Clinical Applications of Gas Therapies

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Questions and Answers

Which concentration of Helium-Oxygen therapy is available for medical use?

65% Helium and 35% oxygen

75% Helium and 25% oxygen

80% Helium and 20% oxygen (correct)

50% Helium and 50% oxygen

What is a potential danger of Nitric Oxide (NO) therapy?

Rebound vasoconstriction (correct)

Increased lung compliance

Decreased airway resistance

Hypoxemia

For what purpose is Carbon Dioxide/Oxygen therapy primarily utilized?

Management of respiratory infections

Increase pulmonary ventilation

Relief of hiccups (singultus) (correct)

Treatment of chronic obstructive pulmonary disease

How is Nitric Oxide delivered for therapeutic purposes?

Via the I-NOvent Signup and view all the answers

What is the method of action for inhaled Nitric Oxide therapy?

Short-acting and delivered directly to the lung Signup and view all the answers

What is the primary purpose of croupettes in medical treatment?

Aerosol therapy Signup and view all the answers

What defines hyperbaric oxygen therapy according to the Undersea Hyperbaric Medical Society?

Exposure to pressure greater than one atmosphere while breathing 100% oxygen Signup and view all the answers

Which condition may benefit from hyperbaric oxygen therapy?

Decompression sickness Signup and view all the answers

What is one physiological effect of hyperbaric oxygen therapy related to gas bubbles?

Gas bubbles decrease in size according to Boyle’s Law Signup and view all the answers

Which type of chamber is used for treating one patient at a time during hyperbaric oxygen therapy?

Monoplace chamber Signup and view all the answers

What type of therapy utilizes helium-oxygen mixtures to facilitate gas movement?

Heliox therapy Signup and view all the answers

Which of the following physiological effects is NOT associated with hyperbaric oxygen therapy?

Decreased body temperature Signup and view all the answers

How does hyperbaric oxygen therapy impact white blood cells specifically?

Increases their ability to fight infections Signup and view all the answers

In hyperbaric oxygen therapy, what is the term for the process of new blood vessel formation in poorly perfused tissues?

Neovascularization Signup and view all the answers

What is a common misconception about the use of croupettes?

They can be sealed easily for effective therapy Signup and view all the answers

What is the primary characteristic of a High-Flow Oxygen Delivery System?

Delivers all of the patient’s inspiratory flow needs. Signup and view all the answers

Which device is considered a Low-Flow Oxygen Delivery Device that primarily relies on air entrainment?

Nasal Cannula Signup and view all the answers

What is the estimated FiO2 delivery range for a Simple Oxygen Mask?

35-55% Signup and view all the answers

What flow rate is recommended as a minimum for a Simple Oxygen Mask?

5 LPM Signup and view all the answers

What potential hazard is associated with using a Transtracheal Catheter?

Infection Signup and view all the answers

What principle correctly describes a Venturi mask in oxygen therapy?

It delivers specific concentrations of oxygen using different jet sizes. Signup and view all the answers

What is the function of the Reservoir Cannula?

To maintain FiO2 at lower flow rates. Signup and view all the answers

What is the primary indication for Oxygen Therapy based on patients' hypoxemia levels?

PaO2 < 60 mmHg in acute care settings. Signup and view all the answers

What flow rate can a Nasal Cannula deliver?

1 to 6 LPM Signup and view all the answers

What is the primary benefit of using a Venturi mask?

It allows for precise control of oxygen concentration. Signup and view all the answers

Which device is specifically designed to enclose an infant's head while controlling oxygen flow?

Oxygen hood Signup and view all the answers

What is a key feature of anesthesia bag-mask systems?

They require a gas source to operate. Signup and view all the answers

How do oxygen enclosures like incubators affect infant care?

They control the environment and need careful adjustment. Signup and view all the answers

What is a common misconception regarding low-flow oxygen delivery systems?

They can effectively deliver high concentrations of oxygen. Signup and view all the answers

What is defined as hypoxemia in the acute care setting?

PaO2 < 60 mmHg Signup and view all the answers

Which of the following correctly describes Low-Flow Oxygen Delivery Systems?

They do not meet the patient's total inspiratory demand. Signup and view all the answers

Which device is an example of a Low-Flow Oxygen Delivery Device?

Nasal Cannula Signup and view all the answers

What is the significance of the 'Rule of 4’s' associated with Nasal Cannulas?

It calculates the FiO2 given a specific flow. Signup and view all the answers

How is the FiO2 delivered through a Simple Oxygen Mask characterized?

It varies according to the patient's minute ventilation. Signup and view all the answers

What is the primary benefit of using a Transtracheal Catheter?

It uses significantly less flow than a Nasal Cannula. Signup and view all the answers

What is a major hazard associated with the use of a Transtracheal Catheter?

Subcutaneous emphysema Signup and view all the answers

What differentiates High-Flow Oxygen Delivery Systems from Low-Flow systems?

