Precautions for Oxygen Inhalation Moderate Oxygen inhalation is good for health, remember not to overdo it
1How to choose an oxygen inhalation method?
1) Oxygen via nasal cannula: inserted deep, not easy to slip out, suitable for unconscious or comatose patients
2) Oxygen via trachea: For the unconscious.
3) Nasal congestion method: suitable for those who need oxygen for a long time, such as myocardial infarction, shock, etc.
3) Oxygen by mask. However, it is suitable for oxygen therapy in patients with hypoxemia caused by hyperventilation.
4) Oxygen by face account and oxygen account (applicable to children).
5) Oxygen by cricothyroid membrane puncture: It can only be used as a temporary measure to provide effective ventilation.
6) Esophageal sealing catheter: It should only be used as a temporary means for comatose patients without spontaneous breathing when endotracheal intubation is impossible.
7) Endotracheal intubation: comatose without spontaneous breathing.
8) Tracheotomy tube placement: an ideal artificial airway.
2. What problems should be paid attention to in the flow of oxygen inhalation, and which patients are suitable for high flow? Which patients are suitable for low flow?
For patients with diffuse pulmonary interstitial pneumonia, interstitial pulmonary fibrosis, pulmonary interstitial edema, alveolar cell carcinoma and cancerous lymphangitis, the main manifestations are diffuse damage, Hypoxia caused by imbalance of ventilation/blood flow, and stimulate carotid sinus and aortic body chemoreceptors to cause hyperventilation, low PaCO2, high oxygen flow concentration (35%-45%) can be given to correct hypoxia , ventilation improved. However, the effect of high-concentration oxygen inhalation in advanced patients is poor.
For patients with chronic respiratory failure such as chronic obstructive pulmonary disease and other patients with coexistence of hypoxia and carbon dioxide retention, continuous oxygen supply at low flow and low concentration is appropriate. Chronic hypoxia patients have high carbon dioxide partial pressure for a long time, and their breathing mainly relies on hypoxia to stimulate the carotid body and aortic arch chemoreceptors, which are transmitted along the nerves to the respiratory center, and reflexively cause breathing. If high flow and high concentration of oxygen is given, the effect of hypoxia reflex to stimulate breathing will disappear, resulting in respiratory depression, more serious carbon dioxide retention, carbon dioxide anesthesia, and even respiratory arrest. Therefore, it is very important to grasp the oxygen concentration.
3What should be paid attention to in terms of the duration of oxygen inhalation (with examples )?
For COPD patients with hypoxemia, in order to achieve better oxygen therapy effect, oxygen should be inhaled for at least 15 hours a day; if oxygen inhalation is 24 hours a day, Better results. Severely hypoxic patients should be given oxygen continuously for 24 hours. These patients should be monitored for oxygen therapy to avoid oxygen toxicity.
Long-term inhalation of high concentrations of oxygen can produce toxic effects of oxygen, affecting the lungs, central nervous system, erythropoiesis system, endocrine system and retina, and the most important one is the side effects of oxygen on respiratory organs. Under normal circumstances, after 6 hours of continuous pure oxygen inhalation, nausea, irritability, pale face, cough, and chest pain may occur; after 24 hours of oxygen inhalation, the vital capacity can be reduced; after 1-4 days of pure oxygen inhalation, dyspnea may occur. The degree of oxygen toxicity mainly depends on the partial pressure of oxygen in the inhaled gas and the inhalation time.
At present, it is believed that 60%-70% oxygen can be used safely for 24 hours at 101.325kPa; 40%-50% oxygen can be used for 24 hours; if the oxygen concentration is greater than 40%, 2-3 The possibility of oxygen toxicity is greatly increased after days. Therefore, patients who need oxygen therapy should be targeted, and the oxygen concentration cannot be blindly increased due to hypoxemia (if there is a right-to-left shunt in the lung, increasing the oxygen concentration is ineffective).
