Last updated: November 18, 2022
Summary
Oxygen 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.
Pathophysiology
To maintain a constant supply of oxygen to the cells, a variety of physiological adaptations respond to hypoxemia and hyperoxemia. [1]
General principles of oxygen delivery
Nonhumidified oxygen
Humidified oxygen
Basic oxygen delivery systems
Oxygen 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 systems
Short-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
- Oxygenated
hemoglobin (O2Hb) and
deoxygenated hemoglobin (HHb) exhibit different properties of light absorption
- 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 therapy
Description
- 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]
Hyperbaric oxygen
Complications
References
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