Photo Toshiro Kandagawa, who died = Taken in August 1995
Toshiro Kandagawa dies Corona infection, found to have collapsed at a store ... Popular with "Iron Chef" and commercials, 81 years old
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He was receiving treatment such as oxygen inhalation and Avigan administration.
Appeared in many media including the Fuji TV-based cooking confrontation program "Iron Chef", which was a big hit in the 1990s, and was light ... → Continue reading
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Oxygen therapy is performed to enhance arterial blood oxygen carrying capacity and improve tissue hypoxia for the purpose of treating and preventing hypoxemia. for that reason,Respiratory failureだ け で な く,anemia,Myocardial infarctionCirculatory failure such asTrauma,septicemiaApplicable even when tissue metabolism is increased.
The indications for oxygen therapy are:
- Indoor air PaO2 <60 Torr, SaO2 <90% or PaO2And/or SaO2Is below the preferred range for special clinical situations
- Suspected hypoxemia
- Severe trauma
- acuteMyocardial infarction
- Short-term treatment (eg recovery from anesthesia)
Oxygen inhalation in acute care
The primary purpose of oxygen therapy is inhaled oxygen concentration (FiO2) Increase the arterial bloodOxygen partial pressure(PaO2) Is normal, and sufficient oxygen is supplied to the tissue. Also, the alveolar oxygen partial pressure (PAO2) Is less than 70 mmHg, causing hypoxic pulmonary vasospasm,Pulmonary hypertensionOne of the objectives is to prevent this because it can cause illness.
Equipment and instruments
The oxygen supply device is divided into a low flow rate and a high flow rate according to the inspiratory flow rate and the oxygen supply flow rate of the patient. Low flow rate is a general oxygen supply method that is economical and less invasive. On the other hand, for those with a high flow rate, the oxygen supply flow rate is set higher than the patient inspiratory flow rate, so there is no mixing of the atmosphere, and the set FiO2Can be maintained.
There are three types of inhalation devices: nasal cannula (often called nasal), simple face mask, and face mask with reservoir (a water bag for humidification is placed in the immediate vicinity of the mask). Is often used. Inhaled oxygen concentration (FiO2) Is shown in the table below.
|For nasal cannula||In case of oxygen mask||In case of mask with reservoir|
|100% oxygen flow rate (l/min)||FiO2(%)||100% oxygen flow rate (l/min)||FiO2(%)||100% oxygen flow rate (l/min)||FiO2(%)|
When supplying a higher flow rate of oxygen,High flow nose cannula(HFNC, so-called Nasal high flow), Venturi mask or Inspiron nebulizer.. With the high-flow nasal cannula, it is possible to maintain a high FiO90 of over 2% from the nasal cannula by heating and humidifying the inhaled air, and it is possible to set the FiO2 to an arbitrary degree to some extent... The venturi mask has a diluter (coma) that is color-coded for each set oxygen concentration.2 Can be set from 24 to 50%.. The Inspiron nebulizer can supply highly humidified oxygen humidified with a sterilized water bottle, and the oxygen concentration is adjusted with a dial.
- J024 Oxygen inhalation
Due to medical fees, oxygen inhalation at medical institutionstreatmentIt is divided into.
Diving accidentBystanderOxygen supply by
Although not mentioned in the above indications,Decompression sickness(DCS) andArterial air embolismIt is said that oxygen administration is also effective for (AGE). Eventually for these obstaclesHyperbaric oxygen therapyHowever, on-site atmospheric oxygen breathing (NBO)First aidIs recommended as. This is based on the following grounds.
- Overpass in peripheral tissuesSaturationIn the peripheral blood vesselsバ ブ ルIt is said that it takes 30 minutes to 1 hour after the decompression is completed to form the bubbles, and the bubbles injuring the peripheral tissues gradually increase. Breathing 100% oxygen replaces the air in the lungs with total oxygen within a few minutes, and within 30 minutes the nitrogen in the arterial blood (78%) becomes an oxygen window.[Note 1]By theory, it is replaced by oxygen. The hyperbaric oxygen therapy is more effective because the total pressure of the bubbles also rises and the pressure gradient further increases.
- As a result, excess nitrogen in the peripheral tissues is expelled to the venous blood side through the capillary wall, preventing the increase of bubbles and replacing the already formed bubbles with oxygen to reduce the bubbles.
- Bubbles block peripheral blood flow,White blood cell,lymphocytesWas involvedRed blood cellCaused by aggregation. When the oxygen partial pressure is high, hemagglutination can be prevented.
On-site NBO implementation has already been successful in Europe and the United States. For exampleDAN EuropeIn the study conducted in (3.7), only 60.8% of the patients in the non-NBO group had remission or disappeared before the start of recompression treatment, compared with XNUMX% in the NBO group. However, in Japan, it is pointed out that too few divers are qualified to carry out NBO onsite.
