Pediatrics O2 therapy – Flashcards
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T or F - an indication of O2 therapy in children and infants >28 days old is documented hyperoxemia?
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false - hypoxemia
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The PaO2 and SpO2 for hypoxemia in infants are what?
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PaO2 - less than 80 mmHg SpO2 - less than 95%
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Decreased ventilation, apnea, and bradycardia are signs of what in infants?
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worsening symptoms
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What are the initial symptoms of hypoxemia?
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tachycardia and tachypnea
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Where do some signs of central cyanosis appear?
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tongue, lips, and under nose
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Adults and children with central cyanosis have a PaO2 and SpO2 of what?
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PaO2 - 50 to 60 mmHg SpO2 - 85 - 90%
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The primary goal of oxygen therapy is to supply an adequate amount of oxygen to the tissues using the lowest inspired what?
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FiO2
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What is the 1st symptom of O2 toxicity?
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substernal chest pain
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Retinopathy of prematurity (retrolental fibroplasia) occurs in who? what weight?
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some premature infants or low birth weight infants less than 1500 grams
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Infants with retinopathy of prematurity need to have the PaO2 between what levels? SpO2?
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PaO2 - 50 to 80 mmHg SpO2 - 89 to 90%
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What FiO2 percentage presents a significant risk of absorption atelectasis?
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greater than 50%
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T or F - we need to limit exposure to 100% less than 24 hrs?
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true
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We should try to decrease to 70% within how many days? 50% or less within how many days?
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70% - within 2 days 50% or less - within 5 days
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What causes absorption atelectasis?
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oxygen toxicity, causing nitrogen washout
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Patients with sedation or CNS dysfunction are at increased risks for absorption atelectasis because?
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patients breathing at low tidal volumes
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T or F - RRT's should be able to determine the desired goals of therapy, select the mode of admin, monitor response, and recommend appropriate changes
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true
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Variable performance devices are also known as what?
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Low flow devices and devices with reservoirs
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Fixed performance devices are also known as what?
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high flow devices
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T or F - total flow needs to be 10 times patient minute volume?
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false - 3 times
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What affects low flow devices?
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RAFT
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High flow devices are meant to meet and exceed patient needs at what LPM in adults? children?
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adults - greater than 60 LPM infants - greater than 40-60 LPM
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What are 3 key points for children on O2 are what?
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use low flow meters (0.1 to 0.125 - 3 L/min) titrate slowly (0.1 - 0.2 L/min) use bubble humidifier
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T or F - when initiating oxygen therapy, it is better to give too little than too much?
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false - better to give too much at first
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A nasal obstruction is a contraindication for what low flow device?
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nasal cannula
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What is the variable FiO2 of a nasal cannula at 1 LPM of O2?
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22-44%
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The low flow flow meter L/min value used with a nasal cannula is what?
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0.1-0.3 L/min
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T or F - if needed, use a bubble humidifier or blender with a nasal cannula/catheter
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true
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What is the MAX flow for infants and newborns on a nasal cannula?
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2 LPM
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What is the flow used with a simple mask?
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5-10 LPM (minimum 5 lpm)
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What is the variable FiO2 with a simple mask?
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30-50%
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The simple mask delivers a (high/low) concentration of FiO2?
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high
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T or F - simple masks are good for transporting a patient?
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true
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When it comes to pediatric patients vs. adult patient O2 therapy equipment, what is different?
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just the size of the mask
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What is the FiO2 for a partial rebreather? nonrebreather?
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partial - 40-70% nonrebreather - 60-80%
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Flow rates to keep the reservoir bag from deflating (1/3 on inspiration) is what LPM?
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greater or equal to 10 LPM
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What do you do if the bag collapse on inspiration?
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increase the flow!!
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What is AMS?
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altered mental status
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Is a venturi mask a fixed device?
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yes - high flow
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T or F - venturi masks deliver precise oxygen concentration
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true
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What is the FiO2 range for the venturi mask?
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24-50%
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What affects an oxygen analyzer?
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H2O
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What are some other high flow devices?
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oxygen hoods, mist tent, high flow nasal cannula, isolette/incubator, and CPAP
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What is the minimum flow rate of the oxygen hoods? FiO2?
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minimum flow rate - 7 LPM 21-100% FiO2
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When analyzing O2 concentration in an oxygen hood, where do we place the analyzer?
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close to the face, layer effect of gas
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T or F - we can use a blender with an oxygen hood
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true
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Why should we monitory overheating and under heating in an oxygen hood?
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overheating - can cause apnea under heating - can increase O2 consumption
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What is the minimum flow with a mist tent? FiO2?
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Minimum flow - 10 LPM FiO2 - 21-50%
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T or F - a mist tent is a cool aerosol via refrigeration unit
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true
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Where should we place the O2 analyzer when we are analyzing in a mist tent?
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near the patients face - layering effect of gases
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Thick mist difficult to see patient, danger of asphyxiation, over hydration, and fire hazard are some disadvantages of what high flow oxygen therapy device?
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mist tent
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What are mist tents useful in treating the most?
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croup and other types of airway swellings
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A high flow nasal cannula is also an HFT, what is HFT?
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thermal controlled humidification system
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What amount of body humidity does the high flow nasal cannula deliver?
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close to 100% in all patients
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Flows are tolerated by patients because the gas is delivered at body temperature and is fully ____?
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saturated
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Patient communication, decrease panic with claustrophobic patients, easier to eat and drink, high flow flushes anatomic dead space (decreased rebreathing of CO2) are some advantages of what device?
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high flow nasal cannula - HFT
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T or F - the high flow nasal cannula - HFT helps a lot of patients from being ventilated (intubated)
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true
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What are some hazards of the high flow nasal cannula?
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excessive pressures on stomach and lungs
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What high flow device is temperature controlled and in a quiet environment?
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isolette/incubator
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It is difficult to maintain a consistent FiO2 in a isolette/incubator because of what?
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constant opening of door/portholes for care
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There is an increased risk of bacterial growth in the incubators because why?
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moist atmosphere for microorganisms
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What is the FiO2 delivered? if greater than this, use what?
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less than 25%, if greater than 25%, use a oxygen hood
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What is a CPAP?
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continuous positive airway pressure during the respiratory cycle to spontaneously breathing patients
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A CPAP machine does what to FRC? oxygenation?
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increases FRC improves oxygenation ( increase Pao2 ) increase gas exchage
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What devices can be used with a CPAP machine?
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nasal prongs, mask, ETT
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We need to see continuous mist during respiratory cycle to ensure that we are exceeding the patients needs, if we see the gas disappear during the respiratory cycle, what is happening?
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we are not meeting the patients needs
