether the oxygen requirement is increasing or decreasing

32. Bi-Flow Nasal Mask: Designed for patients who suffer from nasal sores from a normal two-pronged nasal cannula, this mask fits over the nose in a ‘cup fit’ style of mask. Bi-Flow Oxygen Mask: Designed as a more comfortable solution for patients who cannot tolerate a cannula or who have recurring necrosis, the design of the mask will provide Fi02 volume comparable to a cannula while eliminating the irritation of the cannula.

33. Humidification The humidifier should always be placed at a level below the patient's head. Why Humidification? Cold, dry air increases heat and fluid loss Medical gases including air and oxygen have a drying effect and mucous membranes become dry resulting in airway damage. Secretions can become thick & difficult to clear or cause airway obstruction In asthma, the hyperventilation of dry gases can compound bronchoconstriction . Indications: Patients with thick copious secretions Non-invasive and invasive ventilation Nasal prong flow rates of greater than 2 LPM (under 2 years of age) or 4 LPM (over 2 years of age) Facial mask flow rates of greater than 5 LPM Patients with tracheostomy

34. Potential complications CO 2 Narcosis - This occurs in patients who have chronic respiratory obstruction or respiratory insufficiency which results in them developing hypercapnea (i.e. raised PaCO 2 ). In these patients the respiratory centre relies on hypoxaemia to maintain adequate ventilation. If these patients are given oxygen this can reduce their respiratory drive, causing respiratory depression and a further rise in PaCO 2 resulting in increased CO 2 levels in the blood and CO 2 narcosis. Pulmonary Atelectasis Pulmonary oxygen toxicity - High concentrations of oxygen (>60%) may damage the alveolar membrane when inhaled for more than 48 hours resulting in pathological lung changes. Retrolental fibroplasia (also known as retinopathy of prematurity) An alteration of the normal retinal vascular development, mainly affecting premature neonates (<32 weeks gestation or 1250g birthweight), which can lead to visual impairment and blindness. Substernal pain-due: characterised by difficulty in breathing and pain within the chest, occurring when breathing elevated pressures of oxygen for extended periods .

35. Oxygen safety Oxygen is not a flammable gas but it does support combustion (rapid burning). Due to this the following rules should be followed: Do not smoke in the vicinity of oxygen equipment. Do not use aerosol sprays in the same room as the oxygen equipment. Turn off oxygen immediately when not in use. Oxygen is heavier than air and will pool in fabric making the material more flammable. Therefore, never leave the nasal prongs or mask under or on bed coverings or cushions whilst the oxygen is being supplied. Oxygen cylinders should be secured safely to avoid injury. Do not store oxygen cylinders in hot places. Keep the oxygen equipment out of reach of children. Do not use any petroleum products or petroleum byproducts e.g. petroleum jelly/Vaseline whilst using oxygen.

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