Mechanical ventilation is used as a last resort when a patient is in severe respiratory distress and cannot tolerate non-invasive ventilation. they are aged under 17 years and their immunity is impaired by drugs or illness and they have any moderate to high risk criteria.

Oxygen LPM Flow Rates and FiO2 Percentages Understanding Oxygen LPM Flow Rates and FiO2 Percentages

not passed urine in the past 12 to 18 hours (for catheterised patients, passed 0.5 ml/kg/hour to 1 ml/kg/hour) If ventilation can be avoided, it should be. Some patients are difficult to wean off the vent (like in severe COPD or ARDS).Myers TR, American Association for Respiratory Care (AARC) (2002 ) AARC Clinical Practice Guideline: selection of an oxygen delivery device for neonatal and pediatric patients--2002 revision & update. Respir Care 47 (6): 707-16. You are absolutely right in your statement about the Venturi devices in relation to peak inspi Oxygen concentrators, depending on the manufacturer, produce up to 96 percent pure oxygen. (Oxygen purity of a concentrator is also known as Oxygen Concentration.) But the 96 percent oxygen produced by the unit does not mean it delivers 96 percent FiO2. As with any drug, if oxygen can be stopped, then the prescription on the drug chart should be crossed off (or discontinued on electronic prescribing platforms).

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Usually, the prescriber would need to specify the target oxygen saturations, oxygen delivery device and desired flow rate/FiO 2. The answer to this question comes down to the flow requirements of the patient! What do I mean by that?You are currently breathing air in and out of your lungs while you are reading this blog, hopefully with enough interest to share it with your friends and colleagues after you finish reading it *wink wink*. The air that you are breathing has to get from point A (the atmosphere) to point B (your lungs). If a car was trying to get from point A to point B, it can only do this if you press the accelerator to achieve a certain speed. The faster the speed, the faster you get from point A to point B. The same principle applies to how we breathe, but we refer to this speed as our peak inspiratory flow. Details of the required flow rate and percentage of oxygen delivery are shown on the coloured mask fittings (see below). needed invasive procedures (for example, caesarean section, forceps delivery, removal of retained products of conception)If you increase the oxygen flow rate beyond the rate recommended for the mask, it will not continue to increase FiO 2. The NC tubing is placed around a patient’s face with the prongs positioned at the nostrils. The NC tubing can be secured behind the patient’s head or around their ears. Oxygen delivery depends on mask: this is marked on the side of the mask, along with the appropriate flow rate setting

British Thoracic Society Guideline for oxygen use in adults

Same system but with a high positive pressure on inspiration and a lower positive pressure on expiration Pneumothorax – Oxygen may increase the rate of resolution of pneumothorax in patients for whom a chest drain is not indicated. General Medical Council. Practical skills and procedures. Published in 2019. Available from: [ LINK] This can be useful in acute pulmonary edema like in CHF, because it reduces intrathoracic pressure and can reduce preload and increase cardiac output, as well as decrease alveolar congestion.When anyone breathes in, air has to get from the atmosphere to our lungs. The speed in which the air moves (or flows) from the atmosphere (point A) to our lungs (point B) is known as a flow rate. Peak inspiratory flow is the fastest flow rate point on a given breath to get air from point A to point B. An NPSA rapid response report ‘Oxygen safety in hospitals’ in 2009 reported 281 serious incidents from Dec 2004 to June 2009 relating to oxygen therapy and that poor oxygen management caused 9 deaths and contributed to a further 35. This report placed an obligation on hospitals to introduce measures to reduce avoidable harm associated with administration of oxygen. Patients who have had an episode of hypercapnic respiratory failure should be issued with an oxygen alert card for future use and a 24% or 28% Venturi mask. There are no absolute contraindications to oxygen therapy if indications are judged to be present. The goal of oxygen therapy is to achieve adequate tissue oxygenation using the lowest possible FiO 2. Imagine for a moment that a ferrari goes from point A to point B 1 mile apart from each other. now imagine the ferrari goes at the end at 150 mph as measured by radar.

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If the patient is at risk of type 2 respiratory failure (e.g. COPD patients who are known to be CO 2 retainers), it may be safer to start at a lower FiO 2 using a Venturi mask and up-titrate if required. Aim for oxygen saturations of 88-92%. Or a decreasedpeak inspiratory flow rate of 20 L/min while receiving 10 L/min of oxygen via a face mask at an FiO2 of 100%: Depending on the oxygen flow rate, there are different colored venturi pieces that are used, with FIO2 of 24-60% FIO2 depending on which venturi valve is used. Levels >40% are generally not used and likely don’t offer more benefit. and arrange for a clinician to review the person's condition and venous lactate results within 1 hour of meeting criteria in an acute hospital setting. HFNC is more comfortable and studies have shown that using HFNC may be a better alternative than using a face mask.

I believe the use of saline nebs has originated from paediatric management of bronchiectasis. They use hypertonic saline which works on the principle of osmosis to draw fluid into the lungs, which loosens mucous and makes it easier to clear. However, 0.9% normal saline does not have this hypertonic effect. It is similar to pouring water over oil, it just slides straight over the mucous.