Oxygen therapies

A more common cause for "altered" P02 values is the age of the individual. Normal P02 values decrease with age in addition, surgical procedures cause a temporary (post-operative period) decrease of the individual s P02 values. Various regression formulas have been presented describing the decrease of P02 with increasing age under normal conditions (6-12)> after surgery (10, 13-17), and with oxygen therapy (10, 16). 

Weinstein PR, Anderson GG, Telles DA. Results of h3fperbaric oxygen therapy during temporary middle cerebral artery occlusion in unanesthetized cats. Neurosurgery 1987 20 518-524. 

Rusyniak DE, Kirk MA, May JD, Kao LW, Brizendine EJ, Welch JL, Cordell WH, Alonso RJ. Hyperbaric oxygen therapy in acute ischemic stroke results of the hyperbaric oxygen in acute ischemic stroke trial pilot study. Stroke 2003 34 571-574. 

Singhal AB, Benner T, Roccatagliata L, Koroshetz WJ, Schaefer PW, Lo EH, Buonanno FS, Gonzalez RG, Sorensen AG. A pilot study of normobaric oxygen therapy in acute ischemic stroke. Stroke 2005 36 797-802. 

Add long-term oxygen therapy if chronic respiratory failure ° Consider surgical treatments... 

Long-term administration of oxygen (greater than 15 hours per day) to patients with chronic respiratory failure has been shown to reduce mortality and improve quality of life.1,2 Oxygen therapy should be initiated in stable patients with very severe COPD (GOLD stage IV) who are optimized on... 

Oxygen therapy should be continued indefinitely if it was initiated while the patient was in a stable state (rather than during an acute episode). Withdrawal of oxygen because of improved Pao2 in such a patient may be detrimental. 

The goal of oxygen therapy is to maintain Pao2 above 60 mm Hg (8 kPa) or Sao2 above 90% in order to prevent tissue hypoxia and preserve cellular oxygenation.1 Increasing the Pao2 much further confers little added benefit and may increase the risk of C02 retention, which may lead to respiratory acidosis. An arterial blood gas should be obtained after 1 to 2 hours to assess for hypercapnia. 

Cluster headache responds to many of the same treatment modalities used in acute migraine however, initial prophylactic therapy is required to limit the frequency of recurrent headaches within a periodic series. A novel therapy specific to cluster headaches is the administration of high-flow-rate oxygen 100% at 5 to 10 L/minute by non-rebreather facemask for approximately 15 minutes.42 If pain is not aborted, then retreatment is indicated. No side effects are seen with short-term oxygen use. If oxygen therapy is not wholly effective, then pharmaceuticals... 

There is no proven antidote for hydrogen sulfide poisoning. Treatment consists of supportive measures such as evaluating and supporting airway, breathing, and circulation (ATSDR 1994). Sodium nitrite may or may not be an effective antidote, but if proper precautions in administration are observed, intravenous administration of sodium nitrite may help some hydrogen sulfide poisoned persons (Hall 1996 Hall and Rumack 1997). Hyperbaric oxygen therapy is controversial, but it may be effective for patients not treated successfully by other measures (ATSDR 1994). 

Smilkstein MJ, Bronstein AC, Pickett HM, et al. 1985. Hyperbaric oxygen therapy for severe hydrogen sulfide poisoning. J Emerg Med 3 27-30. 

Continue oxygen therapy until patient is asymptomatic and blood carbon monoxide levels are below 10%. For individuals with blood carbon monoxide levels above 40%, consider transfer to a hyperbaric facility. 

Patients with acute chest syndrome should receive incentive spirometry appropriate fluid therapy broad-spectrum antibiotics including a mac-rolide or quinolone and, for hypoxia or acute distress, oxygen therapy. Steroids and nitric oxide are being evaluated. 

In severely affected children, the mainstays of therapy for bronchiolitis are oxygen therapy and TV fluids. 

In a patient with chronic respiratory acidosis (e.g., chronic obstructive pulmonary disease), treatment is essentially similar to that for acute respiratory acidosis with a few important exceptions. Oxygen therapy should be initiated carefully and only if the Pao2 is less than 50 mm Hg because the drive to breathe depends on hypoxemia rather than hypercarbia. 

Oxygen therapy should be considered for any patient with hypoxemia during an exacerbation. Caution must be used because many COPD... 

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