The Use of Oxygen Therapy for Patients Suffering from Acute Cardiac Condition - Essay Example

RUNNING HEAD: Oxygen Therapy Oxygen Therapy Student’s Name Institution’s Name Introduction A number of heart-related diseases have been identified and intensive research made on them. The worst thing about these diseases is that they can cause death if ignored (Nathwani et al., 2002). Any occurrence of these diseases is treated with a lot of concern because of the notion of the potential harm it can cause. For instance New Zealand records more than 5000 deaths annually from cardiac complications (MacNee, 2005). Most of these kinds of diseases are associated by the level of oxygen in the blood and specifically most of them are caused by low oxygen levels in the blood (MacNee, 2005). Therefore most of the treatments employed are associated with oxygen issues. This study intends to examine the usage of oxygen therapies mostly used to treat most patients with cardiac complications. Oxygen therapies have largely been used in combating many cardiac complications (Denniston, O’Brien, & Stableforth, 2002). The rationale behind the usage of oxygen therapies is to try to meet the high oxygen demands by the oxygen-deficient blood of the patients. However, if the therapy is inappropriately applied, it can lead to destructive (Denniston et al., 2002) an effect on the patients and therefore maximum care is needed in practice by most clinicians attending to such patients. There are a number of things that a skilled medical practitioner must confirm, as a general rule, from a patient who allegedly appears to have such complications (Piersen, 2004). First, before prescribing any therapeutic treatment, it is advisable as a rule for all medical practitioners to collect previous medical (Nathwani et al., 2002) history of the patient in question, do various physical tests in an attempt to locate the cause of the current condition of the patient, the typology of the complication and decide which method of treatment that will be most appropriate and too, cost effective. Such tests such as the blood count of red blood cells and heart pulse rates are some of vital diagnostic information that a medical practitioner must first address (O’Neill et al., 2004). Common Oxygen Administering Devices There are a number of ways through which oxygen can be administered to the patient and which are practiced in many medical institutions all over the world. The first one is the use of Reservoir Oxygen Delivery method. This involves a setup of apparatus with a function that facilitates exhaled oxygen to be available during the next inhalation (Jindal & Agarwal, 2007). This is facilitated by the use of special reservoir cannulae. These cannulae occur in two types; the pendant reservoir and the ‘moustache configured Oxymizer. The pendant reservoir is attached to the nasal prongs that have a collapsing chamber that hangs over the chest of the patient. The setting saves considerable amounts of oxygen that would otherwise become wasted (Jindal & Agarwal, 2007). For example, a well attended pendant reservoir can save between 2:1 and 4:1 over a continuous flow of oxygen therapy. The moustache configure oxymizer consists of an apparatus that is set to sit right on the face of the patient. It is almost similar to the pendant reservoir in terms of efficiency. Most studies claim that the two oxygen dispensers save quite similar amounts of oxygen that has not been assimilated by the lungs and one may use any of the two. However, the pendant reservoir is more flexible operationally as it can be adjusted to operate at the rates of 0.25 litres per minute and still achieve oxygen saturation that is provided by most other devices with considerably higher rates, that is, one litre per minute. The two Reservoir Oxygen Delivery practices save a steady amounts of oxygen at the rates between 3:1 and 4:1throughout a steady (Jindal & Agarwal, 2007) flow session even during times of exercise. These two are known as continuous flow systems as oxygen flow is not at all stopped at any one time. The second method is the use of electromechanical devices. These deliver oxygen at the time of breathing in and in an alternating manner; delivery is stopped during exhalation (Jindal & Agarwal, 2007). The devices occur in form of a box that is tightly attached to the oxygen reservoir’s dispensing nozzle where a pre-existing solenoid valve opens during the patient’s inhalation and automatically closes during exhaling. The process continues thus in a rhythmical way. The secret is that the valve senses pressure changes in the breathing enclosure of the patient and consequently responds. The device dispenses 15 to 40 millilitres during each inhalation (Jindal & Agarwal, 2007). An advantage over the reservoir oxygen delivery methods above is evident in terms of the