Exercise delays age-related cancer driving by mitochondrial ROS and tissue hypoxia
Tissue Hypoxia and Oxygen Therapy - Prince of Songkla...
Transcript of Tissue Hypoxia and Oxygen Therapy - Prince of Songkla...
Tissue Hypoxia and Oxygen Therapy
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1. ���������� ���!���"#���� $��%&'��'�� �� 2. ���������#� ��#�'��� $��% 3. ������������*&��+��!���"#��,� - tissue hypoxia 4. ���������:��#����; �<�=*>�� $��%�!�*���?@>;A ��+�*��=%����B-�������B�� =:>C�>
��'���*��-�� 5. ;�-���?B ���� ���> ��� $��% 6. ���������;F"*�*���?B��+��+�� ��%� ��=*>�� $��% 7. �+�%&�&��+��+ ������!�� ���@>� +�� �� tissue hypoxia �B- ��=*>�� $��%C;;�-�� &�=:>
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$%&'() 1. Pathway of oxygen transport 2. Causes of tissue hypoxia 3. Effect of oxygen administration 4. Oxygen devices with spontaneous breathing 5. Selection of patient for oxygen devices with spontaneous breathing 6. Effects of inadequate humidification of inspired gases 7. Humidifier and nebulizer 8. Evaluation of oxygen therapy 9. Oxygen hazard
��C�'�+=��;]���� '��� $��%��!���"&'�����#��C* ������C�'�������+:+ �&��@'C�>�>�
#���� $��% ���+�����*��=%�#>�C;����*���^ _�����!������ $��%�#>��@'�'�� �� �B-#�� `�$������C��� C$���� ��� �'�� �� =,� -; &�����*��=%����� $��%�#>�C; ;�-��< 21% #���� �����*�� �+��*B���' =*"'�;b `�$Cc&��% �'�� ��; &��+�C�'C�>�+,� -c��,��C#>�%_�*���C�'�+,� -?��; &������'�� _�������!���:+ �&C�>&��; &���� C;c��C�'#���� $��%
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�� $��%�+�*��=%�#>�C;=;��%-?'�#� ���B �;B+�� `�$���� <���B�;��c�����'?'� (diffusion) �#>�C;�����>�B���f��,��=;�� ( pulmonary capillaries) �#>��@' �-���B����B-,��=�$BB�=�+���� ,��=�$BB� �� $��%%-?'�#� �� oxidative phosphorylation =*> B���;b�B���� ATP (adenosine triphosphate) �����=*>�$BB�=:>�B������� B'� = ���!� �% ���&'��^#���'�� ��&'�C; c��C�'%!��;b&>��C�>�� $��%������&��� %� �� ���+�*��=%�#>�C; �&'�>��'�� ��� ���+,� -?��; &��+�#� ��#�'��� $��%�' =� _&�� *����;bc�������'���+�&>�� ���� $��%������� #��� '�,� -; &� _�!�=*>�'�� ��� ��,� -#���� $��% (tissue hypoxia) �!�=*>C�'�������!���:+ �&C�>&��; &� ���� ?@>��+�%��&>���+� ���@>=������,� -#���� $��% *B� ��=*>�� $��%�B- ��!��� $��%C;=:>=?@>;A �%��� &B��%���c��#�� ��=:>�� $��%�> �
*+�%� �*%�,�((�-.$/% (pathway of oxygen transport) (�@;�+� 1 )
http://www.niehs.nih.gov/factsheets/ozone/ithurts.htm
�@;�+� 1 Oxygen transport
cell
��
FiO2
ventilation
diffusion
http://www.rnceus.com/course_frame.asp?exam_id=18&
directory=abgs
http:www.biology.eku.edu/RITCHISO/301
notes6.htm
