Methods Of Oxygen Administration Research Articles

Investigation of the optimal method of oxygen administration with simultaneous use of a surgical mask: a randomized control study

PurposeFrom the perspective of infection prevention during the Coronavirus disease 2019 (COVID-19) pandemic, a recommendation was made to use surgical masks after extubation in patients in the operating room. For compliance with this recommendation, anesthesiologists need to administer oxygen to the patient with an oxygen mask over the surgical mask. However, no studies have investigated whether this method allows good maintenance of oxygenation in patients. This study aimed to investigate which method of oxygen administration lends itself best to use with a surgical mask in terms of oxygenation.MethodWe administered oxygen to the study subjects using all the following three methods in random order: an oxygen mask over or under a surgical mask and a nasal cannula under the surgical mask. Oxygenation was assessed using the oxygen reserve index (ORi) and end-tidal oxygen concentration (EtO2).ResultThis study included 24 healthy volunteers. ORi values with administration of oxygen were higher in the order of a nasal cannula under the surgical mask, an oxygen mask under the surgical mask, and an oxygen mask over the surgical mask, with median values of 0.50, 0.48, and 0.43, respectively, and statistically significant differences between all groups (P < 0.001). EtO2 values were in the same order as ORi, with median values of 33.0%, 31.0%, and 25%, respectively, and statistically significant differences between all groups (P < 0.001).ConclusionWearing a surgical mask over the nasal cannula during oxygen administration is beneficial for oxygenation and might help prevent aerosol dispersal.

Safety and efficacy of early postoperative hyperbaric oxygen therapy with restriction of transfusions in patients with HCC who have undergone partial hepatectomy

Recent studies have shown that intraoperative blood loss and blood transfusions promote postoperative recurrence of hepatocellular carcinoma (HCC). Hyperbaric oxygen therapy (HBOT) is a specific method of oxygen administration, which is independent of fluid therapy or blood transfusion. The aim of the present study was to assess the usefulness of acute HBOT after liver resection for patients with HCC in order to minimize the requirement for perioperative blood transfusions. Forty-one consecutive patients who showed Hb level < 9.0 mg/dl at the end of hepatic resection were randomly assigned to a control group (n = 21) or an HBOT group (n = 20). HBOT at 2.0 atm. with inhalation of 100% oxygen for a duration of 60 min was performed at 3, 24, and/or 48 h after the end of the hepatectomy. Regarding postoperative hepatic hemodynamics, liver function tests, and outcome data, prospective comparisons were completed in both groups. The two groups of patients were similar with respect to results from preoperative assessments. In six patients from the HBOT group, who experienced intraoperative major bleeding or showed fatal hepatic hypoxia (ShvO(2) < 50%), the levels of ShvO(2) and serum lactate were significantly improved after HBOT. When compared to the control group, the HBOT group showed better changes of ShvO(2), serum lactate, and bilirubin levels for the first 3 postoperative days following surgery. Additionally, the HBOT group did not experience any fatal complications and had a lower incidence of postoperative hyperbilirubinemia than the control group. We also observed that postoperative NK cell activity and cancer-free survival in the HBOT group tended to be better than in the control group, although the differences did not reach significance. These results suggest that acute HBOT after hepatectomy, aimed at reducing perioperative erythrocyte transfusions, may be employed for overcoming deficiencies in systemic and hepatic oxygen supply and thus diminishing postoperative complications. As an added benefit, such therapy may affect postoperative immunological responses and long-term survival after liver resection in HCC patients. Further analyses of the use of HBOT is warranted to confirm surgical outcome data and to assess the economic impact on healthcare costs.

Nasopharyngeal oxygen therapy produces positive end-expiratory pressure in infants.

The World Health Organisation recommends nasopharyngeal catheters as a safe and efficient method of oxygen administration in infants. However, little is known about the mechanisms of the improvement in oxygenation. The aim of the present study was to determine whether nasopharyngeal oxygen therapy produces positive end-expiratory pressure (PEEP). Nine spontaneously breathing infants (median age 13 months, range 10 days to 20 months) after heart surgery were investigated. All patients had normal pulmonary blood flow at the time of the study (Qp:Qs=1:1). Oxygen (oxygen fraction 1.0) was delivered by an 8 F catheter inserted into the nasopharynx (tip just visible below the soft palate). The pulmonary mechanics were analysed using a single compartment model of the respiratory system. Oesophageal pressure (Pes) at end-expiration, dynamic lung compliance (C(L)) and resistance (R(L)), minute ventilation, PaCO2 and PaO2 were measured at baseline without a nasopharyngeal catheter or oxygen, and at oxygen flows of 0.5 l/min, 1.0 l/min and 2.0 l/min. All the flows generated significant increases in PEEP. Mean difference in PEEP (SD, paired t-test versus baseline): 1.6 cm H2O (1.4, P=0.008) with 0.5 l/min of oxygen; 2.8 cm H2O (2.7, P=0.014) with 1.0 l/min of oxygen; and 4.0 cm H2O (2.9, P = 0.004) with 2.0 l/min of oxygen. There was a significant correlation between all the nasopharyngeal flows (in ml/kg per min) and the generated PEEP (P<0.001) and between the C(L) values and the generated PEEP (P < 0.05). There was no significant difference in PaCO2 and R(L). Minute ventilation was significantly less with nasopharyngeal oxygen than at baseline. As expected, PaO2 increased significantly with increasing oxygen flows. Administration of oxygen through an 8 F nasopharyngeal catheter at flow rates recommended by the World Health Organisation (0.5 l/min in newborns, 1.0 l/min in infants) produces moderate amounts of positive end-expiratory pressure. The levels achieved may contribute to an improvement in oxygenation by altering the visco-elastic properties of the lung.

