Administration of Supplemental Oxygen
Supplemental oxygen is commonly used in modern medicine and is fundamental to the treatment of hypoxemia. This print supplement and the related video focus on the administration of supplemental oxygen in adult patients in an acute care setting
DID YOU KNOW:
- Hospital Oxygen is NOT FREE
- Pulse oximeters are key to oxygen therapy. They consist of two light-emitting diodes, one in the red range and one in the infrared range, and a detector. Oxygenated and deoxygenated haemoglobin absorb light at different wavelengths differently. Deoxygenated or ‘‘blue’’ blood absorbs light maximally in the red band, whereas Oxygenated or ‘‘red’’ blood absorbs light maximally in the infrared band. The ratio of absorption of the two wavelengths of light are then compared with an algorithm in the microprocessor generated by empirically measuring the absorption in healthy volunteers at varying degrees of directly measured arterial oxygen saturation. The displayed value is usually an average based on the previous 3 to 6 seconds of recording.
- At an SPO2 of 94%, additional oxygen is of NO BENEFIT. At this level, the standard dissociation curve is relatively flat, which means that the oxygen content of the blood does not change significantly even with large increases in oxygen.
- Oxygen DOES NOT CURE DIFFICULTY IN BREATHING (DYSPNOEA), just HYPOXIA.
- Oxygen should be delivered to achieve a target saturation of 94–98% for most acutely ill patients or 88–92% for those at risk of hypercapnic respiratory failure e.g. COPD
- Humidification of supplemental oxygen commonly delivered by bubbling oxygen through either cold or warm sterile water before it reaches the patient should NOT be used because there is NO EVIDENCE of a clinically significant benefit but there is a risk of infection.
- Nasal prongs delivers 4% additional oxygen per 1 litre of flow i.e. at 1L/min it delivers 24% (20% is already in the air), at 2L per min it delivers 28%, 3L/min 32%…and so on so at 6L/min it delivers 44%
- A simple face mask should be used at a minimum of 6L/min (normal minute ventilation) to prevent the patient from breathing back their own CO2.
- Application of a self inflating Bag-Valve-Mask on a patient’s face without compressing the bag is called suffocation. Due to the valves system, oxygen is only delivered ON COMPRESSING THE BAG
- Specific targets for oxygen therapy;
- Most patients – 94-98%
- COPD patients – 88-92%
- Heart Attack (ACS) patients – 90%
- Stroke patients – 90%
- Cardiac arrest patients post ROSC – 92-98%
- Nonhypoxic heart attack victims treated with oxygen endure a 25 to 30% more heart damage than patients not given oxygen
- Oxygen supplementation to nonhypoxic patients with mild or moderate strokes may increase mortality.
- High-dose oxygen therapy to produce hyperoxaemia (above normal oxygen saturation) can cause absorption atelectasis
- Oxygen is liberally administered to many critically ill patients, thereby exposing them to supranormal arterial oxygen levels.
- Hyperoxia also results in the formation of reactive oxygen species, which adversely affect the pulmonary, vascular, cnetral nervous, and immune systems.
- Though the optimal PaO2 remains unknown, recent evidence indicates that hyperoxia is associated with increased mortality in post-cardiac arrest, CVA, acute coronary syndrome, and traumatic brain injury patients.
- Take Home Point: Carefully titrate oxygen to the lowest tolerable level to meet the patient’s needs.
Need to calculate your oxygen requirements? Use the calculator below to estimate how long different oxygen sources/cylinders will last or how much/many you will need while using various O2 delivery devices and flow rates.
Giving Oxygen to Emergency Patients in Kenya
Giving Oxygen to
Emergency Patients in Kenya
The ability to deliver oxygen therapy is the cornerstone of the overall approach to managing patients during an emergency, and it has implications for the functioning of the entire system. According to the WHO, oxygen therapy is recommended for all severe and critically ill patients. For these reasons, emergency care centres should be equipped with functioning oxygen systems, including single‐use oxygen delivery interfaces and pulse oximeters.
In a recent survey of emergency care centres across Kenya, over 30% of the facilities did not have a regular supply of oxygen. Close to 90% of those with oxygen did not have piped oxygen in the emergency department and delivered oxygen directly from the tanks to the patient.