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�����&>%� ��*��=%��� FiO2 �+���+����&'�� ��&>�� ��#���'�� �� �����'��>�� FiO2 0.2 �#>�C;=;�� *B��%� �%-�+ ���B �;B+�� `�$�-���;�� (pulmonary gas exchange) ����� $��%%� �� ��,��� �#>��@';���B-#����� `�$������C��� C$���+��;b#����+��� C; $���#� ����� B'� %-&>��;�- ���> �
1. Alveolar ventilation &>���+ `�$?'��#>��� %� ;����'��; &� ���+������*��=%&���&'%�@ ;� *B��B� �'�B�&>��; &� C�'�+������*��=%��� �*���*B��B�&+� C�'�+,� -;���k� (atelectasis) ;��� � (pneumonia) *���!��' �;�� (pulmonary edema)
2. Diffusion &>���+ �����'?'�#�� `�$?'����B�;�� (alveoli) �B-��>�B���f��,��=;�� ( pulmonary capillaries) ��'��; &� c��&>���+�B���C*B?'�;��; &� C�'�+��>�B���,��=;�����&� (pulmonary embolism) *���&+� (pulmonary hypertension)
3. Perfusion &>���+�B�������� ��k� =;����<���*��- �� `�$�+�?'��#>��� (ventilation/perfusion matching)
*B��%� �%���+ ���B �;B+�� `�$�-* '���B����B-�������� $+���;b ���B `�$�-�����>�B���f�� (capillary gas exchange) $���#� ����� B'� %-&>��;�- ���> �
1. Capillary perfusion &>���+�B���C;�B+�����������' &'��^=*>��+���� ���� systemic circulation �B- pulmonary circulation &>���!���; &� C�'�+,� -*� =%B>��*B (congestive heart failure)
2. Oxygen delivery ;�- ���> � ��#�'��� $��%c���� $��%%-%�� ��n+c�c B���;b�' =*"'�B-B-B��= plasma �;b�' >�� �B-����� ���+�&� #��*� =% (cardiac output) ������!�=*>�� $��%C;�@'��������C�> Arterial O2 content = Dissolved O2 + Hb-bound O2 = (0.003 x PaO2) + (1.34 x Hb x SaO2) Oxygen delivery = Cardiac output x arterial O2 content = Heart rate x stroke volume x O2 content
���� ;F%%���+��+?B&'� ��!��� $��%C;����������� %-&>��#���@';����<n+c�c B��, oxygen saturation, PaO2 �B- cardiac output �&' ���+��$BB�%-C�>����� $��%C�>� ���&>��#� ��� ��������#��n+c�c B��= ��;B'���� $��%=*>�$BB��> � ���= oxyhemoglobin dissociation curve $���� ��������#��n+c�c B��= ��%�� ���� $��% (O2 affinity) %-�;�?�&�� pH, PaCO2 , ��<*,@��=�'�� ���B- 2-3-DPG (2-3-diphosphoglycerate) $���C�>%� ��&-��B�$��#����_��B������ &��� ����������-* '�� PaO2 �B- SaO2 $����'�� ��������#��n+c�c B��= ��%�� ���� $��%%-; &� ����� pH 7.4, ��<*,@���'�� �� 37 �����$B�$+���B- PaCO2 40 ��.;��� �&'�>��'���� B'� �;B+���;B�C;%� + %-�+?B�;B+���;B�� ��������#��n+c�c B��= ��%�� ���� $��% (oxygen - hemoglobin affinity changes) �!�=*>�+?B��+�����#�� oxyhemoglobin dissociation curve C�> (�@;�+� 2 )
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http:www.nursingceu.com/NCEU/courses/acidbase2/
�@;�+� 2. Oxygen - hemoglobin affinity changes
������ �� ����+�����#���� $��%C;���$>���!�=*>� ��������#��n+c�c B��= ��%�� ���� $��%�����#� n+c�c B��;B'���� $��%=*>��������=:>C�>B�B� ��%�!�=*>��������#���� $��% (tissue hypoxia)C�> ��C�>=,� -�B����;b�'�� (pH �@�, alkalosis), ��<*,@��&�!� (hypothermia), ,� -������C��� C$��&�!� (hypocarbia), �+ ��B�B�#�� 2-3-DPG $�����C�>�����C�>����B����+�� _����
