oxygen is the foundation of cellular respiration in our bodies and thus is essential for cellular function and life itself therefore when for various different reasons the amount of oxygen our patient is receiving isn't enough then we need to increase the level being delivered to them we have many different ways of doing so which i'm going to discuss in this lesson here [Music] all right you guys welcome back to another video lesson from icu advantage my name is eddie watson and my goal is to give you guys the confidence to succeed in the icu by making these complex critical care subjects easy to understand i truly hope that i'm able to do just that and if i am i do invite you to subscribe to the channel down below when you do make sure you hit that bell icon and select all notifications so you never miss out when i release a new lesson as always the notes for this lesson as well as all the previous videos are available exclusively to the youtube and patreon members you can find links to join both of those down in the lesson description below also don't forget to head over to icuadvantage.com or follow that link down in the lesson description to take a quiz on this lesson test your knowledge while also being entered into a weekly gift card as well as don't forget that you can help support this channel through the purchase of an icu advantage sticker again those are found at the website icuadvantage.com forward slash support link down in the description as i just mentioned oxygen is the key component in cellular respiration so this is where primarily glucose but also lipids and proteins are broken down and usable energy is extracted via the electron transport chain of which oxygen plays a critical role without it we cannot get atp production via this route which really produces the most usable energy this atp is then used to power all the cellular processes that our body requires in order to keep functioning if our patients are in a state of hypoxia then they're at risk of impairing this much needed atp production especially for our high consumers such as the brain and the heart this can really prove disastrous very quickly we need to be constantly monitoring our patients oxygenation primarily through their spo2 and then ensuring that we are delivering enough oxygen to meet their needs and ensure that this vital atp production continues to go on depending on their need we have many ways and levels of oxygen that we can deliver to them so let's actually talk about some of the different oxygen delivery devices depending on the situation and the patient's needs we really have a variety of different devices that are at our disposal to use working in the icu you will become very familiar with these and it is important to understand the differences and the amount of oxygen that's delivered as well as when to use each of them we can in a way think of these different devices as levels of different support with each having the ability to adapt our delivery amounts with each device and remember as i discussed in the oxygen toxicity lesson there are potential risks and consequences to oxygen therapy and therefore we want to use the least amount possible to meet our patients needs so when we talk about these devices we have the first kind of group or category of these devices which are going to be our non-invasive devices so in order for a patient to be able to utilize a non-invasive device they need to be spontaneously breathing if your patient isn't breathing then these devices are going to do very little in the way of delivering oxygen to them now of these non-invasive devices we have first our first grouping of low flow devices and the first one that i want to talk about here is going to be the nasal cannula so this here is the bread and butter of oxygen delivery and certainly the most common one that you'll use many of our patients in the icu are going to require oxygen support and this is often used when their needs are pretty low this device has two prongs that do go in the nostrils and then the tubing wraps around their ears kind of comes back underneath their chin and sort of rest on their neck we do want to make sure though that this is not too tight and we do want to be doing our preventative care and potentially cushions to prevent pressure injuries especially back around behind the ears the nasal cannula is capable of delivering anywhere from one to six liters per minute of flow of oxygen through it and this comes out to about 24 to 44 fio2 really kind of depending on the manufacturer the flow is limited though so turning the regulator above 6 liters per minute is really not going to increase the flow through this device now the nasal cannula can be combined with humidification for patient comfort and really to prevent drying out that nasal mucosa really humidification should be used anytime we're above at or above 4 liters per minute of flow and our nasal cannula can still help deliver oxygen to our quote unquote mouth breathers but especially heavy mouth breathers and those who have block nasal passages that the nasal cannula really might not be a good choice so what i really want you to think of when you're thinking of the nasal cannula is think of this as the go-to for our basic oxygen needs if your patient just isn't getting enough oxygen from room air alone then this is probably going to be your first go-to as long as they're not massively descending this also will probably be the last stop of oxygen support that the patient will get before they transition back to room air all right the next non-invasive low-flow device that i want to talk about is going to be the simple mask so sort of stepping our way up next we have our simple mask here and this particular mask is actually identified by having the plastic mask that's going to cover the patient's nose and mouth without a reservoir bag and just basically simple tubing coming off of that that's going to go to our wall regulator there is an elastic strap that basically goes around the patient's head as well as a flexible metal piece on the nose that really ensures proper fitting there this device is capable of delivering 6 to 12 liters per minute of flow and this essentially equates to 35 to 50 percent fio2 although if the mask is not fit properly then we're going to have more room air mixing in and diluting that oxygen that's currently being delivered this simple mask often has an attachment for nebulizers and this is gonna be for medication delivery which is typically how our breathing treatments are gonna be delivered we do have small openings on the sides of the mask that allow for proper mixing of the delivered oxygen with room air to get that proper fio2 concentrations