OXYGEN THERAPY
PROFESSOR CONOR BURKE
MD, FRCP(i), FRCP (LOND), FCCP, FFSEM
CONSULTANT RESPIRATORY PHYSICIAN
CONNOLLY HOSPITAL
MATER UNIVERSITY HOSPITAL
BONS SECOURS HOSPITAL
UNIVERSITY COLLEGE DUBLIN
LIFE
• TISSUE OXYGEN DELIVERY
• TOD = CaO2 x CO
BLOOD OXYGEN CONTENT
• DISSOLVED O2 (<1%)
+
• HAEMOGLOBIN BOUND O2 (>99%)
EVOLUTION
• BODY “DEFENDS” PaO2 OF 8.0 kPA
1. INCREASED VENTILATION
2. HYPOPXIC PULMONARY
VASOCONSTRUCTION
3. POLYCYTHAEMIA
DOMICILIARY OXYGEN
• THERAPEUTIC (COPD)
• PALLIATIVE
DOMICILIARY OXYGEN ASSESSMENT
(COPD)
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ABG (NOT SAT)
30 MINUTES ON ROOM AIR
8 WEEKS POST EXACERBATON
ABG TWICE 3 WEEKS APART
THERAPEUTIC DOMICILIARY OXYGEN
• COPD ONLY
• PaO2 < 7.3 kPa
• PaO2 < 8 kPa +
PULMONARY HYPERTENSION
ODEMA
POLYCYTHAEMIA (Ht > 55%)
TITRATION
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START AT 1L/M
AIM FOR PaO2 > 8.0 kPa
If PaCO2 INCREASES ? BIPAP
NOCTURNAL HYPOXIA
EXERCISE HYPOXIA
DURATION (THERAPEUTIC)
• MRC TRIAL
• NOT TRIAL
• AT LEAST 15 HOURS DAILY
AMBULATORY O2
• SAO2 < 90% ON 6 MWT
• CLINICAL IMPROVEMENT
OXYGEN CONCENTRATORS
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DELIVER UP TO 5 (9) L/M
NASAL PRONGS (CONSERVERS)
VENTURI MASK
TRANSPORTABLE
CYLINDERS
• BACK-UP
• AMBULATORY
SHORT BURST O2
• CLUSTER HEADACHE
• 15 L/M (CYLINDER) FOR 30 MINUTES
AIR TRAVEL
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PaA2 > 9.3 kPa SAFE
HYPOXIC CHALLENGE
FEV1 < 30%
BULLOUS DISEASE
RECENT EXACERBATION (6 WEEKS)
RECENT PNEUMNOTHORAX
SAFETY
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CIGARETTES
VAPING
CHARGING
UNDER MATERIAL
VASELINE