������ �� ����+�����#���� $��%C;���# ��!�=*>� ��������#��n+c�c B��= ��%�� ���� $��%B�B� n+c�c B��;B'���� $��%=*>��������=:>�����#� ��C�>=,� -�B����;b �� (pH &�!�,acidosis), ��<*,@���@� (hyperthermia), ,� -������C��� C$���@� (hypercarbia), �+ �������#�#�� 2-3-DPG $�����C�>=,� -$+�*���#���� $��%�������
*B��%� n+c�c B��;B'���� $��%=*>��������=:>�B> �>������� $��%%���#>��@' ���B �;B+�� `�$�-����$BB� (cellular gas exchange) ��� ���B �;B+�� `�$?'� cell membrane �B- mitochondria �B-#� �� metabolism �+�� ��%� ��_C$��&'�C;
Tissue hypoxia
���*&�#��,� - tissue hypoxia %��B> ��%� � ��?��; &�#��#� �����*����� B'� $�����'�C�>&�����*&����+
1. Hypoxic hypoxia $���� ��%� � ��?��; &�#�� ���B �;B+�� `�$�+�;�� (pulmonary gas exchange) � ��������� $��% (PaO2) =�B���&�!�*�����+� '� ,� - hypoxemia $���� ��C�>%� *B�����*&�&�� BC ���B �;B+�� `�$; &��+��-���;��
1.1 FiO2 &�!� �:' =�+��@� (high altitudes) 1.2 Alveolar hypoventilation ���,� -�+� `�$�#>��@'���B�;��>�� '�; &� �!�=*>�+�� $��%=
���B�;�� (PAO2) B�B�
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1.3 Ventilation/perfusion mismatch ��� � ��C�'����B�-* '��;����< `�$�B-�B����+�?'� $����;b���*&��+����'���+����#��,� - hypoxemia �:' asthma, hemo/pneumothorax, atelectasis, pneumonia
1.4 Diffusion defect ��� � ��?��; &�#�����B�;���+��!�=*> `�$���'?'�C�>B!��� 1.5 Shunt effect ��� �+���B��#���B��� �!�=*>C�'���?����?� �B �;B+�� `�$
$��� ��=*>�� $��%�������!�=*>,� - hypoxemia �+�� ��%� ,� - ventilation/perfusion mismatch, hypoventilation �B- diffusion defect �+#�C�>
2. Anemic hypoxia =,� -$+� �!�=*>�+n+c�c B��C�'��+����=#� ��#�'��� $��% 3. Circulatory hypoxia �!�=*>������B����+�!��� $��%C;�@'��������C�'��+���� �:' ,� -
shock, arterial occlusion 4. Histotoxic hypoxia �$BB�C�'������!��� $��%C;=:>C�>�:' ,� - cyanide toxic ���^�+�
��#�'��� $��%; &� 5. Hypermetabolic hypoxia =,� -�+��$BB�&>�� �� metabolism �� '��+��-�� ���!���#��
;���B-*� =%%- supply C�> ��> BC �+� B'� ��#>��&>%-�!���; &� �:' ,� -&'��C�������;b���
Oxygen therapy
�����?@>��+��������*&�#�� tissue hypoxia �B> _&>������+��@> ��+ ��=*>�� $��%� '?@>;A �=,� -&'��^ $����+*B� ��=*>���+
1. ������� ��,� -�� $��%=�B���&�!� (correct document/suspected acute hypoxemia) ���+����������;����<�� $��%=���B�;�� ( alveolar oxygen tension; PAO2) �B-=�B��� (PaO2)
2. �����B��� ��#�� ��#���� $��%������� (decrease symptoms of chronic hypoxemia) c���w��-=?@>;A �c��;���:' c�����B�c;A���� �!�=*>�� ���*����B�B� �B-�!�=*>�@>�� &� %� ,� - chronic hypoxemia C�>��_ #�
