Oxygen Delivery Devices 
Low Flow Devices
 • Nasal ...

Oxygen Delivery Devices 

Low Flow Devices

 • Nasal cannula: FiO2 24-40%. Easy to administer but highly variable flow/FiO2 relationship. Keep flow <6. Humidify if >4L

 • Oxymizer: FiO2 24-45%. Primary function is to conserve oxygen, but can deliver slightly higher FiO2 than NC

 • Simple facemask: FiO2 35-50%. Keep flow >5L to avoid rebreathing trapped CO2 in mask, only short-term

 • Shovel mask: FiO2 24-50%. Difficult to control FiO2 - consider in patients with stable need for O2 who do not tolerate NC

 • Non-rebreather: easily accessible – consider starting with this for the acutely hypoxemic patient

     o Theoretically delivers 100% FiO2, but true delivery 60-90% FiO2 due to entrainment of room air

     o Air entrainment is increased (true FiO2 lower) when patient is tachypneic or drawing large tidal volumes

     o Flow should be set >10L to adequately fill the reservoir

High Flow Devices

 • Venturi mask: FiO2 24-50%. Delivers a fixed FiO2 independent of RR, tidal volume. Flow rate decreases with increasing FiO2. Consider for patients who need more careful titration of oxygen, as in COPD patient with specific SpO2 goals. NOT for use in acute respiratory distress.

 • High-Flow Nasal Cannula (HFNC): Delivers up to 100% FiO2 (when mouth is closed) at flow rates 10-60 L / min and provides small amount of PEEP (approximately 0.7 cmH20 / L) when patient’s mouth is closed

     o Some evidence for ↓90-day mortality vs. NIPPV for pts with hypoxemic respiratory failure not due to pulmonary edema or obstructive lung disease (NEJM 2015;372:2185)

     o Decreases intubation rate but no change in mortality in immunocompromised pts

     o Extubation to HFNC equivalent to extubation to NIPPV in terms of reintubation rate

     o Consider use in pure hypoxemic respiratory failure

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MGH White Book Manual
Account created for the MGH Internal Medicine Housestaff Manual "White Book" - https://stk10.github.io/MGH-Docs/WhiteBook-2019-2020.pdf

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