Last updated: November 18, 2022 SummaryOxygen therapy is commonly used in hospital settings for the management of acute and chronic respiratory conditions, and increasingly in the community for patients with chronic conditions requiring home oxygen therapy. As with all
treatments, oxygen therapy has side effects, and inappropriate use with inadequate monitoring can be fatal. The method of oxygen delivery, monitoring,
target oxygen saturation, and indications for weaning should all be tailored to the individual patient. For discharged patients who require
long-term oxygen therapy, risks should be discussed with patients and adequate monitoring should be established. PathophysiologyTo maintain a constant supply of oxygen to the cells, a variety of physiological adaptations respond to hypoxemia and
hyperoxemia. [1] General principles of oxygen deliveryNonhumidified oxygenHumidified oxygenBasic oxygen delivery systemsOxygen delivery devices and flow rates should always be matched to patients' individual oxygen requirements, which can be varied and dynamic. Simple oxygen face mask
[5]Venturi mask Nonrebreather mask (NRB)
[5]Advanced oxygen delivery systemsShort-term oxygen therapy Pulse oximetry [28][29]- Technical background
- Oxygenated
hemoglobin (O2Hb) and
deoxygenated hemoglobin (HHb) exhibit different properties of light absorption
- O2Hb: ↑ infrared light absorption, allows ↑ red light pass through the measurement site (e.g., fingertip)
- HHb: ↑
red light absorption, allows ↑ infrared light pass through the measurement site
- An oximeter uses LEDs (light-emitting diodes) emitting both red and infrared light → a photodetector is positioned on the other side of the finger, opposite the LEDs, and detects the amount of light (and whether it is red or infrared light) passing through the measurement site → a processing unit calculates the amount of O2Hb → oximeter displays
SpO2
- Reference range:
Resting oxygen saturation > 95% is generally considered normal.
- A PaO2 of 100 mm Hg is necessary to reach a
SpO2 level of ∼ 98%.
- Measurement can be inaccurate in patients with: [1]
-
Nail polish
- Poor
perfusion, e.g., severe hypotension
- Darker
skin pigmentation and saturations of < 85%
-
Carbon monoxide exposure, including chronic low-level exposure in smokers
- Methemoglobinemia
[30]
- Monitoring
- Should be performed for the majority of patients receiving oxygen therapy
- Generally accurate to within 1–2 % of true
SaO2 until saturations drop to < 80%
[1]
- Patients in whom pulse oximetry is inaccurate and patients at risk of
hypercapnic respiratory failure should undergo regular
ABGs. [1]
Pulse oximetry provides falsely high values in cases of
carbon monoxide poisoning, as complexes of
hemoglobin and
carbon monoxide are indistinguishable from oxygen-hemoglobin complexes! Home oxygen therapyDescription- Oxygen therapy may be provided on a long-term basis outside of a hospital for patients with chronic conditions.
-
Nasal cannula is the most common method of delivery but alternatives may be used depending on the underlying condition.
- Home oxygen may be provided via an oxygen concentrator, compressed oxygen cylinders, or liquid oxygen, depending on patient needs and preference.
Indications Long-term oxygen therapy
[3]- Description
- The most common form of home oxygen delivery
- Treatment is typically low flow (1–2 L/minute) oxygen via
nasal cannula or TTOT.
- Typically used in
advanced lung disease if patients remain chronically
hypoxic despite maximal medical therapy
- Patients prescribed LTOT should use it for a minimum of 15 hours a day. [33]
- Monitoring
- Start at a rate of 1 L/minute; titrate to
SpO2> 90% (an ABG should be performed to confirm PaO2 is > 60 mm Hg) [31]
- If there are signs of worsening
hypercapnia, the patient should be assessed for noninvasive home ventilation. [31]
- Patients prescribed
LTOT, nocturnal, or ambulatory oxygen therapy should receive follow-up and monitoring at home after 4 weeks and after 3 months. [31]
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At what percent does oxygen intervention become necessary?
Oxygen treatment is usually not necessary unless the SpO2 is less than 92%. That is, do not give oxygen if the SpO2 is ≥ 92%. Oxygen therapy (concentration and flow) may be varied in most circumstances without specific medical orders, but medical orders override these standing orders.
What are the levels of oxygen therapy?
The amount of oxygen is different for each person and is based on how well your lungs are working. The best target for most adults is 92 to 96% SpO2. The best target for most children is 90 to 95% SpO2. Your best target range may differ if you have certain types of lung disease.
What are the 4 indications of oxygen therapy?
Indications. Chronic obstructive pulmonary disease (COPD). Cystic fibrosis.. Pulmonary fibrosis.. Sarcoidosis..
What are the three main complications of o2 therapy?
Fluid buildup or bursting (rupture) of the middle ear. Sinus damage. Changes in vision, causing nearsightedness, or myopia. Oxygen poisoning, which can cause lung failure, fluid in the lungs, or seizures.
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