3. �����B� ���!���#���-��*��=%�B-�-��*� =% (decrease cardiopulmonary workload) �����%� ,� -#���� $��%�!�=*>&>���+ ���!���#���-��*� =%�B-*B���B����� #� ������!�=*>�'�� ��C�>����� $��%��'����+���� ������+ ��#���� $��% %-�!�=*>�-��*� =%�B-*B���B���B>��*B C�>&�� BC =�?,@���+� 1
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�?,@���+� 1 ,� -*� =%B>��*B �+�� ��%� hypoxemia
���� ��=*>�� $��%%���+?B&'��'�� �����+
1. ����� PAO2�B- PaO2 2. :' �B� work of breathing �!�=*>?@>;A ��@>�� �*����B�B� 3. B� myocardial workload ���:' �B�c� ���+�%-� ��,� -��>�B���*� =%&+� (myocardial
ischemia) �B-*� =%�>�# ��!���B>��*B (right heart failure) � %� +�������@� ���#>��'�:+ #>�*>�� #>�� ��- �� = ��=*>�� $��% &�� AARC
Clinical Practice Guideline 2002 $���C�>=*>�!�����#�� oxygen therapy ��� ��=*>�� $��%=� ���#>�#>�+��� '�=����� �� (ambient air) ���+�����;x�� ��B-�� ���� ���+�� ��%� ,� - hypoxia
#>��'�:+#�� ��=*>�� $��% (indication of oxygen therapy)
1) �+*B� y�#�� ��#���� $��%=�B��� (documented hypoxemia) ��� �+,� - PaO2 < 60 ��.;���*��� SaO2< 90% �����*��=%�#>�=����� ��; &�*��� �'� PaO2 *��� SaO2 &�!� '��'��+�&>�� ��=,� -?��; &������'��
2) =���,� -�+���� '���%%-� ��,� - hypoxemia &����*B��C�>��� ���� �������&>�B> C�>� ' ?@>;A �*B��c��CkC*�>
3) ,� -����%_�#������ (severe trauma) 4) ,� - B>�����*� =%#���B��� ( acute myocardial infarction) 5) ��=*>�� $��%:' ���^*B�� ���!�*�&� �������'���:' *B�� �������B� *���
*B�� ��?'�&���-c�
#>�*>�� (contraindication) C�'�+#>�*>���+�:���%#���@' ����� ��<�&'��^
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#>�� ��- ���B-,� -��� $>��+���%� ��#� 1) ��%� ��,� - � ��*��=%=?@>;A ��+�*��=%��� ������+�'� PaO2 �+��� '�*�����'� �� 60 ��.
;��� c���+��'� PaCO2 �@� '�,� -; &� 2) ��%� ��,� -;���k� (absorption atelectasis), �� $��%�;b��� (oxygen toxicity) *��� �
���!���#���-��#�+� !�%�������;B ;B��=������*��=% (ciliary) �B-�-��,@����>� ���_��B���#� (leukocytic) �����=*>� ���#>�#>#���� $��%=B�*��=%�#>� (FiO2) > 0.5
3) � ��- �� ��=*>�� $��%=?@>;A ��+�C�>������%� paraquat *���C�>��������+�!���� bleomycin 4) #<-�!�?'�&������B�$��� =������*��=% � �%!� ��� ���#>�#>#���� $��%�+�=:>=*>&�!��+����
�����*B+ �B+��� ��&��Ck 5) ���+� ���#>�#>#���� $��%�+��@����� <�+�� ��CkC*�>%-�!�=*>#� ��&��Ck �����
����#� 6) � ��- �� ��=*>� ��:��' � ���� $��%c���w��- ��=*>� ��:����B-���f��
(nebulizer) �����������,� -&���:������+��+�=������*��=%C�>
� ����$>.%�� >�?(�� �((�-.$/%*(��, �� @
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&�����+� 1 �� ������B�� #��,� -#���� $��%
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J%.B*(�(����P�C)?((�-.$/%�F )��+MI?�Q�@AGK) @C/$(� (oxygen devices with spontaneous breathing)
