Oxygen Therapy for the PT
PT 743
Ashley Parish, PT, DPT, CRT, CCS
Objectives
• Understand implications for supplemental oxygen therapy
• Recognize side effects of oxygen
• Identify and describe oxygen therapy devices seen in PT practice
• Calculate how long an E cylinder tank will last with various liter
flows and devices
• Demonstrate an understanding of PT implications of O2 therapy
in a lab setting
Review of O2
• General indication is hypoxemia
• SpO2<90%; PaO2<60 mm Hg
• O2 saturation measured non-invasively by pulse oximetry (Spo2)
• Values > 90% are considered normal
• Measured invasively by an arterial blood gas sample
• Oxygen is a drug
• Alteration of Fio2, liter flow, or mask must be approved by MD
• Too much O2 can cause oxygen toxicity, absorption atelectasis,
retinopathy of prematurity
Why is Oxygen Therapy Good?
• Decreases mortality, pulmonary vascular resistance
• Physical performance/function are higher
• COPD: increase 6MWD and decreases dyspnea
during exercise sessions
• Supplemental O2 good for non-hypoxemic patients:
increases exercise time and work rate
Flow Meters
• 100% Oxygen comes from wall source
• Titrated to appropriate Fio2 by design
of mask
• Typical flow meter has 1-15LPM flows
• Can have flow meters with higher or
lower flows
• Example 1/4-3LPM
Nasal Cannula
Room air (RA) .21 Fio2
1 LPM .24 Fio2
2 LPM .28 Fio2
3 LPM .32 Fio2
4 LPM .36 Fio2
5 LPM .40 Fio2
6 LPM .44 Fio2
• Typically use a water bottle/humidifier with flows greater than 4LPM
• Easy for patients to talk, eat/drink
High Flow Nasal Cannula
• Provides warm, humidified O2 at adjustable
flow rates and Fio2s
• Thicker nasal prongs
• Maximum flow rate is 60 LPM and Fio2 max
is around 100% or 1.00
• Higher flow rates delivered can match
higher inspiratory flow rates for patients
with increased WOB and minute ventilation
Venturi Mask
• Also called air entrainment mask
(AEM)
• Delivers .24-.50 Fio2
• Fixed precise Fio2
• Do NOT use water bottle with mask
• Might be needed for exercise instead
of NC
Simple Mask
• Also called closed face mask
• 5-6LPM= .40 Fio2
• 6-7LPM= .50 Fio2
• 7-8LPM= .60 Fio2
• Can interfere with talking and eating
Partial Rebreather Mask
• Fio2 .40-.60
• Allows for some rebreathing of air
• Why would you want to
rebreathe exhaled air?
• Reservoir bag should remain at least
1/3-1/2 full on inspiration
Non-rebreather Mask
• Provides the highest concentration of
supplemental 02 available via face mask
• Fio2 .60-.80
• Prevents rebreathing of air
• Reservior bag should remain 1/3-1/2 full
during inspiration
• Might need with exercise but not at rest
Trach Collar
• Delivers .28-1.00 Fio2 on a flow
greater than 10LPM
• Held in place with elastic strap
that goes around the neck
• Needs to be humidified
• Can be hooked up to a venturi
set up for ambulation
Open-top Face Mask
• Also called open face tent
• Used for patients with facial trauma or
claustrophobia
• Flow greater than 10LPM
• Fio2= .30-.55
Oxyhood
• Delivers up to .50 Fio2 with liter
flows greater than 10LPM
• Good for spontaneous breathing
infants who need extra O2
Mechanical Ventilation
• Can be invasive or non-invasive
• Delivers .21-1.00 FiO2
• Can mobilize patients who are
mechanically ventilated
E Cylinder
• Hook O2 devices to cylinder in order
to mobilize patients
• Pull E cylinder in portable cart
• Has gauge to tell you how full the
tank is
• **Full tank is 2200 PSI**
Tank Calculations
•Cylinder Factor for an E cylinder is .28
•A full E cylinder as 2200 PSI
•Formula: PSI x Cylinder factor / liter flow
•The higher the flow of the device, the faster your tank will run
out
Tank Calculation Example:
A patient is currently on a 3L NC. The PT wants to take the
patient to the gym and needs to know how long the O2 tank will
last. PT notes that the tank is at 2200 PSI
2200 x .28 /3LPM= 205.33 minutes
205.33/60= 3.42 hours
.42 x 60= 25 (gets exact minutes)
The tank will last 3 hours and 25 minutes
Tank Calculation Example:
• A patient is on 6L NC and wants to ambulate to the cafeteria.
An E cylinder has 1800 PSI. How long will the tank last in hours
and minutes?
Answer
• 1800 x .28/ 6LPM= 84 minutes
• 84/60= 1.4 hours
• .4 x 60= 24
• Answer= 1 hour and 24 minutes
Portable Oxygen & Home Source
• Liquid O2
• Home O2
Concentrator
• Various
cylinder sizes
PT Considerations
• Fio2 is dependent on proper fit of masks
• Can provide O2 extension tubing if ambulating more than 6
feet from bed
• Ensure portable tanks have sufficient O2 prior to use
• Observe for signs of hypoxemia: SOB, accessory muscle use,
confusion, pallor, cyanosis
• Document type (of mask) and amount of supplemental O2
used during sessions
Session Summary
• What is O2
• Various masks in relation to PT
• Various ways to deliver O2
• Tank calculations
