To continue to live human requires oxygen (O2) atmospheric, that is, for the accomplishment of a body work remains the need to add the air opening to the lungs, develop blood circulation and trigger exclusive metabolic pathways in the skeletal muscles, Resulting in a greater uptake and use of O2.
Oxygen therapy at home is the object of this research, believing that it is the good use of oxygen directly in the patient’s airways so that their saturation is acceptable.
The main objective of this research is to investigate in scientific works the main benefits of the adequate use of home therapy citing its employability according to prescriptions, effects, contraindications and methods of oxygen administration. Therefore, oxygen therapy is the use of oxygen spontaneously in the patient’s airways so that their saturation is sufficient.
Aiming at a study of the benefits of home therapy about cost benefit through literature review, this article based on the following problem situation: What are the benefits of proper use of home therapy by physiotherapists for cost benefit? The type of study for the research in question was the bibliographical one. Therefore, several selections of works that portray the theme were carried out, as well as surveys carried out on websites, in order to find a theoretical basis for the following hypothesis: Home oxygen therapy is a common and respectable treatment in internal medicines, but it is not exercised According to the best care, although the cost benefit is low.
The beneficial results of home therapy are an evolution of pulmonary gas exchange (PaO2); Vaso pulmonary arterial dilation; Reduction of pulmonary arterial resistance; Reduction of pulmonary arterial pressure; Reduction of cardiac output; Reduction of cardiac workload; Vaso constriction systemic.
Oxygen therapy is the administration of supplemental oxygen to raise or maintain oxygen saturation above 90%, correcting the damage of hypoxemia. It should be administered based on some parameters used to assess the degree of blood oxygenation.
When the inspired fraction of oxygen is elevated, there is an increase in the arterial pressure of oxygen and, consequently, a decrease in the respiratory work necessary to maintain the alveolar oxygen tension, as well as the myocardial work responsible for the maintenance of the supply of oxygen to the tissues.
Indication: Oxygen therapy is indicated whenever there is a deficiency in the supply of oxygen to the tissues.
Oxygen blood pressure (PaO2), usually between 90 and 100mmHg, refers to the amount of oxygen dissolved in the plasma and values below normal indicate inefficient gas exchange.
Another important index is the saturation of arterial oxyhemoglobin (SatO2) that is proportional to the amount of oxygen carried by hemoglobin. Its value is equal to or greater than 97% and can be monitored by pulse oximetry or invasively through collection and analysis of arterial blood.
Venous oxygen saturation (SvO2), mixed venous oxygen pressure (PvO2), arterial oxygen content (CaO2) and systemic oxygen release (PO2) are other parameters that should also be considered.
The primary goal of oxygen therapy is to increase the amount of oxygen carried by the blood to the tissues.
By increasing the concentration of oxygen in the alveolar air, a difference is created between the partial pressure of this gas within the alveoli and the oxygen dissolved in the plasma, facilitating the passage of oxygen to the capillary, its dissolution in plasma and association with hemoglobin, Reducing the effects of hypoxemia.
• Adults, infants, and infants over 28 days old to correct hypoxemia: Hypoxemia (adults, children, and infants) PaO2 <60 mmHg or SaO2 <90% in ambient air (neonates) PaO2 <50 mmHg or SaO2 <50% in Ambient air
• severe trauma, acute myocardial infarction, unstable angina, post-anesthetic recovery from surgical procedures and acute, chronic respiratory failure
Main causes of hypoxemia of respiratory origin
• V / Q change
• alveolar hypoventilation (CNS changes, neuromuscular changes)
• diffusion disorders
• Shunt (mix of oxygenated and non-oxygenated blood)
Main causes of hypoxemia of non-respiratory origin
• the decrease in PaO2
• fall or chemical change in hemoglobin
• There are no contraindications for oxygen therapy in the literature.
Equipment (low flow, with reservoir and high flow)
Low flow system
• Nasal cannula: disposable plastic device, composed of 2 tips (1 cm long), connected to a long tube and a small gauge for oxygen supply. Connected directly to the flowmeter or a bubble humidifier. Even with extra moisture, flows above 4 L / min cause dryness and nasal bleeding. It is indicated for stable patients who require small concentrations of oxygen and in prolonged home therapy
• Nasal catheter: composed of a soft plastic tube with small holes at its end. It is introduced into the nasal cavity, gradually, until it is visualized behind the uvula. (Depth equal to the distance between the nose and the earlobe). Once inserted, it is fixed to the tip of the nose. Positioning stimulates the production of secretion (replacement every 8 hours). It is indicated for patients who will undergo procedures in which the cannula impedes tracheal access and as prolonged therapy for infants
High flow system
– always exceeds that of the patient, providing a fixed concentration of oxygen
– run at a flow rate above 60 L / min
– mix O 2 and ambient air through entrainment system or mixers
• Entrainment (Venturi mask): conducts an O2 source at high pressure through a jet through an inlet port. The larger the orifice and the inlet jet, the greater the O 2 concentrations. The mask body has an outlet for exhaled air. The concentration of O2 is obtained through the exchange of O2 jet inlet parts. It is indicated for patients who need low concentrations, but precise.
• Air mixer allows separate input of compressed air and O2 sources that are mixed manually or using a precision valve, allowing exact control of the desired concentration. The manual mixing is done by setting the separately compressed air flow meter and O2.
System with reservoir
– exceeds that of the patient by storing an oxygen volume equal to or greater than the patient’s VC
– the system in which the oxygen is stored in a reservoir that incorporates the device, which is released during the inspirations
– Provides higher concentrations of O2, using smaller flows than the low flow system.
• Mask with reservoir: it is plastic, disposable and covers the mouth and nose. The mask body stores the O2 between the patient’s inspirations. Expiration occurs through holes in the side of the mask body. It is indicated for emergencies and short-term therapy requiring moderate or high O2 concentrations. Partial rebreathing masks (it has a valve that allows oxygen to flow into the mask during inspiration and, during expiration, is directed to the reservoir along with expired CO2, which escapes as the reservoir is filled with Oxygen) and non-rebreathing (prevents rebreathing through a one-way valve at expiration) have a flexible reservoir bag of 1 L that can produce high concentrations of O2.
Precautions and Complications
• Patients with chronic hypercapnia may present with ventilatory depression when they receive high concentrations of O2.
• May be toxic and depress the mucociliary and leukocyte function
• retinopathy in preterm infants when on O2 administration that elevates PaO2 above 80 mmHg
• bacterial contamination (fogging and humidification system): should be changed every 48 or 72 hours