amount of the oxygen saved and thus efficiency. Remarkably, electromechanical device can save oxygen twice as much as that saved by the reservoir oxygen delivery methods and can record a saving rate of 7:1and this explains well the difference in efficiency in view of the other continuous flow systems. In view of its efficiency, most studies suggest that it is a high time the device was adopted by various hospital that emphasize on use of modern efficient equipment. This observation pledges for the need to save the available amount of oxygen in view of experienced medical practitioners and that of the financiers in the medical departments. But what about the high fees tagged to the application of the device? What about the patient’s affordability index? What about his or her point of view? Does it mean that because the device is ultramodern, costly on purchase and sophisticated in terms of maintenance costs that we adopt it on the grounds that the patient pays for these costs while enjoying same amount of oxygen that could just be obtained through the use of the usual continuous flow dispensers? There are also the electronic demand devices that even occur in portable forms and are as well highly efficient but the impact is on the patient as these are too costly (Mbamalu et al., 2007). Besides, various reports from patients say that these devices produce an irritating click sounds at the bed and as a result most patient reject its use on them. This is understandable. Patients deserve comfort that advocate for quick recovery (Inwald et al., 2001) and therefore that one last bit automatically rules these electronic demand devices out. The third method is the use of transtracheal catheters. This takes the form of a slender and delicate tube and unlike in the above methods, this tube is directly inserted into the trachea. Oxygen is then delivered by a tubing attached to the neck (Kallstrom, 2002). This method is by far much effective in the sense that there are no wastages that occurs at the nasopharynx and that the oxygen delivered is pure backed by the reasoning that it never mixes (Kallstrom, 2002) with the atmospheric air thus ensuring maximum care to the patient in this respect. Using this one observation, then the method becomes very important in the treatment of patients at critical stages for example, in a coma, who lack the ability needed to deliver large amounts of oxygen into their lungs. Again, most patients at (Kallstrom, 2002) critical stages of a disease will require supply of large amounts of oxygen supply as this method ensures direct supply of undiluted (Bateman & Leach., 1998) oxygen to the lungs. However, the transtracheal catheters save relatively lower amounts of oxygen that mostly record rate between 2:1 and 3:1. Some studies suggest improvement on saving capacity which can be met by combining it with pulsed oxygen delivery. Most patients find this method uncomfortable (Mbamalu et al., 2007) but what about its effectiveness? Most patients, due to this effect, prefer intratracheal catheter, a modified form of the latter that may not be seen–most patients do not like it when they see the tubing-work across their face as they consider themselves ‘dead’ (Rodriguez-Roisin, 2006; Huang, 2005) and this could exacerbate their health condition – as the tubes can be hidden under the collar (Donner, 2006). Better still, this modification lacks the nasal irritation and is never removed before sleeping. There are a number of disadvantages with the use of this method. With the use of catheters, there is a small risk of infection and occurrence of subcutaneous emphysema. Again, the tubes may be blocked by mucus in the nasal cavity or by the possible secretions in the tracheal groove and thus irritation is more or less unavoidable because the catheters will need cleaning on a daily basis. Transtracheal catheters are largely available in markets all over the world that occur in different forms and prices. Basing on the fact that catheters may be the only applicable method in some cases especially when a patient requires large supplies (Huang, 2005) of oxygen with high concentrations, it is a method that may be unavoidable in many medical institutions, especially for facilitating intensive care for the patients (O’Neill et al., 2004). Conclusion Most of cardiac diseases emanate from low oxygen content in the blood and this necessitates oxygen prescriptions for patients suffering from such complications. Each of the three methods of administering oxygen into a patient discussed above suits well to a particular purpose given existence of particular limiting factors such as financial, efficiency and effectiveness, and to a lesser extent, the comfort zone of the patient (Higgins et al., 2007). A particular medical institution can weigh them in accordance to the reality on the ground and