Oxygen Therapy: Systems and Indications in the Pediatric and Adult Population
Cristina García-Muro, Moisés Alejandro Alatorre-Jiménez, Vickramjeet Johal, Alejandro Marín-Medina, Ramandeep Kaur, Eduardo Esteban-Zubero
Abstract
Hypoxemia is defined as the decrease in arterial partial pressure of oxygen (PaO2) below 80 mmHg. One of the ways to alleviate this condition is through oxygen therapy, which consists of administering oxygen at a concentration higher than atmospheric. This therapy is indicated in various pathologies and is aimed to treat hypoxemia and reduce the patient's myocardial demand and respiratory effort. Classically, this treatment has been carried out using low-flow systems, in which the inspiratory fraction of oxygen (FiO2) cannot be regulated. However, an increase in the use of high-flow oxygen therapy (HFO) has been observed in recent years. These systems allow for greater patient comfort as well as more precise regulation of the FiO2.
The purpose of this article is to review respiratory physiology to understand respiratory failure from a clinical and pathophysiological point of view. Likewise, the different oxygen therapy systems most widely used are discussed, as well as their indications for acute and chronic pathologies, both in the pediatric and adult populations.
Keywords
References
1. Walsh BK, Smallwood CD. Pediatric Oxygen Therapy: A Review and Update. Respir Care. 2017;62(6):645-61. doi: 10.4187/respcare.05245.
2. Bach J. A Quick Reference on Hypoxemia. Vet Clin North Am Small Anim Pract. 2017;47(2):175-9. doi: 10.1016/j.cvsm.2016.10.004.
3. Sharma G, Goodwin J. Effect of aging on respiratory system physiology and immunology. Clin Interv Aging. 2006;1(3):253-60. doi: 10.2147/ciia.2006.1.3.253.
4. Baumgardner JE, Hedenstierna G. Ventilation/perfusion distributions revisited. Curr Opin Anaesthesiol. 2016;29(1):2-7. doi: 10.1097/ACO.0000000000000269.
5. Vo P, Kharasch VS. Respiratory failure. Pediatr Rev. 2014;35(11):476-86. doi: 10.1542/pir.35-11-476.
6. Sowho M, Amatoury J, Kirkness JP, Patil SP. Sleep and respiratory physiology in adults. Clin Chest Med. 2014;35(3):469-81. doi: 10.1016/j.ccm.2014.06.002.
7. Hegewald MJ, Crapo RO. Respiratory physiology in pregnancy. Clin Chest Med. 2011;32(1):1-13. doi: 10.1016/j.ccm.2010.11.001.
8. Sebastian JC. Respiratory physiology and pulmonary complications in obesity. Best Pract Res Clin Endocrinol Metab. 2013;27(2):157-61. doi: 10.1016/j.beem.2013.04.014.
9. Sandberg C, Naylor J. Respiratory physiology at altitude. J R Army Med Corps. 2011;157(1):29-32. doi: 10.1136/jramc-157-01-05.
10. Hughes JM. Assessing gas exchange. Chron Respir Dis. 2007;4(4):205-14. doi: 10.1177/1479972307084446.
11. Cettolo V, Francescato MP. Assessing breath-by-breath alveolar gas exchange: is the contiguity in time of breaths mandatory? Eur J Appl Physiol. 2018;118(6):1119-30. doi: 10.1007/s00421-018-3842-y.
12. Schäffer T. Respiratory physiology in sleep and wakefulness. Handb Clin Neurol. 2011;98:371-81. doi: 10.1016/B978-0-444-52006-7.00024-1.
13. Friedman ML, Nitu ME. Acute Respiratory Failure in Children. Pediatr Ann. 2018;47(7):e268-e273. doi: 10.3928/19382359-20180625-01.
14. Lamba TS, Sharara RS, Singh AC, Balaan M. Pathophysiology and Classification of Respiratory Failure. Crit Care Nurs Q. 2016;39(2):85-93. doi: 10.1097/CNQ.0000000000000102.
15. Yeo EJ. Hypoxia and aging. Exp Mol Med. 2019;51(6):1-15. Published 2019 Jun 20. doi: 10.1038/s12276-019-0233-3.
16. Hanley ME, Bone RC. Acute respiratory failure. Pathophysiology, causes, and clinical manifestations. Postgrad Med. 1986;79(1):166-76. doi: 10.1080/00325481.1986.11699244.
17. Markou NK, Myrianthefs PM, Baltopoulos GJ. Respiratory failure: an overview. Crit Care Nurs Q. 2004;27(4):353-79. doi: 10.1097/00002727-200410000-00006.