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1. Low-flow systems devices c��=*>�� $��% 100 % � '?@>;A �c��&���> � flow >�� '� 10 LPM �� �;b variable performance �����%� =*> flow >�� '� inspiratory flow rate demand #��?@>;A � �+ ���%��%���� ��%� ,��� �#>���?�� �!�=*>C�> FiO2 �� *���>��#���@' ��#��#�� reservoir, flow �+��;~��B-B� �<- ��*��=%#��?@>;A � $����+?B&'� minute ventilation ��; �<� low-flow �+���+ 1.1 Nasal cannula *��� nasal prongs (�@;�+� 3) ������=*>�� $��%C�> 24-40% c�� flow �+�
�����#� 1 LPM ����������� FiO2 C�> 0.04 �<+=:> flow >�� '� 4 LPM C�'%!��;b&>��=*>� ��:� C�'� ��;~� flow �� '� 6 LPM ����-�!�=*>?@>;A ��!���"�B-������*��=%�*>�C�> �� =:>=?@>;A ��+��� ���'�#>�����+� C�'&>�� ��� ���#>�#>#���� $��%�@��� �:' ?@>;A ����B�c;A����
1.2 Cannulocollar mask (�@;�+� 8) �;b��; �<�=*>�� $��%=?@>;A ��+��%�-���B> B� �<-�B>�� �� tracheostomy mask �&'�'��+���&'��;b�'��B_ �����=*>� ��:���� humidifier �' =*"'%-�;~� flow ��'��>�� 3 LPM ��+ ���!� <�;����$_&��� $��%�B>�� �� nasal cannula �����%� �+������������ ��,� -&���:������-��������*��=%= ��=*>� ��:���� nebulizer �� '���� humidifier
1.3 Simple face mask (�@;�+� 4) ������=*>�� $��%C�> 35-50% ,c���;~� flow �-* '�� 5-10 LPM %!��;b&>���;~� flow ��'��>�� 5 LPM �����;x�� �,� - rebreathing (exhaled CO2 ) �+���%������@',��= mask � �� �=*>������*>����+ ��%�!�=*>� �� ���-��������&'�?� *��*��� ����� <*>�C�> �� =:>=?@>;A ��� ���'�#>�����+� �&'&>�� �� FiO2 �� '� nasal cannula
1.4 Partial rebreathing mask (�@;�+� 5) ��� simple mask with reservoir bag. � ��;~� flow .=*>�� �� c��=*> bag C�'��� '� 1 = 3 *��� �����*���#�� bag #<-?@>;A �*��=%�#>��&_��+������=*>C�> FiO2 &���+�&>�� ��� ��;~� flow ��'��>�� 6-10 LPM ������=*>�� $��% C�> 40-70% �����%� ;�-��< 1 = 3 #��B�*��=%�� %-�#>�C;��@'= reservoir bag �B-?@>;A �������*��=%����� ��,��� ��?��?'���� exhalation port C�> �>��;~� flow >�� '�� ��&>�� ��#��?@>;A � %�����=*> FiO2C�'���+� �<+&>�� �� FiO2 �+��@�#� � �=*> humidifier �' ��> �
1.5 Non-rebreathing mask (�@;�+� 6 ) B� �<-�B>�� partial rebreathing mask &'�� �&���+ one-way valves 2 %�� %���� ��@'�-* '�� bag �B- mask ���+�����;x�� �C�'=*>B�*��=%�� (exhaled CO2 ) B���#>�C;= bag %���+� 2 %-�+�?';~����� < exhalation port ����� �C�'=*>*��=%����� ��,��� �#>��� C >�!�*���#��B�=:' �*��=%�� ��'�� ���� flow �+��;~�&>���@�����'��>�� 10 LPM �����=*>C�>�� $��%&���+�&>�� �� c��; &�������=*>�� $��%C�> 60-80% �&'&������+��%=*>�� $��%C�>��� 100% ��; �<�:��+����;b variable performance
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��@'�+ �����%� FiO2 �+�C�>��%C�'���+� �>�?@>;A �*��=%��_ �B-&>�� �� flow �� � ��;B+���;b��; �<�:����� *�����%&>��=�'�'�:' �*��=%�>��+#>��'�:+