take the best option. However, in some cases, it should be noted that life of the patient cannot be chanced with and therefore such devices as catheters should be a priority (Brokalaki et al., 2004). Besides, medical departments are characterized by professions with extra hospitality, beyond personal concern (Brokalaki et al., 2004). References Bateman, N.T., & Leach, R.M. (1998). ABC of oxygen: acute oxygentherapy. BMJ, 317, 798- 801. Brokalaki, H., Matziou, V., Zyga, S., Kapella, M., Tasaras, K., Braokalaki, E., et al. (2004). Omissions and errors during oxygen therapy of hospitalised patients in a large city of Greece. Intensive Crit Care Nurs. 20, 352-357. Denniston, A.K., O’Brien, C., & Stableforth, D. (2002). The use of oxygen in acute exacerbations of chronic obstructive pulmonary disease: a prospective audit of pre- hospital and hospital emergency management. Clin Med. 2, 449-51. Donner, C.F. (2006). Acute exacerbation of chronic bronchitis: need for an evidence-based approach. Pulm Pharmacol Ther. 19, 4-10. Higgins, R.D., Bancalari, E., Willinger, M., & Raju, T.N. (2007). Executive summary of the workshop on oxygen in neonatal therapies: controversies and opportunities for research. Pediatrics. 119, 790-796.108. Huang, Y.C. (2005). Monitoring oxygen delivery in the critically ill. Chest. 128(5 suppl. 2), 554S-560S. Inwald, D., Ronald, M., Kuitert, L., McKenzie, S.A., Petros, A. (2001). Oxygen treatment for acute severse asthma. BMJ. 323, 98-100. Jindal, S.K., & Agarwal, R. (2007). Oxygen Therapy. New Delhi: Jaypee Brothers Medical Publishers Ltd. Kallstrom, T.J. (2002). AARC Clinical Practice Guideline: oxygentherapy for adults in the acute care facility – 2002 revision and update. Respir Care. 47, 717-20. MacNee, W. (2005). Prescription of oxygen: still problems after all these years. Am J Respir Crit Care Med. 172, 517-518. Mbamalu, D., Banerjee, A., Hinchley, G., & Idowu, A. (2007). How much do new junior doctors in emergency medicine understand about oxygen therapy? Br J Hosp Med (Lond). 68, 156- 157. Nathwani, D., Williams, F., Winter, J., Ogston, S., & Davey, P. (2002). Use of indicators to evaluate the quality of community- acquired pneumonia management. Clin Infect Dis. 34, 318-23.106 O’Neill, B., Bradley, J.M., McKevitt, A.M., Heaney, L., Riley, M, McGovern, V. et al. (2004). Prescribing practice for intermittent oxygen therapy: a GP survey. Chron Respir Dis. 1, 139-142. Piersen, D.J. (2004). Translating new understanding into better care for the patient with chronic obstructive pulmonary disease. Respir Care. 49, 99-109. Rodriguez-Roisin, R. (2006). COPD Exacerbations. Thorax. 61,535-44. APPENDIX The following table shows differing opinions on the best method of oxygen therapy application. Argument Bateman et al, 1998 Inwald et at, 2001 Kallstrom, 2002 O’Neill et al, 2004 Mbamalu et al, 2007 Reservoir oxygen delivery methods Best for non- critical stages of the patient. However, modifications needed to improve oxygen saving capacity. Easy to avoid risk of further internal infections. Unsightly but comfortable to the patient’s other feelings. The low cost of maintenance does not impact negatively on the patient. Applicable in many medical institutions. The most flexible and available, although wasteful in terms of oxygen spillages. Wasting a lot of oxygen (relatively). Air contaminate thus not good for patients requiring large & pure doses. Rather cheap. Simple in operation and comfortable to patients. Relatively not effective in saving oxygen. Important for non-critical patients. Technologically readily available all over the world Electromechanical methods May not be technologically available in some countries or areas – needing some source of energy and some skills. Rather efficient and effective in saving oxygen. Maintenance cost is high but the most efficient in saving oxygen. Cost impacts negatively on the patient financially. Not laborious, but possible atmospheric air contaminating oxygen, costly. Efficient in saving oxygen Internal infection not likely. Highly effective in oxygen saving. Popularity low due to availability of alternatives. High oxygen saving rating. Requiring some special skills. Catheters More effective on critical patients. . No concerns of oxygen saving rate. Not comfortable on patients. Important for critical patients. No concerns of oxygen saving. Not so much oxygen saving but most effective on patients requiring intensive care. Not comfortable on many patients but exceptionally important for critical stages of cardiac and respiratory complications. No contamination, no dilution of oxygen on the way. Rather costly but inevitable in some special cases. Efficient in critical complications of the patient. Likely to cause further internal infections, laborious. Not laborious yet more effective and unavoidable in some situations. Read More