Pipeline intra‐hospital oxygen distribution networks are helpful to supply oxygen at high pressure to equipment such as anaesthetic machines and ventilators or directly connected to patients with a flow-meter and tubing. A key advantage of pipeline systems is that they allow the distribution of oxygen to multiple patients simultaneously and obviate the need for handling and transporting heavy cylinders between hospital wards.
Installation Of Oxygen Gas Manifolds In Emergency Care Centres
“We now have piped oxygen for more patients in the emergency department and don’t have to keep rationing the oxygen for patients who need it” Emergency Nurse, Machakos Level 5 Hospital
Our oxygen gas manifolds are designed to boost capacity of emergency departments to supply the correct pressure and volume of oxygen from gas cylinders located outside the building through a pipeline system to the emergency department. The typical medical oxygen manifold commonly consists of four (4) sources and a manual changeover from empty source to full source and five (5) oxygen terminal outlets (sockets) installed in the emergency department. This boosts the capacity to deliver oxygen therapy from 1 oxygen tank per patient to 1 oxygen tank for up to 10 patients simultaneously.
The oxygen manifolds are specifically designed for optimal functionality and reliability, and offer users several very tangible advantages:
- Closed metal box, anti‐interference.
- The pressure of oxygen resource is stable and adjustable
- Pressure gauge displays make it easy to plan for refiling of the oxygen cylinders
- Continuous oxygen supply
- Multiple patients can receive oxygen simultaneously from one source
Help us do more
Everyday, more and more patients are presenting to emergency care centres across Kenya requiring oxygen. We have already installed Oxygen Gas Manifolds in the emergency departments at the following facilities;
- Machakos Level 5 Hospital
- Thika Level 5 Hospital
- Kajiado County Referral Hospital
- Turkana County Referral Hospital
- Alupe Sub-County Hospital (Busia County)
- Makindu Level 4 Hospital (Makueni County)
- Mbagathi Level 5 Hospital (Nairobi County)
- Iten County Referral Hospital (Elgeyo Marakwet County)
- JM Kariuki Memorial County Referral Hospital (Nyandarua County)
These were the priority areas due to the large patient volumes the see in the emergency department but we continue to seek additional support to install the manifolds in many more emergency departments that are in need.
Each Oxygen Gas Manifold costs approximately $ 6,000 and can be installed in 5 days. Your support will go a long way in ensuring emergency care centres across Kenya can handle emergency cases requiring oxygen simultaneously and help save more lives.
For more details on this and how you can be part of our efforts to strengthen emergency care in Kenya, click the button below or send us an email at firstname.lastname@example.org or call us on 020 2100054 or 0710 633 855
Oxygen therapy for acutely ill medical patients: a clinical practice guideline
What you need to know
- It is a longstanding cultural norm to provide supplemental oxygen to sick patients regardless of their blood oxygen saturation
- A recent systematic review and meta-analysis has shown that too much supplemental oxygen increases mortality for medical patients in the hospital
- For patients receiving oxygen therapy, aim for peripheral capillary oxygen saturation (SpO2) of ≤ 96% (strong recommendation)
- For patients with acute myocardial infarction or stroke, do not initiate oxygen therapy in patients with SpO2 ≥ 90% (for ≥ 93% strong recommendation, for 90-92% weak recommendation)
- A target SpO2 range of 90-94% seems reasonable for most patients and 88-92% for patients at risk of hypercapnic respiratory failure; use the minimum amount of oxygen necessary
Top 10 Posts of 2017
Mistakes that Kill during Cardiopulmonary Resuscitation
- Too Slow or Too Fast Chest Compressions
- Too Shallow or Too Deep Chest Compressions
- Too Many or Too Slow Breaths
- Leaning on the Chest
- Too Many Interruptions
- Giving Up Too Soon
- Too Slow Adaptation
Oxygen Bubble Bottles or Bacteria Swimming Pools?
Humidified oxygen is widely administered in hospitals and EMS vehicles and this is presumed to alleviate nasal and oral discomfort in the non-intubated patient. Humidification of supplemental oxygen is commonly delivered by bubbling oxygen through either cold or warm sterile water before it reaches the patient. However, the effect on patient comfort is negligible. Bubble humidifiers may, however, represent an infection hazard and should not be used.
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The Health Act 2017 – Emergency Care
Thank you for all the support in 2017. We look forward to providing you with even greater emergency care content in 2018. From all of us at the Emergency Medicine Kenya Foundation, HAPPY NEW YEAR!
And don’t’ forget…
The Health Act 2017 – Emergency Care