CEUFast, Inc. is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. ANCC Provider number #P0274.
≥92% of participants will know best practices for oxygen delivery.
Oxygen (O2) commonly treats medical conditions with poor tissue and arterial oxygenation. This course examines the clinical recommendations for using O2 therapy in different disease conditions.
After completing this continuing education course, the participants will be able to meet the following objectives:
The delivery system is determined by the O2 requirements, breathing pattern, mouth opening, and risk of hypercapnia. Once therapy is initiated, the team should reassess the patient to detect possible signs of clinical deterioration at the early stage of treatment. It is essential in patients with no prior history of supplemental O2 therapy. Early reassessments should also examine the risks of complications or the need for intensive care (Quinten et al., 2018). The reassessment interval should be determined by the severity of vital signs and the extent of hypoxemia. Patients who are started on O2 therapy can be reassessed every 4 to 6 hours. Continuous monitoring may be needed depending on where the treatment was initiated. Regardless of where therapy was initiated, continuous monitoring is recommended if multiple vital signs are outside the normal physiological ranges.
Depending on the patient's age, O2 requirements, therapeutic goals, tolerance, and humidification needs, various O2 delivery methods are available for both inpatient and pre-hospital settings. These delivery systems are categorized into two broad classes, low-flow delivery methods, and high-flow delivery methods.
These delivery systems allow the administration of inspired supplemental O2 of different percentages.
Figure 1: Reservoir Bag
The concentration of O2 administered and the flow rate of delivery are considered primary factors in the evaluation of the effectiveness of an O2 therapy protocol. A study focused on nasal high-flow O2 therapy in patients with hypoxia and reported how the effective inspiratory O2 concentration depends on the patient's respiratory flow and breathing pattern (Schwabbauer et al., 2014). As with this study, other studies on supplemental O2 therapy have consistently explored nasal high-flow O2 therapy in conditions requiring O2.
In a systemic review of a randomized-controlled quasi-experimental study, Marjanovic et al. (2020) compared high-flow O2 therapy versus conventional O2 therapy in patients with acute respiratory failure admitted to the emergency department. The researchers indicated that high-flow O2 decreased dyspnea and the respiratory rate in the study population (Marjanovic et al., 2020).
Figure 2: Ambu bag
Humidified O2 is not required in low-flow O2 delivery and short-term high-flow O2 administration courses (Calligaro et al., 2020). Therefore,
Clinical studies highlight the benefits of humidified O2 in patients with viscous secretions. The decision to use humidified O2 in the therapy course should be made individually. The practitioner must critically examine the risks and benefits of such a decision since the clinical evidence supporting humidified O2 therapy is insufficient to recommend wide use. Poiroux et al. (2018) published a study investigating the effects of dry versus humidified O2. The study could not demonstrate that non-humidified O2 was less effective in these patients than humidified O2 after 6–8 hours of therapy.
In emergencies, administer O2 empirically without a formal prescription to restore airflow. The lack of formal O2 prescription should not restrict O2 administration in a formal setting. The O2 concentration, the flow rate, the adjustment, and the patient's response should be documented.
In acutely ill patients presenting for clinical intervention, O2 therapy (if indicated) should be aimed at maintaining a patent airway. In patients with cardiac arrest, respiratory distress, or respiratory arrest, administer O2 empirically. The American College of Chest Physicians and the National Heart, Lung, and Blood Institute recommend a list of conditions to classify clinical conditions requiring empirical initiation of O2 therapy.
Nurses are expected to recognize the clinical signs of inadequate tissue oxygenation. The pathophysiological mechanisms resulting in low tissue oxygenation are broadly categorized into two groups. The two groups include those impairing the O2-hemoglobin complex system and those causing arterial hypoxemia. Recognizing these mechanisms requires careful patient evaluation. However, more than one mechanism may contribute to poor tissue oxygenation in the same patient.
Some patients require special consideration in O2 therapy.
These patients depend on a higher-than-normal carbon dioxide level for breathing. Regardless of the respiratory problem, the recommended target O2 saturation range is 88 - 92%. Treatment should be based on ABG results.
Supplemental O2 therapy should aim at a target saturation range of 92 - 96% or 88 - 92% in patients with a high risk of hypercapnic respiratory failure (Kopsaftis et al., 2020).
Supplemental O2 therapy is recommended in pregnant women who suffer from major trauma, sepsis, or acute illness. During labor, supplemental O2 can be administered to women with underlying hypoxemic conditions.
Urgent medical assessment and clinical intervention are required in patients at risk of respiratory failure due to neurological disorders.
Arterial oxygenation reduction is considered one of the major complications in many perioperative care plans. In the case of a significant decrease in arterial oxygenation characterized by a SpO2 of less than 90%, supplemental O2 therapy should be initiated as a corrective plan.
Oximetry should be monitored in patients using patient-controlled analgesia for hypoxemia. The primary clinical aim of O2 therapy in these patients is to maintain a stable O2 saturation level.