18. Roussos C, Koutsoukou A. Respiratory failure. Eur Respir J Suppl. 2003;47:3s-14s. doi: 10.1183/09031936.03.00038503.
19. Adler D, Janssens JP. The Pathophysiology of Respiratory Failure: Control of Breathing, Respiratory Load, and Muscle Capacity. Respiration. 2019;97(2):93-104. doi: 10.1159/000494063.
20. Miller PE, van Diepen S, Ahmad T. Acute Decompensated Heart Failure Complicated by Respiratory Failure. Circ Heart Fail. 2019;12(5):e006013. doi: 10.1161/CIRCHEARTFAILURE.119.006013.
21. Khan FA, Chitkara RK. Complications of acute respiratory failure. Postgrad Med. 1986;79(1):205-14. doi: 10.1080/00325481.1986.11699247.
22. McDonald CF, Blyth CM, Lazarus MD, Marschner I, Barter CE. Exertional oxygen of limited benefit in patients with chronic obstructive pulmonary disease and mild hypoxemia. Am J Respir Crit Care Med. 1995;152(5 Pt 1):1616-9. doi: 10.1164/ajrccm.152.5.7582304.
23. Eaton T, Garrett JE, Young P, Fergusson W, Kolbe J, Rudkin S, et al. Ambulatory oxygen improves quality of life of COPD patients: a randomised controlled study. Eur Respir J. 2002;20(2):306-312. doi: 10.1183/09031936.02.00301002.
24. Khor YH, Renzoni EA, Visca D, McDonald CF, Goh NSL. Oxygen therapy in COPD and interstitial lung disease: navigating the knowns and unknowns. ERJ Open Res. 2019;5(3):00118-2019. doi: 10.1183/23120541.00118-2019.
25. Zieliński J. Long-term oxygen therapy in conditions other than chronic obstructive pulmonary disease. Respir Care. 2000;45(2):172-7.
26. Sandoval J, Aguirre JS, Pulido T, et al. Nocturnal oxygen therapy in patients with the Eisenmenger syndrome. Am J Respir Crit Care Med. 2001;164(9):1682-7. doi: 10.1164/ajrccm.164.9.2106076.
27. Moran F, Bradley JM, Piper AJ. Non-invasive ventilation for cystic fibrosis. Cochrane Database Syst Rev. 2017;2(2):CD002769. doi: 10.1002/14651858.CD002769.pub5.
28. Arias MA, García-Río F, Alonso-Fernández A, Sánchez AM. [Sleep apnea-hypopnea syndromes and heart failure]. Rev Esp Cardiol. 2007;60(4):415-27.
29. Luna Paredes MC, Asensio de la Cruz O, Cortell Aznar I, Martínez Carrasco MC, Barrio Gómez de Agüero MI, Pérez Ruiz E, et al. [Oxygen therapy in acute and chronic conditions: Indications, oxygen systems, assessement and follow-up]. An Pediatr (Barc). 2009;71(2):161-74. doi: 10.1016/j.anpedi.2009.05.012.
30. Barjaktarevic I, Cooper CB. Supplemental Oxygen Therapy for Patients with Chronic Obstructive Pulmonary Disease. Semin Respir Crit Care Med. 2015;36(4):552-66. doi: 10.1055/s-0035-1556058.
31. Balfour-Lynn IM, Primhak RA, Shaw BN. Home oxygen for children: who, how and when? Thorax. 2005;60(1):76-81. doi: 10.1136/thx.2004.031211.
32. Kallstrom TJ; American Association for Respiratory Care (AARC). AARC Clinical Practice Guideline: oxygen therapy for adults in the acute care facility--2002 revision & update. Respir Care. 2002;47(6):717-20.
33. Pilar-Orive FJ, López-Fernández YM. Oxigenoterapia de alto flujo. An Pediatr Contin. 2014;12(1):25-9. doi: 10.1016/S1696-2818(14)70163-5.
34. MacIntyre NR. Supporting oxygenation in acute respiratory failure. Respir Care. 2013;58(1):142-50. doi: 10.4187/respcare.02087.
35. Gotera C, Díaz Lobato S, Pinto T, Winck JC. Clinical evidence on high flow oxygen therapy and active humidification in adults. Rev Port Pneumol. 2013;19(5):217-27. doi: 10.1016/j.rppneu.2013.03.005.
Submitted date:
03/15/2020
Reviewed date:
03/22/2020
Accepted date:
04/06/2020
Publication date:
07/18/2020