High-Flow systems guarantee a specific FiO2. Signup and view all the answers

What is a characteristic feature of a non-rebreathing mask?

It requires a minimum flow rate of 10 LPM. Signup and view all the answers

What is the maximum percentage of oxygen that a HiOx80 disposable high FIO2 oxygen mask can deliver?

80% Signup and view all the answers

What is a key characteristic of the anesthetic bag-mask system?

Requires a gas source Signup and view all the answers

How does a high-flow nasal cannula (HFNC) aid in respiratory therapy?

By generating gas flows that meet patient’s inspiratory needs. Signup and view all the answers

Which type of oxygen enclosure controls both temperature and FiO2 for infants?

Incubator Signup and view all the answers

What effect does the cool mist aerosol with Venturi exert on blood vessels?

Reduces swelling via vasoconstriction Signup and view all the answers

What is a critical requirement for ventilating a patient with a 40% Venturi mask?

Flow from the flowmeter must exceed the patient's inspiratory needs. Signup and view all the answers

What can occur if the reservoir of a reservoir mask collapses during use?

Decreased efficiency in oxygen therapy. Signup and view all the answers

Why is it essential to analyze oxygen concentration near an infant's head in a Head Box?

Variations in O2 concentration may occur Signup and view all the answers

What is a primary advantage of the Vapotherm high-flow system?

It minimizes rain-out and enhances humidity. Signup and view all the answers

What distinguishes a partial rebreathing mask from a non-rebreathing mask?

It permits some rebreathing of exhaled gases. Signup and view all the answers

How do mist tents typically deliver oxygen?

Through humidification and warming Signup and view all the answers

What is the primary function of a Head Box or Oxyhood?

To enclose the infant's head and adjust gas flow Signup and view all the answers

Which clinical condition is NOT treated with Helium-Oxygen therapy?

Treatment of persistent pulmonary hypertension Signup and view all the answers

What is a danger associated with the use of Nitric Oxide (NO) therapy?

Formation of nitrogen dioxide (NO2) Signup and view all the answers

What is a characteristic of the delivery method for Nitric Oxide therapy?

Delivered directly to the lung using I-NOvent Signup and view all the answers

Which mixture composition is available for Carbon Dioxide/Oxygen therapy?

5/95% carbon dioxide to oxygen Signup and view all the answers

What is a potential benefit of hyperbaric oxygen therapy related to white blood cells?

Increased ability to fight infections Signup and view all the answers

What is the principle that explains the decrease in trapped gas bubbles during hyperbaric oxygen therapy?

Boyle's Law Signup and view all the answers

Which of the following conditions is NOT typically treated with hyperbaric oxygen therapy?

Chronic bronchitis Signup and view all the answers

What specialized therapy employs helium and oxygen mixtures to improve gas movement?

He/O2 Therapy Signup and view all the answers

Which physiological mechanism enhances oxygen transport during hyperbaric oxygen therapy?

PSaturation of plasma with oxygen Signup and view all the answers

What is one challenge associated with the nursing care of patients using croupettes?

Difficult to seal Signup and view all the answers

Which of the following does hyperbaric oxygen therapy decrease the size of during treatment?

Gas bubbles Signup and view all the answers

Study Notes

Clinical Applications of Helium-Oxygen Therapy

Utilized for exacerbation of asthma, post-extubation stridor, refractory croup, and severe airway obstruction in chronic bronchitis and emphysema.

Helium-Oxygen Mixtures

Available concentrations: 80% Helium/20% oxygen, 70% Helium/30% oxygen, 60% Helium/40% oxygen.
Actual flow is impacted by the low density of helium; standard flowmeters are not accurate.
Correction factors for flow rates:
- 80:20 mixture: 1.8 × liter flow
- 70:30 mixture: 1.6 × liter flow
- 60:40 mixture: 1.4 × liter flow

Carbon Dioxide/Oxygen Therapy

Used for various disorders like singultus.
Common gas mixtures: 5% CO2/95% O2 and 7% CO2/93% O2.

Nitric Oxide (NO) Therapy

Administered for persistent pulmonary hypertension in newborns.
Highly reactive, forming nitrogen dioxide (NO2) or nitric acid (HNO3).
Delivered via I-NOvent with the potential for rebound vasoconstriction; cautious weaning is crucial.

Hyperbaric Oxygen Therapy

Defined as exposure to pressure greater than one atmosphere while breathing 100% oxygen.
Physiological effects include reduction of trapped gas bubbles and increase in plasma supersaturation with oxygen (up to 1500 mmHg).
Conditions that benefit: gas gangrene, radiation necrosis, carbon monoxide/cyanide poisoning, decompression sickness, and severe acute anemia.

Equipment for Hyperbaric Oxygen Therapy

Monoplace chamber accommodates one patient; multiplace chamber allows more than one patient and healthcare provider.
Increased ability of white blood cells to fight infections and promoted neovascularization to poorly perfused tissues.