O2 saturation level monitoring is clinically crucial in stroke management as it impacts disease prognosis. Saturation levels should be monitored every four hours in these patients with all episodes of hypoxemia. If hypoxemia develops post-stroke, the practitioner should assess the patient. O2 should only be initiated in severe cases involving airway occlusion after securing airway integrity.
Ventilated patients in the Intensive Care Unit must be monitored closely and placed on supplemental O2. The risk of hypercapnic respiratory failure is minimal under mechanical ventilation. However, there are increasing submissions on the harmful effects of supplemental O2 on ventilated patients (Palmer et al., 2019).
O2 delivery, therapy monitoring, and vital sign documentation are all fundamental requirements in supplemental O2 care (O'Donnell et al., 2019). The British Thoracic Society guideline prescribes a 5-minute periodic check for patients started on O2. The recommendation also includes patients who require an increased O2 concentration and those whose O2 therapy has been stopped. In stable patients responding to therapy, SpO2 and the necessary variables should be monitored at least four times daily. Saturation levels should be monitored continuously in those with an active critical illness. After every episode of therapy change, the new saturation rate, flow rate, and delivery system should be recorded on the patient's chart after 5 minutes.
The German S3 guidelines were developed for the National Disease Management Guidelines (AWMF).
Positioning is considered a fundamental factor in therapy effectiveness. In conscious hypoxemic patients, an upright positioning may improve tissue O2 saturation levels and disease prognosis.
In non-hypoxemic patients in palliative care, nonpharmacological options, including relaxation exercises, cooling of the face, airflow from a table fan, and walking aids, should be considered the primary therapy option. Opioids are effective in the management of dyspnea in non-hypoxemic patients.
On O2 therapy discontinuation, the expert consensus in modern medicine states that O2 delivery should be reduced when a patient is clinically stable, and O2 saturation is above the target range or within the range for several hours.
Amoke is a 45-year-old African American, crushing it hard in her career as the Chief Brand Promoter for Megatron Capital Financing. Her demanding work schedule involves around-the-clock work and travel plans. She had just returned from a trip to Lagos, a metropolis in Africa's biggest economy, Nigeria. The journey to Lagos was largely successful; however, Amoke's 3-weeks extended stay exposed her to the hydrocarbon-polluted air in Lagos.
Two days after the visit, she reportedly fainted while presenting a new brand campaign. She was rushed to a Chicago Hospital and admitted to Emergency Observation Care. On examination, Amoke's first clinical summary documented the following signs and symptoms:
There was documented long-term drug use. No evidence of strangulation or domestic abuse. No personal or family history of asthma and no documentation of any chronic medical problems. She was reportedly healthy until that morning at the board meeting. She mentioned how her symptoms started during the last few days of her trip. Her vital signs during the first hour of admission include:
Her increased heart rate (tachycardia) indicated altered metabolism as the body struggled for oxygenated air and proper lung perfusion. Amoke's resting respiratory rate is higher than the medical standard of 12-20/min for adults. Finally, a low O2 saturation rate of 85% and the complaints of chest pain on inhalation suggest a lung oxygenation problem.
She was unresponsive to repeated Salbutamol 5 mg nebulizer treatments. Her complaints of gripping chest pain increased, and she regressed quickly, becoming unresponsive to sudden touch as her heart rate increased by 9 points. She was given a supplemental O2 regimen. A concentrated O2 regimen was initiated. She was also hooked to an ECG to monitor the heart's electrical activity. A nitroglycerin tab was given for the chest pain.
About 20 minutes later, the supplemental O2 therapy significantly improved her condition. She had pupil dilation in response to light and exhibited a conscious response to gripping touch. Her ECG showed a stable pattern. Her vitals also improved significantly, with her heart rate falling to 85/min and her pulse oximetry O2 saturation increasing to 96%. She was scheduled for a blood test and x-ray imaging for further investigations. Amoke's case is another in a long list of medical evidence suggesting the efficacy of O2 supplementation therapy in inpatient emergency admissions.
CEUFast, Inc. is committed to furthering diversity, equity, and inclusion (DEI). While reflecting on this course content, CEUFast, Inc. would like you to consider your individual perspective and question your own biases. Remember, implicit bias is a form of bias that impacts our practice as healthcare professionals. Implicit bias occurs when we have automatic prejudices, judgments, and/or a general attitude towards a person or a group of people based on associated stereotypes we have formed over time. These automatic thoughts occur without our conscious knowledge and without our intentional desire to discriminate. The concern with implicit bias is that this can impact our actions and decisions with our workplace leadership, colleagues, and even our patients. While it is our universal goal to treat everyone equally, our implicit biases can influence our interactions, assessments, communication, prioritization, and decision-making concerning patients, which can ultimately adversely impact health outcomes. It is important to keep this in mind in order to intentionally work to self-identify our own risk areas where our implicit biases might influence our behaviors. Together, we can cease perpetuating stereotypes and remind each other to remain mindful to help avoid reacting according to biases that are contrary to our conscious beliefs and values.