�@;�+� 3 Nasal cannula �@;�+� 4 Simple face mask
�@;�+� 5 Partial rebreathing mask �@;�+� 6 Non-rebreathing mask
���; ;����< flow ��'��>���+�&>���;~������=*>C�> FiO2 &���+�&>�� ��#�� low-flow systems devices (&�����+� 2 )
&�����+� 2 Guidelines for estimating FiO2 with low-flow oxygen devices
Exhalation port
11
2. High-flow systems devices ������=*> flow C�>��'� ��*����� '� respiratory flow demand #��?@>;A ������%� �+��; �<��+��������@������ ��,��� �#>���?�������=*>C�> flow �� ��&���+�&>�� �� �B> %��=*>� '?@>;A � ������ !�*� FiO2�+�&>�� ��C�> %��%���;b��; �<��+�=*> FiO2 �'�#>�����+� ����;b fixed performance ;�- ���> � 2.1 Air-entrainment system $����+ air-entrainment port �������@��� ��,��� �#>���?��
?'� jet orifice= flow ;����<�� c�������*B� ��#�� venturi effect (�@;�+� 7) ����+ negative pressure ?'��@�B_ ^ �!�=*>�@��� ���#>���C�>;����<�� c���+;�A�;���� ���#>�#>#���� $��%%� ,��� %-&>��=:>�' � �� nebulizer �����������=*>� ��:�C�>�� �*��-�!�*���=?@>;A ��+�=:> artificial airway �:' tracheostomy mask (�@;�+� 8) *��� T-piece (�@;�+� 9) ������=*>�� $��%C�>��'��>�� 35% � %� + ������=:>C�> �� aerosol mask (�@;�+� 10) �����=*>C�>� ��:��+���+����*B��%� ����'�:' �*��=%,��*B�� �������B� �����%� air-entrainment system =*>� ��:��'�#>���@�%��&>��&'� �� corrugate tube $����;b����'�#>��=*"' �C�'=*>�'�&������C�!� B��&� �;b*��!�,��=�'�
�@;�+� 7 Venturi effect
Jet
Entrainment port
12
�@;�+� 8 Tracheostomy mask �@;�+� 9 T-piece �@;�+� 10 Aerosol mask
�.TG� ��F %�P flow *(�((�-.$/%H++ magic box C% high flow system, fixed performance
�������!� <;����< flow ��'��>���+�� ��;~������=*>C�> FiO2 &���+�&>�� ��C�>%� magic box
���+
�>�&>�� �� FiO2 0.6 %!��;b&>���;~� flow =*>C�>��'��>���� '�*�����'� �� respiratory flow demand #��?@>;A � �����'��>�� 3-4 ��'�#�� minute ventilation �����>�?@>;A �!�*� 50 kg *��=% 20 ����&'���+ �������!� < flow �+�&>���;~�C�>���+ minute ventilation = 5-7(ml/kg) x RR = (7 x50) x 20 = 7 LPM peak inspiratory flow rate = 3-4 #�� minute ventilation = 21-28 LPM &>�� �� FiO2 0.6 &>���;~� flow O2 &'� air 1:1 ���� &>���;~� flow ��'��>�� = 21/2 ��� 28/2 = 11-14 LPM
���� ������;�-��<����' #���� $��%&'��� ���+��#>���?��&����&���' �+��!� <C�> %� magic box �����&>�� �� FiO2 &���+�&>�� ��&��&�����+� 3 ���+
&�����+� 3 Approximate oxygen to air ratios for common oxygen concentration
Air 20
60
O2 100 40
40
O2100 : Air
40 : 40
1 : 1
13
ME$�G@*(�� �C)?((�-.$/%�� >$*?>*?%�I� (Effects of inadequate humidification of inspired gases)
��=*>�� $��%� ���#>�#>�@�^ %!��;b&>��=*>� ��:��' ��> � �����%� �� $��%%-�!�=*>