Indications for Oxygen Therapy

Hypoxemia classifications:
- Acute care: PaO2 < 60 mmHg or SaO2 < 90%.
- Sub-acute/home care: PaO2 < 55 mmHg or SaO2 < 88%.
- Patients with cor pulmonale or congestive heart failure may require oxygen therapy at PaO2 of 56-59 mmHg.

Oxygen Delivery Systems

High-flow systems provide all inspiratory flow needs without air entrainment.
Low-flow devices partially meet inspiratory gas flow; include nasal cannula, simple masks, and partial/non-rebreathing masks.

Low-Flow Oxygen Delivery Devices

Nasal Cannula: Delivers 1-6 LPM; effective FIO2 up to 44%.
Simple Mask: Delivers 35-55% FIO2; requires minimum flow rate of 5 LPM.
Transtracheal Catheter: Surgically inserted for continuous O2, using less flow than nasal cannula but carries certain risks.

High-Flow and Environmental Oxygen Devices

Anesthesia bag-mask systems provide 100% FiO2 but require gas source.
Environmental devices like incubators, head boxes (oxyhoods), and mist tents help regulate oxygen concentration and temperature for infants.

Gas Densities

Densities: O2 (1.429 g/L), Air (1.29 g/L), CO2 (1.98 g/L), He (0.1785 g/L), N2O (1.98 g/L), NO (1.34 g/L).
Understanding gas densities is essential for the layering effect within oxygen enclosures and accurate oxygen analysis.

Indications for Oxygen Therapy

Hypoxemia defined as PaO2 < 60 mmHg or SaO2 < 90% in acute care settings.
For sub-acute/home care, PaO2 < 55 mmHg or SaO2 < 88% indicates hypoxemia.
In sub-acute/home care, PaO2 of 56-59 mmHg or SaO2 < 89% associated with:
- Cor pulmonale
- Congestive heart failure
- Erythrocythemia with hematocrit > 56

Oxygen Delivery Systems

High-Flow Systems: Deliver all inspiratory flow needs; no air entrainment.
Low-Flow Devices: Provide partial inspiratory gas flow; air entrainment occurs.

Low-Flow Oxygen Delivery Devices

Nasal Cannula: Delivers 1 to 6 LPM, achieving up to 44% FiO2; FIO2 varies with tidal volume and respiratory rate.
Nasal Catheter: More invasive than nasal cannula, positioned in the oropharynx.
Reservoir Cannula: Maintains a higher FiO2 at lower flows using a small reservoir.
Transtracheal Catheter: Surgically inserted for long-term oxygen delivery; requires less flow than nasal cannula but poses infection risks.
Simple Mask: Delivers 35-55% FiO2, requires minimum flow of 5 LPM.
Partial Rebreathing Mask: Rebreathes some exhaled gas, achieving up to 70% FiO2.
Non-Rebreathing Mask: Provides up to 100% FiO2; incorporates one-way valves to prevent CO2 rebreathing.
HiOx80 Disposable Mask: Delivers high FiO2 (>80%) at low flow rates without entrainment.

High-Flow Oxygen Delivery Systems

High-Flow Nasal Cannula: Achieves high FiO2 and washes out CO2; requires humidification.
Venturi Mask: Delivers a precise FiO2 using air entrainment ratios.
Anesthesia Bag-Mask Systems: Provide 100% FiO2; unable to function without a gas source.

Oxygen Enclosures or Environmental Devices

Incubator: Controls temperature and FiO2 for infants; frequent care may disrupt O2 regulation.
Head Box/Oxyhood: Encloses the head, requires careful O2 analysis due to layering effects.
Mist Tents (Croupettes): Used for aerosol therapy; O2 concentration control can be challenging.

Hyperbaric Oxygen Therapy

Exposure to pressure > 1 atmosphere while breathing 100% oxygen.
Physiological effects include decreased gas bubble sizes (Boyle's Law), improved O2 transport, and enhanced white blood cell function.
Conditions benefiting from therapy include gas gangrene, radiation necrosis, and decompression sickness.
Types of chambers include monoplace (one patient) and multiplace (multiple patients).

Helium-Oxygen Therapy

Low density of heliox improves gas movement around obstructions.
Used for acute asthma exacerbations, post-extubation stridor, and severe airway obstruction.
Available concentrations include 80% He / 20% O2, and flow rates must be adjusted due to low density.

Carbon Dioxide/Oxygen Therapy

CO2/O2 mixtures (e.g., 5/95% or 7/93%) used historically for various disorders such as singultus.

Nitric Oxide Therapy

Used for treating pulmonary hypertension in neonates.
Inhaled nitric oxide poses risks such as NO2 formation and rebound vasoconstriction. Delivered using I-NOvent device.

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Description

Explore the clinical applications of helium-oxygen, carbon dioxide-oxygen, and nitric oxide therapies in this informative quiz. Learn about the specific mixtures, their uses in treating various respiratory conditions, and the important corrections in flow rates. Test your understanding of these vital therapeutic gases and their implications in medical practice.