that we're expecting these holes also allow for co2 to escape so that being said it's important when we're using the simple face mask that we have a minimum of six liters of flow that's being delivered through there and this is going to ensure that the co2 is flushed out of the mask and not re-breathed back by the patient so if we're running this at less than 6 liters per minute that co2 is going to get trapped in there and that patient is going to be rebreathing that back in which obviously potentially is not good for them now this mask can deliver slightly more oxygen than a nasal cannula but is more preferred for heavy mouth breathers so it's often used initially after excavation for surgical procedures so like pacu if you're recovering your patient in your room after surgery it is more intrusive though than the nasal cannula so some patients really may not like having this mask fitting over their face all right the next non-invasive low flow device i want to talk about is going to be the venturi mask and these are like simple masks but they are capable of delivering precise concentrations of oxygen so the oxygen tubing actually attaches to a special connection that is either adjustable by twisting it or replacing a part in there and these adjustments basically change the size of the hole that allows room air to come in and mix with the delivered oxygen allowing us more precise control over the delivered amount of oxygen to the patient so all of this really varies based on the manufacturer but on average these are capable of delivering anywhere from 4 to 12 liters per minute of oxygen and this equates to 24 to 60 percent fio2 so with this device we can deliver even more oxygen at the higher end but really i want you thinking of this as your fine control of oxygen needs for your patient you can really dial in exactly the fio2 that you want and ensure that you have precise delivery of that amount to the patient all right next i want to talk about really what we do for patients with trachs at least when it comes to non-invasive oxygen delivery and there's really three different pieces of equipment that we use we have our t-piece our trait collar and our trach shield and so essentially these devices are going to deliver oxygen around the opening of the tracheostomy but it is still going to be a passive non-invasive way of delivering this oxygen they essentially work by using blow-by essentially so the trait collar is more contained around the trach while the trach shield is sort of a more open uh and less precise way of delivering that oxygen both of these though don't use a direct connection to the trach the t piece though does have a direct connection on there and does deliver the most precise oxygen to the patient for all of these devices though they do have to be used with humidification as the trach is bypassing the mouth and the nose which does provide that natural humidification of air now for these when they hook up to the wall they hook up to that humidification and then they often have a ventari-like device for controlling how much oxygen is being delivered and again this usually ranges from 4 to 12 liters per minute equating to anywhere from 24 to 60 fio2 all right so another non-invasive low flow device that i want to talk about is going to be the face shield or the face tent and this is really the same concept as the trach shield where you sort of have this shield or tent around the patient's face that the oxygen is going to come into and fill that area around the patient's face providing the concentrations that we want to deliver to them the only difference here is this is obviously for patients of a normal airway versus this type of device in and around the patient's trach now this can be a good choice for patients who do not tolerate wearing that simple mask or the venturi mask but they do need a little bit higher flows than we're getting from let's say a nasal cannula all right the next low flow non-invasive oxygen delivery device is actually going to be our rebreather masks and there's two different kinds that we have the first is our partial rebreather and honestly personally i've never really used this one here as they don't seem to have a whole lot of place with the host of different devices that we have that said essentially this is like a simple mask but it has a reservoir bag of 100 oxygen that's attached to it we do need to ensure that that reservoir bag does inflate and that is not kinked or obstructed or anything but it does have holes on the side of the mask that still allow for air movement in and out to dilute the oxygen delivered as well as allowing that co2 to escape and so we do still have that same minimum 6 liters per minute in order to prevent that co2 we're breathing but our partial rebreather is actually capable of flows anywhere from 6 to 10 liters per minute which gives us 35 to 60 fio2 now from there we have our non-rebreather mask and this is actually another mask that you're going to become very familiar with so this is a non-invasive device that's capable of delivering the highest concentrations of oxygen with low amounts of flow still so this is just like the partial rebreather so we've got our face mask that has a reservoir bag except for the holes on the side are actually mostly replaced with one-way valves so this allows for when the patient expires for the expired co2 to escape out of there while closing back off and ensuring that the oxygen that's being delivered is exactly what we want so these mass are capable of flows from 6 to 15 liters per minute and this equates anywhere from 60 to 100 percent fio2 in reality there's still going to be some mixing of room air and therefore you know sort of our maximum range on this is probably 90 to 95 percent fio2 but with this we also have the same precautions with a minimum six liters per minute of flow and ensuring that the reservoir bag remains inflated now typically when we're reaching for this we're maxing out its flow and really trying to deliver as much oxygen to our patient before having to move to another device or getting out our back valve mask if your patient is rapidly desaturating this may be your go-to quickly to ensure that they're getting high levels of oxygen pretty quickly if this is happening with your patient don't fuss around with stepping up through all the different devices in these situations this is our emergency go-to get the mask on get to delivering 100 uh fio2 for them and then from there if your patient is still desaturating with having this non-breather mask on then they're likely going to need a higher level of support something like bipap or intubation all right the next non-invasive low flow device is