A practical method for oxygen administration during cosmetic facial surgery.

An effective and practical method of oxygen administration during cosmetic facial surgery under local anesthesia is described. A large volume of oxygen is delivered directly to the nasopharynx, and partial upper airway obstruction caused by the tongue falling into the pharynx is resolved, yet the apparatus does not interfere with execution of the operation.

Arterial Oxygen Saturation Before Intubation of the Trachea

Arterial oxygenation in patients was measured with an ear oximeter to assess factors that were associated with hypoxaemia at the induction of anaesthesia. Twenty patients breathed air during the induction of anaesthesia with thiopentone and following neuromuscular blockade with suxamethonium. Mean SaO2 decreased from 95.7% before induction to 85.5% 1 min after induction. The SaO2 at 1 min was less in those patients whose weight was more than expected (SaO2 80.5%), than in those patients whose weight was as expected or less than expected (SaO2 88.8%). Other factors such as haemoglobin concentration, FEV1, FVC, age, or smoking habits, were not related to the degree of arterial desaturation. To assess the efficacy of different methods of oxygen administration, four groups of 10 patients, were given oxygen in different ways using a Magill anaesthetic system with a supply of 10 litre min-1. Measurements were made for up to 3 min after the induction of anaesthesia and maintenance of apnoea. Group I breathed normally from the system for 1 min before anaesthesia was induced. Group II were treated similarly, but the mask had a standardized leak, a 9.5-mm diameter hole. Group III took three vital capacity breaths from the system before anaesthesia, and group IV breathed air before anaesthesia, but their lungs were given three maximal manual inflations after the induction of anaesthesia. Mean SaO2 values after 3 min apnoea were: 96.8% (group I), 93.6% (group II), and 98.0% (group III). In group IV, measurements were stopped at 2 min when mean SaO2 was 92.9%.(ABSTRACT TRUNCATED AT 250 WORDS)

ARTERIAL OXYGEN SATURATION BEFORE INTUBATION OF THE TRACHEA: An assessment of oxygenation techniques

Arterial oxygenation in patients was measured with an ear oximeter to assess factors that were associated with hypoxaemia at the induction of anaesthesia. Twenty patients breathed air during the induction of anaesthesia with thiopentone and following neuromuscular blockade with suxamethonium. Mean SaO2 decreased from 95.7% before induction to 85.5% 1 min after induction. The SaO2 at 1 min was less in those patients whose weight was more than expected (SaO2 80.5%), than in those patients whose weight was as expected or less than expected (SaO2 88.8%). Other factors such as haemoglobin concentration, FEV1, FVC, age, or smoking habits, were not related to the degree of arterial desaturation. To assess the efficacy of different methods of oxygen administration, four groups of 10 patients, were given oxygen in different ways using a Magill anaesthetic system with a supply of 10 litre min-1. Measurements were made for up to 3 min after the induction of anaesthesia and maintenance of apnoea. Group I breathed normally from the system for 1 min before anaesthesia was induced. Group II were treated similarly, but the mask had a standardized "leak", a 9.5-mm diameter hole. Group III took three vital capacity breaths from the system before anaesthesia, and group IV breathed air before anaesthesia, but their lungs were given three maximal manual inflations after the induction of anaesthesia. Mean SaO2 values after 3 min apnoea were: 96.8% (group I), 93.6% (group II), and 98.0% (group III). In group IV, measurements were stopped at 2 min when mean SaO2 was 92.9%.(ABSTRACT TRUNCATED AT 250 WORDS)

An alternative: nasal cannula oxygen therapy for infants who are oxygen dependent.

Employed as a pediatric pulmonary clinical nurse specialist, and instructor of pediatrics at Georgetown University Medical Center and School of Medicine, Washington, D.C., at the time she developed the modified nasal cannula method of oxygen administration. She is currently working on a high-risk infant follow-up project at the Perinatal Center, Sutter Memorial Hospital in Sacramento, CA

High flow oxygen therapy for pneumatosis coli.

Symptomatic and radiological resolution of pneumatosis coli was achieved by intermittent high flow oxygen therapy in five patients. In each case the extent of the disease was defined by colonoscopy and contrast radiography before treatment. Despite the confirmation of pneumocyst resolution, recurrence of colonic gas cysts was noted in two patients at six months and one year after treatment. Bacteriological studies indicated that resolution of the disease, induced by oxygen therapy, was not associated with eradication of anerobic bacteria from stool and colonic mucosa. The clinical features and response to treatment of this group of patients are discussed, with particular reference to previously reported methods of oxygen administration.

