Which is a potential complication of oxygen therapy via nasal cannula for patients?

Last updated: November 18, 2022

Summary

Oxygen therapy is commonly used in hospital settings for the management of acute and chronic respiratory conditions, and increasingly in the community for patients with chronic conditions requiring home oxygen therapy. As with all treatments, oxygen therapy has side effects, and inappropriate use with inadequate monitoring can be fatal. The method of oxygen delivery, monitoring, target oxygen saturation, and indications for weaning should all be tailored to the individual patient. For discharged patients who require long-term oxygen therapy, risks should be discussed with patients and adequate monitoring should be established.

Pathophysiology

To maintain a constant supply of oxygen to the cells, a variety of physiological adaptations respond to hypoxemia and hyperoxemia. [1]

General principles of oxygen delivery

Nonhumidified oxygen

Humidified oxygen

Basic oxygen delivery systems

Oxygen delivery devices and flow rates should always be matched to patients' individual oxygen requirements, which can be varied and dynamic.

Simple oxygen face mask [5]

Venturi mask

Nonrebreather mask (NRB) [5]

Advanced oxygen delivery systems

Short-term oxygen therapy

Pulse oximetry [28][29]

Technical background
- Oxygenated hemoglobin (O2Hb) and deoxygenated hemoglobin (HHb) exhibit different properties of light absorption
  - O2Hb: ↑ infrared light absorption, allows ↑ red light pass through the measurement site (e.g., fingertip)
  - HHb: ↑ red light absorption, allows ↑ infrared light pass through the measurement site
- An oximeter uses LEDs (light-emitting diodes) emitting both red and infrared light → a photodetector is positioned on the other side of the finger, opposite the LEDs, and detects the amount of light (and whether it is red or infrared light) passing through the measurement site → a processing unit calculates the amount of O2Hb → oximeter displays SpO2
Reference range: Resting oxygen saturation > 95% is generally considered normal.
- A PaO2 of 100 mm Hg is necessary to reach a SpO2 level of ∼ 98%.
- Measurement can be inaccurate in patients with: [1]
  - Nail polish
  - Poor perfusion, e.g., severe hypotension
  - Darker skin pigmentation and saturations of < 85%
  - Carbon monoxide exposure, including chronic low-level exposure in smokers
  - Methemoglobinemia [30]
Monitoring
- Should be performed for the majority of patients receiving oxygen therapy
- Generally accurate to within 1–2 % of true SaO2 until saturations drop to < 80% [1]
- Patients in whom pulse oximetry is inaccurate and patients at risk of hypercapnic respiratory failure should undergo regular ABGs. [1]

Pulse oximetry provides falsely high values in cases of carbon monoxide poisoning, as complexes of hemoglobin and carbon monoxide are indistinguishable from oxygen-hemoglobin complexes!

Home oxygen therapy

Description

Oxygen therapy may be provided on a long-term basis outside of a hospital for patients with chronic conditions.
Nasal cannula is the most common method of delivery but alternatives may be used depending on the underlying condition.
Home oxygen may be provided via an oxygen concentrator, compressed oxygen cylinders, or liquid oxygen, depending on patient needs and preference.

Indications

Long-term oxygen therapy [3]

Description
- The most common form of home oxygen delivery
- Treatment is typically low flow (1–2 L/minute) oxygen via nasal cannula or TTOT.
- Typically used in advanced lung disease if patients remain chronically hypoxic despite maximal medical therapy
- Patients prescribed LTOT should use it for a minimum of 15 hours a day. [33]
Monitoring
- Start at a rate of 1 L/minute; titrate to SpO2> 90% (an ABG should be performed to confirm PaO2 is > 60 mm Hg) [31]
- If there are signs of worsening hypercapnia, the patient should be assessed for noninvasive home ventilation. [31]
- Patients prescribed LTOT, nocturnal, or ambulatory oxygen therapy should receive follow-up and monitoring at home after 4 weeks and after 3 months. [31]

Hyperbaric oxygen

Complications

References

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Which is a complication of the use of a nasal cannula?

Nasal cannulas are usually very well tolerated, but complications can occur and include drying of mucous membranes, nasal trauma, and epistaxis.

What is the main complication of oxygen therapy?

Fluid buildup or bursting (rupture) of the middle ear. Sinus damage. Changes in vision, causing nearsightedness, or myopia. Oxygen poisoning, which can cause lung failure, fluid in the lungs, or seizures.

What are the disadvantages of nasal cannula?

Several drawbacks are associated with these devices, which may limit efficacy and tolerance of oxygen delivery. Usually, oxygen is not humidified at low flow, and complaints, especially dry nose, dry throat, and nasal pain, are common.

What are the complications of the oxygen and the device?

Risks Of Oxygen Therapy.

Depression of ventilation: ... .

Hyperbaric oxygen toxicity: ... .

Fire hazard: ... .

Absorption atelectasis: ... .

Retinopathy of prematurity (ROP): ... .

Bacterial contamination associated with certain nebulization and humidification systems is a possible hazard..

Pulmonary toxicity: ... .

Low flow oxygen delivery system..

high-flow nasal cannula