Oxygen for the Critically Ill

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Oxygen for the Critically Ill
Oxygen for the Acutely unwell
Oxygen for COPD Patients
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2 Important Messages

• Oxygen is a treatment for Hypoxia not
  Breathlessness
• Oxygen saturations should be checked and recorded
  along with the concentration of inspired oxygen

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Critically Ill

• All critically ill patients receive high flow
  Oxygen
• 15L/min via reservoir mask

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Critically Ill?
Cardiac arrest or resuscitation Anaphylaxis
Shock Head Injury
Sepsis Major Pulmonary haemorrhage
Trauma Carbon Monoxide Poisoning
When stabilised manage as per Guidelines for the
acutely unwell
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Acutely Unwell?
Examples-
Acute Asthma Pulmonary Embolism
Pneumonia Pleural Effusions
Heart Failure Pneumothorax
If unsure give 15L via reservoir mask and
complete initial assessment.
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Acutely Unwell

• Need to achieve saturations 94-98
• Give whatever is needed to achieve these
  saturations
• If Sats lt85 give 15L/min via reservoir mask
• Otherwise
• Start with 10L/min via Hudson mask
• (but reassess and give more if needed)

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Acutely Unwell
Remember If in doubt Give 15L via Reservoir
mask And complete initial assessment
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(And others at risk of retaining CO2)
COPD Patients

• Need to achieve saturations of 88-92
• Give 28 Oxygen via venturi mask
• (If unable to achieve desired saturations try
  higher concentration Venturi masks)
• Perform Arterial Blood Gas
• Perform Blood gas analysis 30-60 mins after every
  change in oxygen concentration

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ABG in COPD Patients

• If pCO2 is lt6.0kPa
• It is safe to aim for saturations of 94-98
• If developing hypercapnia (pCO2 gt6KPa) along with
  ongoing hypoxia
• Do NOT Decrease Oxygen!
• Consider need for assisted ventilation NIV or
  Intubation.

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Oxygen Guidelines

• More detailed guidance from the British Thoracic
  Society
• www.brit-thoracic.org.uk/
• NHS Tayside Oxygen Prescribing chart is derived
  From these Guidelines