According to the design of the oxygen delivery device, there are usually three basic styles: low flow, gas storage tank and high flow. Regarding the range of oxygen uptake fraction (FiO2), the oxygen system can be divided into those indicated by low oxygen (<35%), moderate oxygen (35% -60%) or high oxygen (> 60%). Some devices can provide a wide range of oxygen percentages. When choosing an oxygen delivery device or an oxygen mask, the two most important questions that a respiratory therapist must address are: how much oxygen the mask can deliver, and whether the weather-resistant FiO2 delivery is stable, or changes with breathing patterns.

Now we will review different oxygen delivery masks, clinical indications and usage.

1.Use of Nasal Catheters-Low Flow Delivery

The low-flow oxygen delivery system consists of a nasal cannula, a nasal tube, and a tracheal tube. They are designed to provide supplemental oxygen, which is usually less than the patient's total minute ventilation. Because the patient's minute ventilation exceeds the flow rate, the oxygen delivered by the device will be diluted by the ambient air, so less than expected oxygen is inhaled.

A standard nasal cannula provides 24-44% FiO2 at a supply flow of 1-8 liters per minute (LPM). The formula is FiO2 = 20% + (4 x oxygen flow rate). FiO2 is affected by breathing rate, tidal volume, and pathophysiology. The slower the inspiratory flow, the higher the FiO2; the faster the inspiratory speed, the lower the FiO2. Nasal intubation is not recommended for acute severe hypoxemia because the percentage of oxygen delivered is very inconsistent. The patient's upper airway serves as an oxygen reservoir for the nasal catheter. For flow rates greater than 4 LPM, a humidifier is recommended to ensure that the dry inhaled gas is humidified. Nasal intubation is best for patients who have a relatively stable breathing pattern, require a low percentage of oxygen, or require supplemental oxygen during surgery or diagnosis, or for home care.

2.Simple oxygen mask or non-breathing oxygen mask-gas storage system

The gas storage system collects and stores oxygen during inspiration and expiration. When the patient's tiny ventilation flow exceeds the device delivery flow, they can withdraw gas from the reservoir at any time. To increase the oxygen concentration delivered, a mask reservoir is usually used. The volume of the oxygen mask is approximately 100-300 cm3, depending on the size. It can provide 40-60% FiO2 at 5-10 liters. FiO2 is affected by breathing rate, tidal volume, and pathology. Masks are also a good choice for patients with nasal irritation or nasal st or severe breathing. Due to the low humidity delivered and the drying effect of oxygen, a simple oxygen mask should only be used for a few hours. This device is best suited for short-term emergencies, surgical procedures.

When FiO2> 40% is needed and used for acute desaturation, a non-breathable oxygen mask should be used. At flow settings greater than 10 liters, it can deliver up to 90% of FiO2. This device is best suited for acute cardiopulmonary emergencies requiring high FiO2. For patients requiring precise and high oxygen percentages, the device should be used for less than four hours due to insufficient humidity delivery and variable FiO2.

3.Venturi oxygen mask or aerosol mask-high flow delivery

The high-flow oxygen delivery system provides a given oxygen concentration at a flow equal to or exceeding the patient's inspiratory flow requirement. If the delivered flow exceeds the total patient flow, accurate FiO2 delivery can be achieved.

When the venturi hood mixes oxygen with room air, it can produce high-flow oxygen-enriched oxygen at the required concentration. It produces accurate and constant FiO2 with oxygen concentration levels usually set to 24%, 28%, 31%, 35% and 40%, respectively. Venturi hoods are often used when clinicians are concerned about CO2 retention or inconsistent respiratory drive. It is commonly used in the population of patients with COPD, and the risk of knocking out patients with hypoxic drivers needs to be considered.

Depending on the setting, the aerosol-generating device can transfer the content of FiO2 from 21% to 100%. The flow rate is usually set to 10 LPM by adjusting the clips on the top of the aerosol container to select the FiO2 required. A humidity device is connected to the flow meter and a wide-bore tube connects it to the patient's mask. The wide-bore pipe and the gas storage bag are placed in a line to act as an oxygen reservoir to ensure accurate high FiO2 is provided. The device increases the moisture content for patients and helps liquefy residual secretions. This oxygen delivery option is ideal for tracheostomy patients because it allows the inhaled air to be oxygenated, humidified, and even heated if necessary. They can be attached to aerosol masks, tracheostomy masks, and even T-pieces. During inhalation, you should see aerosol spray from the mask or container. To ensure accurate oxygen distribution through this system, an oxygen analyzer should be used. The device can be used to ensure accurate oxygen delivery and maintain humidity in the artificial respiratory tract.

The best oxygen delivery results usually depend on choosing the right oxygen delivery equipment. When choosing an oxygen delivery device, the respiratory therapist should include the following in their recommendations: the goal of the oxygen delivery, the patient's condition and cause, and the performance of the selected device.

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