i bc27f85be50b71b1 (242 page)

Table ill-A.!, Continued

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DevicefFio2

Description

Clinical Implications

Tracheostomy mask

Purpose: provides supplemental, humidi

• Significant mu.c:ing with RA occurs.

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or collar

fied 0) or air at a tracheostomy site.

•

Humidification is particularly important for a patient

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Fio,

1:;

� 25-70%

Consists -of: a mask placed over a stoma

with a tracheostomy, as the tracheostomy bypasses the

or tracheostomy. [r is held in place by

natural humidification system.

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an elastic strap around the patient's

• Moisture may collect in the tubing and should be

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neck. Humidified 0, is delivered by

drained before moving the patient.

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o

large bore tubing (Figure UJ-A.4).

• The mask can easily shift; re-position it over the site if

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necessary.

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• Gently pull the mask away from the patient to access

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the tracheostomy site for bronchopulmonary secretion

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clearance.

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Partial non

Purpose: provides a high Fio2 to the

• The partial non-rebreather mask is able to provide a

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rehreather mask

patienr while conserving rhe 0, supply.

similar Fio2 to the non-rebreather mask at lower flow

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Fio2 = 35-95%

Consists of: a closed face mask co'Vering

rares.

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the nose and mouth with ventilation

•

The closed face mask may imerfere with talking, eating,

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holes on either side, held in place with

and drinking.

an elastic scrap around the patient's

•

High 0, concentration may be drying and uncomforhead. A reservoir bag is attached at the

table; however, humidification is not used with this

base of the mask. The flow of 0, is

method, because it interferes with 01 delivery.

regulated to permit [he initial one-third

of the expired tidal volume (02-rich

anatomic dead space) to distend the

reservoir maximally, therefore allowing

some rebrearhing of air. The balance of

expired air docs not enter the reservoir

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Non-rebreather face

Purpose: provides the patient with the

• See Parrial non-rebreather mask, above.

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mask

highest concentration of supplemental

• Physical therapy intervenrion is usually deferred if a

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Fio2 "'" 80-95%

0") available via a face mask in a

patient requires this rype of device to maintain

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va-

oxygenation. However, bronchopulmonary hygiene

riable performance system.

Consists of: a closed face mask covering

may still be indicated.

the nose and mouth. It is attached to a

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reservoir bag, which collects 100%

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OJ' A one-way valve berween the

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mask and bag allows 02 to be

inspired from the bag through the

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"

mask. Additional one-way valves on

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the side of the mask allow expired

gases to exit [he mask, thus prevent

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co

ing re-breathing of expired air (Figure

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III-A.5).

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Fio2 = fmcrion of inspired oxygen; Ipm = liters per minure; O2 = oxygenj RA = room air.

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·Lisred from leasr to most oxygen support.

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Sources: Data from RR Kirby, RW Taylor, JM Civerra (eds). Handbook of Critical Care (2nd ed). Philadelphia: Lippincon-Raven, 1 997; JM

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Rothsrein (ed). The Rehabilitation Specialisr's Handbook (2nd cd). Philadelphia: FA Davis, 1 998; MR Kinney, S8 Dunbar, JM Virello-Cicciu, er

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a1. (cds). AACN's Clinical Reference for Critic::d Care Nursing (4rh cd). St. Louis: Mosby, 1998j JG Weg. Long-term oxygen therapy for CO PD.

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Postgrad Mcd t 998;1 03: t 43-158; D Frownfelter, E Dean (eds). Principles and Practice of Cardiopulmonary Physical Therapy (3rd cd). St.

9

Louis: Mosby, 1 997; and EF Ryerson, AJ Block. Oxygen as a Drug: Clinical Properties, Benefits, Modes and Hazards of Adminisrration. In GG

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Burton, JE Hodgkin (cds), Respiratory Care: A Guide to Clinical Practice (3rd cd). Philadelphia: lippincon, 1991.

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Table lli-A.2. Fixed Performance Oxygen Delivery

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DevicefFio2

Descri ption

Clinical lmplic3tions

Air entrainment mask

Purpose: provides a specific concen

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•

The closed face mask incerferes with coughing,

(Venci mask, Venturi

tration of supplemental 02'

talking, eating, and drinking and may be very drying

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"

mask)

Consists of: 3 high-flow system with a

and uncomfortable. Patients often remove the mask

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Fio2 ... 24-50%

closed face mask over the nose and

for these reasons.

;:

mouth and a jet mixing device

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•

Educate the patient on the importance of keeping the

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located at the base of the mask,

mask in place.

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o

which forces 1 00% 02 past an

• Humidification is not used with this method, because

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encrainmenc valve. The valve can be

humidification will interfere with 02 delivery.

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adjusted to entrain a specific per

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cencage of RA to mix with the °2)

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allowing precise control of Fi02

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(Figure III-A.6).

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BiPAP

Purpose: provides positive inspiratory

• BiPAP may deliver supplemental 02 at a specific

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Fio, = 21-100%

and positive end expiratory presconcentration, or it may deliver RA.

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sure without intubation to decrease

•

Patiems may feel claustrophobic owing to [he tighr

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the work of breathing by reducing

fit of the mask.

the airway pressure necessary to

•

The equipment may be noisy; rhus, [he therapist may

generate inspiration throughout the

need [Q speak loudly to communicate with [he

respiratory cycle. May be used to

patient.

avoid intubation and mechanical

• Abrasions on the bridge of the nose can occur and

vencilation in cases of acute

may be prevented with a dressing that provides

respiratory failure. Often used in

padding to the area without interfering with the tight

the hospital or home setting for the

fit of the mask.

management of obstructive sleep

•

Depending on the patienr's oxygen requirements,

apnea.

BiPAP may be turned off, and alternate methods of

0] delivery may be used ro allow the patient