actually going to be our bag valve mask so this is the resuscitation device that should be in each and every one of your rooms make sure that at the start of your shift as well as with any new admissions that this piece of equipment is in there this is vital i've seen some places that do classify this as an invasive delivery device and we'll kind of get into talking about that here more in a minute but given that this can be used with the mask attachment and not invasively really going into the patient at all i think it's best considered as a non-invasive device so with this device in addition to being able to deliver 100 oxygen at 15 liters per minute we do have the bag portion of this which we're able to squeeze and allows us to deliver breaths to the patient there is a soft form mask that we use to create a seal around the patient's nose and mouth and this allows us to ensure that the oxygen delivery and that we have proper ventilation as i did mention in the airway management lesson we're often going to utilize either oropharyngeal airway or a nasopharyngeal airway when we're using this and ultimately with the bag valve mask when all else fails this is going to be our last stop of support in an emergency either before intubation or even if they're already intubated and desating on the vent so that mask portion on the back valve mask actually detaches and allows us to attach the bag valve mass to the end of the et tube all right so now staying within our non-invasive devices we do transition from our low flow devices to our high flow devices and the first of these is actually the high flow nasal cannula and so i'll probably do a future lesson on these but the basics are that this is a special type of nasal cannula that allows for a very high flow and oxygen delivery so depending on the manufacturer they can deliver up to 40 to 60 liters per minute of flow and up to 100 fio2 we do have adjustments for both the fio2 being delivered via an oxygen blender as well as adjustments for the flow rates that are being delivered now because of these high rates of flow even if someone is a mouth breather that this device is going to work just fine there is also some thought that at our higher flows we can actually achieve some physiological peep to help with the oxygenation now these devices must be humidified and also have controls to adjust the temperature of the air being delivered which typically we're going to have warm humidified air being delivered to the patient so this is a very high level support device and can really deliver very high levels of oxygen at very high flows so if your patient is descending and really requiring a lot of oxygen but not necessarily needing ventilatory support that the high flow nasal cannula can be a great choice for them and then another high flow non-invasive device would be our cpap or our bipap and i am just going to mention these briefly here as i do have a whole separate lesson where i go over these much more extensively which i'll link to up above but basically these devices deliver positive pressure to our patients typically via a mask that covers their nose and mouth and then is secured tightly around their head to ensure that we have a good seal these can often be used to prevent intubation in some patients but do need to be utilized on conscious patients if your patient is on bipap and just lying there unresponsive you better get ready to intubate alright so now moving on from there let's actually talk about a couple invasive devices that we have so one of the last pieces of equipment that i'm going to mention here is one of the most supportive ways that we have to deliver oxygen to our patient and that's going to be through a ventilator so again this is going to be a super quick review but i do have a whole series here that i'll link to up above if you do want to learn more about this in more detail so this does require intubation with an endotracheal tube in order to have full control of their airway as well as full control over the breasts that we're going to be delivering to them now the ventilator does deliver positive pressure breaths to our patient and they allow us much more control over many things including the rate and size of these breaths as well as the percentage of oxygen that's being delivered which of course we can go all the way up to 100 fio2 and then finally the last invasive device i want to talk about is going to be our extracorporeal membrane oxygenation or ecmo and this is really the most extreme oxygen delivery device that we have available again i have a whole series on ecmo that i'll link to here but the gist of this is that we insert large cannulas into our patients blood vessels we remove deoxygenated blood oxygenate it and remove co2 via the oxygenator on the ecmo circuit and then return this oxygenated blood back to the patient obviously this is the most extreme the most invasive of these devices but this is also the highest level of support that we can go and technically is a device to deliver oxygen so i did want to kind of include that in our continuum of discussion here because depending on where you work what i see you're working in a lot of the stuff you're going to come across you're going to have experience with and it really helps to kind of understand the different levels of support where we're wanting to use this for our patient what our expectations are or maximum support that we can expect from a particular device and then ultimately where is our next step to go if whatever device we're currently working with is not enough so i hope that you guys found this information useful if you did please leave me a like on the video down below it really helps youtube know to show this video to other people out there as well as leave me a comment down below i love reading the comments that you guys leave and i try to respond to as many people as i can make sure you subscribe to this channel if you haven't already and a special shout out to the awesome youtube and patreon members out there the support that you're willing to show me and this channel is truly appreciated so thank you guys so very much if you'd be interested in showing additional support for this channel you can find links to both the youtube and patreon membership down below head on over there and check out some of the perks that you guys get for doing just that as well as check out some of the links to other nursing gear as well as some awesome t-shirt designs i have down there as well make sure you guys stay tuned for the next lesson that i release otherwise in the meantime here's a couple awesome lessons i'm going to link to right here as always thank you guys so much for watching have a great day