Resp Care
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Oxygen therapy is extensively used in premature infants and adults with respiratory insufficiency. In the premature infant the goal during manual control of the F(IO(2)) is to maintain adequate oxygenation and to minimize the exposure to hypoxemia, hyperoxemia, and oxygen. However, this is frequently not achieved during routine care, which increases the risks of associated side effects affecting the eye, lungs, and central nervous system. ⋯ On the other hand, there are growing concerns related to unnecessarily high F(IO(2)) levels that increase the exposure to hyperoxemia and excessive oxygen use in settings where resources are limited. Systems for automated closed loop control of F(IO(2)) have been developed for use in neonates and adults. This paper will give an overview of the rationale for the development of these systems, present the evidence, and discuss important advantages and limitations.
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The physiologic changes that occur in ventilation during sleep contribute to nocturnal oxygen desaturation in those with lung disease. Nocturnal supplemental oxygen is often used as therapy, although convincing data exist only for those who are hypoxemic both during sleep and wake. ⋯ Because of its prevalence, obstructive sleep apnea may commonly overlap with lung disease in many patients and have important consequences. Patients with overlap syndromes may be good candidates for noninvasive ventilation during sleep.
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Mass casualty events and disasters, both natural and human-generated, occur frequently around the world and can generate scores of injured or ill victims in need of resources. Of the available medical supplies, oxygen remains the critical consumable resource in disaster management. Strategic management of oxygen supplies in disaster scenarios remains a priority. ⋯ The Strategic National Stockpile supplies medications, medical supplies, and equipment to disaster areas, but it does not supply oxygen. Contracted vendors can deliver oxygen to alternate care facilities in disaster areas, in the form of concentrators, compressed gas cylinders, and liquid oxygen. Planning for oxygen needs following a disaster still presents a substantial challenge, but alternate care facilities have proven to be valuable in relieving pressure from the mass influx of patients into hospitals, especially for those on home oxygen who require only an electrical source to power their oxygen concentrator.
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Oxygen is necessary for all aerobic life, and nothing is more important in respiratory care than its proper understanding, assessment, and administration. By the early 1970s P(aO(2)) had become the gold standard for clinically assessing oxygenation in the body. Since the 1980s the measurement of arterial oxygen saturation by pulse oximetry has also been increasingly used as an adjunct to (but not a replacement for) P(aO(2)). ⋯ In addition, the original goals of "normalizing" arterial oxygenation with high tidal volumes and lung-distending pressures have required modification as appreciation for ventilator-related lung injury has emerged. High concentrations of inspired oxygen may play a role in such injury, but aggressive measures to reduce them in order to avoid oxygen toxicity-which dominated ventilator management in previous decades-have been tempered in the present era of lung-protective ventilation. Although some additions and modifications have emerged, much of what we understand today about oxygen in respiratory care is owed to the pioneering work of Thomas L Petty more than 40 years ago.