Ideas and anomalies in the evolution of modern oxygen therapy.

Ideas and anomalies in the evolution of modern oxygen therapy.

Choice of Method for Administration of Oxygen

The need for carefully controlled continuous oxygen therapy for patients with chronic obstructive airways disease has been amply stated (Campbell, 1960 ; Hutchison et al., 1964). Further, it has been suggested that patients with cardiogenic shock require as high a concentration of oxygen as possible in the inspired air (MacKenzie et al., 1964). It is surprising, therefore, that, with the exception of the Ventimask, little or no information is provided by the manufacturers of the many devices at present available in regard to the concentrations of oxygen likely to be delivered to the patient. Few data have been published comparing the performance of these various pieces of equipment in an attempt to define which is the most appropriate to use in a given set of circumstances. Campbell (1960) pointed out the danger of intermittent oxygen therapy and the need for continuous administration, and it is not uncommon for a patient to be treated continuously with oxygen for several days. Clearly, then, the method used should be comfortable for the patient and should interfere with his activities and those of his attendants as little as possible. This aspect of oxygen therapy has been largely ignored by those writing on the subject. This paper describes the investigation of a number of methods of oxygen administration commonly employed. The aspects that have been particularly examined are: (1) how accurately the concentration of oxygen that each delivers can be predicted ; (2) to what extent rebreathing occurs ; and (3) how comfortable and convenient the methods are.

METHODS OF OXYGEN ADMINISTRATION IN RESPIRATORY FAILURE.

SummaryPhysiological and clinical evidence suggest that the hypoxic hypoxia of respiratory failure in patients with chronic lung disease should be managed by using inspired oxygen concentrations in the range 24 to 33 per cent.Conventional methods of oxygen administration do not permit the requisite control but it can be simply achieved using the principle of high air flow with oxygen enrichment (HAFOE).Methods of implementing HAFOE using the Venturi principle are described and our present practice outlined.

TECHNIQUES OF OXYGEN ADMINISTRATION

As all the methods of oxygen administration in common use produce satisfactory levels of arterial oxygen saturation, the choice of a method to suit a particular occasion should be based on other considerations. The main advantages and disadvantages of each of the common methods of oxygen administration are given.

Chest injuries in civilian practice.

Current practices in the treatment of chest injuries encountered in civilian practice are discussed with some consideration given their physiologic rationale. Penetrating injuries of the chest wall and lungs, with and without sucking wounds, are discussed in some detail in regard to their emergency treatment and follow-up care. Crushing injuries to the chest wall, with and without paradoxical motion, are described, together with their potential complications and management. Detection and treatment of the contused heart, and the heart with a penetrating wound are described. General consideration of complicating pneumonia, atelectasis, ileus, diaphragmatic hernia, hemothorax and other complications is given. Recommendations are made in regard to the use of intercostal nerve block for the relief of pain, methods of oxygen administration, and the use of x-ray assistance in the management of all types of chest injuries.

Improvised Methods of Oxygen Administration

Improvised Methods of Oxygen Administration

Oxygen Administration and Inhalation Apparatus

A FIFTH memorandum in the Emergency Medical Services Series has been issued by the Ministry of Health entitled “Oxygen Administration—Indications, Methods and Types of Apparatus” (H.M. Stationery Office. 2d.net). The administration of oxygen is a valuable aid in the treatment of some forms of gas poisoning and lung disease, and in some surgical conditions such as shock and chest wounds. The memorandum incorporates the results of research on the subject, and is intended primarily for the guidance of medical officers in charge of hospitals. It describes the conditions for which oxygen therapy is likely to be effective, methods of oxygen administration, and the more important types of apparatus for the purpose, including a new form of nasal mask.

Use of Oxygen in Climbing

PROF. YANDELL HENDERSON'S article on “The Last 1,000 ft. on Everest”, published in NATURE of June 3, p. 921, gives expression to the physiologist's doubts about the possibility of climbing to 29,000 ft. without the use of oxygen. Prof. Henderson attempts the difficult task of analysing the fall in climbing speed with increase in altitude and suggests that it reaches zero at 29,000 ft. If this conclusion is correct, it is folly to attempt the ascent of Mount Everest without oxygen, but mountaineers may answer that information about climbing speeds at great altitudes is too scanty to justify any precise estimate of limiting altitudes and may point out that, so far, climbers have done as well without oxygen as with it. The most compelling argument in favour of the use of oxygen would be the production of a really effective apparatus. On this point Prof. Henderson is emphatic that the so-called open apparatus is valueless and that a closed unit, involving absorption of carbon dioxide, is essential. But in spite of the possible theoretical advantage of the latter type, it has never been successfully used for climbing at high altitudes. The open apparatus, however, as is pointed out in an article on p. 961 of this issue, by a member of last year's Everest expedition, has twice been used with some success. For the future, it is clear that there is ample room for improvement in methods of oxygen administration in climbing. Increase in efficiency of utilization is desirable provided that it does not sacrifice other essential qualities, but another and perhaps easier line of attack is the reduction of weight by mechanical improvement of valves and cylinders.