Oxygen therapy in Covid-19 adult and pediatric patients

Oxygen therapy is the administration of additional oxygen given to patients :

• Severe Acute Respiratory Infection.
• Respiratory distress.
• Hypoxemia.
• Shock with a SpO target > 94%.

During oxygen therapy, SpO² monitoring must be carried out.

Emergency signs that require oxygen therapy :

• SpO² < 94%.
• Obstruction or not breathing.
• Respiratory distress.
• Central cyanosis.
• Signs of shock (acral cold, Capilary Refill Time > 3 seconds, pulse is weak and fast).
• Loss of consciousness.
• Convulsions.
• Signs of dehydration (lethargy, skin tugor slows).

Algorithm for enhancing supportive respiratory therapy.

Indication of giving oxygen therapy ➡ giving oxygen therapy ➡ (Monitor if SpO² fails to respond) ➡ Start intubation if there is an indication ➡ Intubation and Invasive Mechanical Ventilation

Indications for oxygen therapy ➡ Oxygen therapy ➡ (Monitor if SpO² fails to respond) ➡ Considered in patients with mild-moderate degree and without hypercapnia, normal mental status, stable hemodynamics ➡ Non-Invasive Ventilation ➡ Intubation and Invasive Mechanical Ventilation

Indications for oxygen therapy ➡ Oxygen therapy ➡ (Monitor if SpO² fails to respond) ➡ Considered in patients with mild-moderate degree and without hypercapnia, normal mental status, hemodynamically stable ➡ High Flow Nasal Cannula ➡ Intubation and Invasive Mechanical Ventilation

Indications for oxygen therapy ➡ Oxygen therapy ➡ (Monitor if SpO² fails to respond) ➡ Considered in patients with mild-moderate degree and without hypercapnia, normal mental status, stable hemodynamics ➡ Bubble Continuous Positive Airway Pressure ➡ Intubation and Invasive Mechanical Ventilation

Oxygen therapy in adults.

• Put the prongs in the nostril, hook it behind the ear. Flow > 5 lpm can cause dry mucosa.
• Make sure the mask covers the nose and mouth. Pull the rubber over the head.
• Make sure the bag is full to deliver high-flow oxygen concentrations.

• Start by giving 5 lpm oxygen.
• Use nasal prongs.
• Monitor response.

➡ If the increase in respiratory distress or SpO² < 90%

• Use a face mask.
• Increase oxygen from 6-10 lpm.
• Monitor response.

➡ If the increase in respiratory distress or SpO² < 90%

• Use a face mask with a reservoir.
• Increase oxygen 10-15 lpm.
• Make sure the bag is inflated.
• Call a doctor for help.
• Monitor response.

➡ If the increase in respiratory distress or SpO² < 90%, transfer to the hospital with an invasive mechanical ventilator facility

• Tracheal intubation may be needed.
• Start manual ventilation (bagging) with high flow oxygen.

Estimated FiO² when administering oxygen :

• O² Speed ​​2-4 L / min ~ FiO² 0,28-0,36
• Speed ​​O² 5 L / min ~ FiO² 0,40
• Speed ​​O² 6-10 L / min ~ FiO² 0,44-0,60
• Speed ​​O² 10-15 L / min ~ FiO² 0,60-0,95

If respiratory distress and hypoxemia fail to be corrected even with the use of adequate oxygen therapy aids, use the ABCDE Basic Emergency Care assessment quickly.

If there is a mental status disorder in the patient even though SpO² > 90%, consider :

• Airway management, ventilation preparation if needed, no need to wait until the patient's blood gas analysis comes out.
• Check AGD if it is not available to evaluate ventilation. Patients with acute respiratory acidosis from carbon dioxide (CO²) retention cannot be detected only with SpO.
• Consider alternative causal disorders of mental status and treat them (eg hypoglycemia, electrolyte disturbances and disorders of the central nervous system).

Oxygen therapy in children.

• Nasal cannula is fixed with tape on the right and left cheeks near the nose.
• Oxygen therapy using nasal cannulas is preferred for infants and children < 5 years old with hypoxemia.

Oxygen therapy is given at ➡

• SpO² < 90% in children with respiratory distress alone.
• SpO² < 94% in children with emergency signs with or without respiratory distress.

Oxygen therapy is started using nasal kanul at flow velocity ➡

• 0.5-1 lpm for neonates.
• 1-2 lpm for infants.
• 2-4 lpm for older children.
• Oxygen therapy uses a suitable face mask with a speed of 4 lpm to reach SpO ≥ 94%.

In conditions of persistent hypoxemia even with adequate oxygen flow :

• Start Continuous Positive Airway Pressure if available.
• Start administering oxygen from the second source by using a face mask with a reservoir bag.