������*��=%�*>� *B���B���f���& �B-� ��,� -?��; &�&'��^&����C�>���+ 1. �!�=*>�-�� cilia �!���?��; &� 2. ���*-�*+� #> 3. � �� necrosis #��?��*B���B���f�� 4. � ��������*��=%�*>��& �;b�?B 5. � ���B����� ���� <�������?��������*��=% 6. � �� ��&���:���+��������?��������*��=% 7. ,� -;���k� (atelectasis) 8. ,� -;��� � (pneumonia)
� �C)?(����P��� >J&'%��+�I,��+((�-.$/% (Humidifier and nebulizer)
%� �+�C�> B'� ���B> '���; �<� ��=*>�� $��%%!��;b&>���+��; �<�=*>� ��:�� ��@'C;�> � $�����; �<�=*>� ��:�;�- ���> � 2 ;�-�,�=*"'^ ��� humidifier �B- nebulizer
1. Humidifier (�@;�+� 11)=*>� ��:�C�>>�� '� nebulizer BC ��� ���' `�$?'�B�!�c��&���!�=*>������ ��:���������#�� `�$ %-�*_ '�C�>k��!�$����'�#>��=*"' ���+�?� ���?��>��*�����+� '� bubble humidifier �� =:> �� low flow system *���,� -?@>;A ��+�������*��=%; &�C�'C�>&>�� ��� ��:��@���
2. Nebulizer (�@;�+� 12) C�>� ' pneumatic jet nebulizer, ultrasonic nebulizer BC �����*B� #�� venture effect ����+�����!�?'��'��B_ ^ : ��B@ B��!�=*>� ��B-���f���B_ ^ =�@;B-���!� (�@;�+� 13) C�>� ��:��+��'�#>���@������%� �+���+�?� ���?���� �� =:>�' � �� artificial airway �+�&>�� ��� ��:��� �:' T piece , artificial nose ( heat and moisture exchanger)
14
�����%� nebulizer =*>� ��:��'�#>���@�%��&>��&'� �� corrugate tube $����;b����'�#>��=*"' �C�'=*>�'�&������C�!� B��&� �;b*��!�,��=�'� c��%-&>���;~� flow =*>�� �� ��*��=%#��?@>;A � ���%-C�> FiO2 �+����+� ���� &C�>%� �+�?@>;A �*��=%�#>�%-&>���+C�!��*B����@'���� < ;B���'�*������� <*>� � (�@;�+� 14 )
�@;�+� 11 Humidifier �@;�+� 12 Nebulizer
�@;�+� 13 Nebulizer with venturi effect
15
���������;� ���& &'��#�� humidifier �B- nebulizer C�>���&�����+� 4 ���+
&�����+� 4 � ���& &'��#�� humidifier �B- nebulizer
Humidifier Nebulizer
Humidification gaseous aerosol Airway target upper airway lower airway Flow system low-flow high-flow FiO2 variable fixed
Tubing small-bored corrugated Cost cheaper expensive Nosocomial infectious less more
� ����$>.%MI?�Q�@)E��[B?��+((�-.$/% (evaluation of oxygen therapy)
*B��%� �+��+ ��=:>��; �<��� $��%�B> %!��;b�+�%-&>���+ ��;�-���?B ���� ���> ��� $��%�B-%-&>���+ ���fx��- �����+
1. Patient �+ ������fx��- �����+ 1.1 Clinical assessment c��;�-����-��&'��^ C�>� ' �-�� cardiovascular, pulmonary
�B- neurologic status '��+#�%� ����*���C�' 1.2 Assessment of physiologic parameters C�>� ' ��&� % PaO2 *��� oxygen saturation
c���w��-?@>;A ��+�C�>��� ���� ���> �,� -&'��^���+ - �����C�>��� ���!�����> ��� $��%*���,��= 12 :�� c��*B��%� C�>��� ���� ���> �
FiO2 < 0.4
�@;�+� 14 Nebulizer �B- corrugate tube �'�=*"' �*_C�!��+�;B���'�
16
- ,��= 8 :�� c��*B��%� C�>��� ���� ���> � FiO2 > 0.4 (� ����?@>;A ��+���@'= postanesthetic care unit)
- ,��= 72 :�� c��=?@>;A � myocardial infarction - ,��= 2 :�� c��=?@>;A �c�����B�c;A���� (COPD)
