China
Africa
Explore chapters and articles related to this topic
The patient with acute respiratory problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
All patients receiving oxygen therapy must have their oxygen saturation levels measured regularly and the concentrations of inspired oxygen titrated accordingly, with extra caution taken with individuals at risk of hypercapnia. While oxygen therapy is not beneficial to non-hypoxaemic individuals, a sudden drop in oxygen saturation of 3% or more is an early sign of acute deterioration, which should prompt further assessment. The target oxygen saturation rate is 94–98% unless the individual is at risk of hypercapnia, in which case the target is 88–92%. In serious illness with milder degrees of hypoxaemia, oxygen can be administered through nasal cannulae at 1–6L/min or by a simple face mask at 5–10L/min (a simple face mask must not be used at flow rates less than 5L/min, as this may result in carbon dioxide rebreathing). The medical team may also prescribe 24%, 28%, 35%, 40% or 60% oxygen via a venturi mask. When administrating oxygen via a venturi mask, it is important that the nurse sets the correct flow rate to ensure the correct percentage. The correct flow rates are indicated on the mask (2L/min for 24%, 4L/min for 28%, 8L/min for 35%, 10L/min for 40% and 15L/min for 60%). For individuals in respiratory distress with RR greater than 30/min, the flow of gas needs to be increased to meet the raised demand for flow. When using the venturi mask, this can be achieved by doubling oxygen flow rate; the design of the air entrainment port in the mask means that the percentage of oxygen delivered will remain the same.
Guidelines for Supplemental Oxygen
Published in Ravi Gupta, S. R. Pandi Perumal, Ahmed S. BaHammam, Clinical Atlas of Polysomnography, 2018
Ravi Gupta, S. R. Pandi Perumal, Ahmed S. BaHammam
High-flow devices: These delivery systems deliver oxygen of precise concentration at flow higher than the patient’s inspiratory flow. An example of these devices is the Venturi mask. High-flow oxygen is usually delivered through a facemask with humidification. High-flow systems are not often used in the sleep center.
Acute respiratory insufficiency
Published in Louis-Philippe Boulet, Applied Respiratory Pathophysiology, 2017
The first intervention to offer to the hypoxemic patient will be oxygen supplementation according to the mode of administration and the flow of oxygen chosen. It will be possible to increase the FiO2 at levels varying from 25% to 100%. The nasal prongs are the first line of intervention in a patient suffering from a mild to moderate hypoxemia. It will be minimally insufficient in a patient with a high breathing flow or presenting essentially an oral respiration. A venturi mask will generally allow oxygen to be brought more effectively to these patients. Some of these masks have a reservoir that allows accumulating oxygen during the expiratory phase, to make it more readily available during the next inspiration. They offer the best FiO2.
Managing Covid-19 in patients with heart failure: current status and future prospects
Published in Expert Review of Cardiovascular Therapy, 2022
Hawani Sasmaya Prameswari, Iwan Cahyo Santosa Putra, Wilson Matthew Raffaello, Michael Nathaniel, Adrian Sebastian Suhendro, Achmad Fitrah Khalid, Raymond Pranata
Therefore, a stepwise approach to oxygen supplementation is a must. Firstly, placing a finger on oxygen saturation and monitoring its reading closely. Secondly, achieving the predesignated target of SpO2 above 95% (SpO2 > 90% in chronic obstructive pulmonary disease) through a stepwise approach is beneficial. The availability of types of support equipment is inversely related to their invasiveness, complexity, and extent of support required. Therefore, nasal prongs and high-flow nasal cannula could be a first-line choice [160]. Venturi mask or mask with reservoir bag are chosen according to the patient’s SpO2 and PaO2/FiO2 ratio. Persistent respiratory distress and/or hypoxemia, which cannot be relieved by high flow oxygen, might necessitate the use of noninvasive ventilation and prone positioning [161,162]. In refractory conditions, the use of endotracheal intubation, a low tidal volume (6–8 ml/kg ideal body weight) lung protective invasive mechanical ventilation, and low-level airway platform pressure ≤ 30 cmH2O, should be done immediately [32]. Thirdly, early identification of patients with severe illness (defined as fever or suspected respiratory infection and respiratory rate >30 breaths/min and/or SpO2 ≤93% in room air and/or severe respiratory distress), and appropriate admission to designated hospital wards or ICUs for further close monitoring is critical. It is noteworthy that the criteria of ICU admission in HF patients is generally the same as the non-HF patients [32,163].
Spontaneous psoas haematoma: a life-threatening complication of anticoagulation in COVID-19. A case series of four episodes
Published in Infectious Diseases, 2021
Verena Zerbato, Alessandro Marco Bozzato, Stefano Di Bella, Mauro Giuffrè, Paola Martingano, Anna Di Giusto, Sofia Battisti, Maria Assunta Cova, Roberto Luzzati, Marco Francesco Maria Cavallaro
A 62-year-old man with hypercholesterolaemia and hypertension was admitted to our hospital for SARS-CoV-2 pneumonia and pulmonary embolism. Anticoagulant therapy with LWMH, antibiotics, and intravenous dexamethasone was started. The patient required 7 d of non-invasive ventilation, and was later de-escalated to Venturi mask oxygen. On day 13 from admission, he experienced an abrupt right low back pain, and haemoglobin levels dropped from 15 to 7.9 g/dL, without hemodynamic instability. An abdominopelvic computed tomography (CT) was performed, and a large right psoas haematoma without signs of active bleeding was found (Figure 1). The patient was treated conservatively with red blood cell transfusions and supportive measures. Anticoagulation therapy was, temporarily, discontinued. He was discharged at home after 30 d of hospital stay with prophylactic LWMH, without further complications.
Pneumocystis jirovecii pneumonia in an immunocompetent patient recovered from COVID-19
Published in Infectious Diseases, 2021
Giulio Viceconte, Antonio Riccardo Buonomo, Amedeo Lanzardo, Biagio Pinchera, Emanuela Zappulo, Riccardo Scotto, Nicola Schiano Moriello, Maria Vargas, Carmine Iacovazzo, Giuseppe Servillo, Ivan Gentile
Ten days after discharge, he started complaining low-grade fever, cough and exertional dyspnoea. Then, 18 d after discharge, the patient was admitted again to our unit. His SpO2 on room-air was 85% and his arterial PaO2 was 54.3 mmHg. Therefore, oxygen therapy with FiO2 60% on Venturi mask was started. On admission, SARS-CoV-2 detection through polymerase chain reaction (PCR) on nasopharyngeal swab tested negative; he had normal blood count, with CD4 + 895/mm3, CD8 + 322/mm3, LDH 440 U/L and CRP 5.8 mg/dL. A HRCT showed remarkable worsening of the ‘ground glass’ pattern (Figure 1(C)). Ceftobiprole 500 mg i.v. TID, oseltamivir 75 mg p.o. BID and levofloxacin 750 mg p.o. QD were then started, with no improvement. Two consecutive beta-D-glucan assays resulted negative.