2. Equipment %!��;b&>���+ ���fx��- ���B-;����;B+����; �<�&���,��?@>;A � 2.1 &>��&� %�:_���; �<�=*>�� $��%�� :����'��>�� 1 ����&'� � 2.2 &>��&� %�:_���; �<�=*>�� $��%�'������#��� '� 1 ����&'� � c���w��-��; �<�=*>
�� $��% =?@>;A ����+ - �+� c>��+ ���;B+���;B�#��� ���#>�#>#���� $��%�+�=:> c���w��-?@>;A ��+�=:>
high-flow blending systems - ?@>;A ��+�=�' artificial airways - ?@>;A ��+�=:> heated gas mixture - ?@>;A ��+��� �����C�'���+�*���C�>��� FiO2 > 0.5
2.3 &>���+ ��&� %�����; �<��� $��%�+�?@>;A �=:>��@'#<-��B����>��?@>;A ��:' C; ��_ $���� *����>��&� ?@>;A �
*?($�G@*(�� �C)?((�-.$/% ( oxygen hazard) ��=:>�� $��%�+#>��+ �B-#>�� ��fx��- ������+�C�> B'� C;�B> �&' ��=:>�� $��%� ���#>�#>�@�*���=:>&��&'� ��;b�-�-� B�� �!�=*>� ��,� - oxygen toxicity �B-� ��?B��+�&'�� �� -&'��^ &����C�>���+ 1. Physiological hazard from hyperoxygenation
1.1 ?B&'��-�� CNS �!�=*>� ��,� - tremors, twitching, paralysis �B- convulsion C�> $���������� �� ��C�>��� hyperbaric pressure (�� $��%�+�� ������ '� 1 ����� ��)
1.2 ?B&'��-��&� �!�=*>� ��,� - retinopathy of prematurity $����� %-��=��� �B�� '� !�*��+�C�>����� $��%% PaO2 �� ?��; &�%�!�=*>� ��,� - retinal vasoconstriction �B- necrosis =�+����
1.3 ?B&'��-��������*��=% - �!�=*>������*��=%�*>� ���*-�*+� #> B� ���!���#���-�� cilia - �!�=*> � ��*��=%=?@>;A �c�����B�;A��c�� �����%� ��+� hypoxic drive - �!�=*>�@"��+�,� - hypoxic pulmonary vasoconstriction - �!�=*>� ��,� - absorption atelectasis �����%� �� $��%C;���+�&!��*'�
Cc&��% �!�=*>���B��k�
17
- �!�=*>� ��,� - bronchopulmonary dysplasia �B- pulmonary hypertension & fibrosis &����C�> ����?,@���+� 3
�?,@���+� 3 ,� - pulmonary hypertension & fibrosis �+�� ��%� high FiO2
1.4 ?B&'��-�� metabolic �!�=*>�'���B+� !�*� B�C�> 1.5 ?B&'��-��*� =%�B-*B���B��� �!�=*>� ��,� - pulmonary vasodilatation �B-
systemic & cerebral vasoconstriction 2. Psychological dependent 3. Mechanical hazard �!�=*>� ��CkC*�>C�>c���w��-�� $��%� ���#>�#>�@� 4. Bacterial contamination %� � ��:��+�B�B� ������B�;��c���w��-�����=:>�' � �� nebulizer
%� ;F"*� ��� ��,� - oxygen toxicity %��� ��- ��C�'=*>�� $��% 100% � � 24 :�� c��*����>�=*>� ���#>�#>B�B��;b 70% C�'� �� � 48 :�� c�� � ���#>�#> 50% C�'� �� � 5 �
���� ��=*>�� $��%�+���#>��+�� ���&���+�C�> B'� C;�B> �&' _�+#>���+�*� =:>� ���#>�#>�@�^ *���=:>�;b� B�� ����?@>��+�%��&>��&�-*� �B-�@>%� �B�� =:>�� $��%&��� ��%!��;b�B-�+#>��'�:+��'�� *B��%� �+�=:> ��?@>;A ��B> _&>���+ ���fx��- ��&B��� B�������,� -#��?@>;A ��;B+��C; c����%&>���;B+��:��#����; �<� ��=:>�����?@>;A ���'B�*�������������� $��%�� C�>�����?@>;A ��� ���+#�*���*��#>��'�:+
$(�� �(? �(.�
18
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