Unlike on-site administration of oxygen in on-site NBO, demand-based equipment is often used due to the limited supply of oxygen. Also,Hyperbaric oxygen therapySince it has a strong personality as a first aid until it becomes possible, it is also a feature that highly concentrated oxygen administration is recommended. However, given the risk of oxygen-induced lung injury, DAN guidelines require NBO not to exceed 6 hours. Also, on-site NBO,Cave divingOxygen administration under high environmental pressure is also assumed, soOxygen poisoningIt should also be noted.
Oxygen inhalation in chronic care
RespiratorPatients with diseases need to inhale a high concentration of oxygen for a long period of time, so inhale oxygen while living at home under the prescription of a doctor.Home oxygen therapy(British: home oxygen therapyHOT) is being done. This requires strict management, such as a short-term hospitalization of a medical institution and adjusting the oxygen flow rate by adjusting the oxygen flow rate while measuring the oxygen gas concentration in arterial blood. In addition, oxygen can be inhaled with a portable device even when the user is out.
Equipment and instruments
There are the following devices for producing oxygen for home and mobile use.
- Oxygen concentrator
- running costThe electricity cost, rental fee (generated according to medical expenses borne by you), and running cost are lower than oxygen cylinders. It is common to use a high-concentration oxygen concentrator at home and a portable oxygen bottle when going out.
- Portable oxygen generator
- Liquid oxygenThe gas oxygen is supplied by gradually vaporizing. Since it does not use electricity, it does not cost electricity and can be used even during a power outage. In addition, it becomes possible to administer high-concentration/high-flow oxygen... There is a device that puts two kinds of drugs and water in a dedicated plastic bottle to generate 100% oxygen for about 10 minutes. In recent years, as a countermeasure against terrorism, instruments such as oxygen cylinders that generate oxygen cannot be brought in as baggage for safety reasons. However, the portable oxygen generator that reacts this drug with water is the only oxygen generator that can be mounted on an aircraft, and is suitable for mountaineering and traveling to high altitudes.altitude sicknessIt is an essential tool for prevention. Previously, technology was required to transfer and fill liquid oxygen,Sun sunshineHas developed and rented "Hotaru" that can be filled and operated easily and safely..
- Liquid oxygen container
- Generally, a container filled with liquid oxygen is called a "liquid oxygen container" or a "liquid acid container". This involves various dangers such as frostbite, so permission and use training are required when installing it at home. In recent years it has become easier to uselife lineSince it is not affected by, the use cases are increasing. Use a liquid acid container at home and a portable liquid acid container by yourself when you go out, or use a portable oxygen bottle. Electricity is only for batteries.
- Portable oxygen bottle (oxygen bottle)
- It is a high-pressure gas container filled with gaseous oxygen used when going out. When it is empty, refill it with a professional packing company and use it. Oxygen bottle in JapanOxygen cylinderSometimes called. Aluminum containers for medical useFiberglass,Carbon fiberThere are many things that are wrapped around, and are lightly permitted to be brought into the aircraft (notification required). Some portable oxygen bottles can be filled at home (in Japan,High Pressure Gas Safety ActCannot be used according to the regulations of.) It is generally used by using a device called a breathing synchroniser (demand valve, Sanso saver) that puts out or stops oxygen according to breathing. Medical gas containing oxygen is a pharmaceutical product, so it is not possible to supply it without going through a medical institution.Pharmaceutical Affairs LawProhibited by Disposable small oxygen cylinders filled with oxygen in aluminum cans are also on the market, and an oxygen valve is connected to adjust the flow rate, but it can only be used for an extremely short time (about 9 minutes).
- Portable liquid oxygen container
- It is a container for carrying liquid oxygen under normal pressure when going out. Compared to the size of portable oxygen cylinders, most of them are smaller and lighter, and you can go out for a longer time than portable oxygen cylinders. In recent years, its portability and merits of being able to use it for a long time and more convenient use have become possible, and the number of examples of use is increasing (cannot be brought into an aircraft). The disadvantage is that oxygen is made into a liquid state at a low temperature.thermosAs it is stored in a container with such a structure, it gradually evaporates even if it is not used, so the storage time is about 57 days in Helios Reservoir and about 18 hours in Helios Portable.
- Oxygen generator/oxygen can (oxygen spray)
- An oxygen generator is a device that puts a tablet in water to generate oxygen by a chemical reaction with water, but once the reaction starts, it can not be stopped and the usable time is short, and the oxygen can is generally The spray can used is filled with oxygen, often with a mask covering the mouth, and is not suitable for continuous use. It is generally used when you feel sick temporarily.
No fire is allowed (minimum 2 m, preferably 5 m range) when using any container or device. However, there are many fire accidents due to cigarettes, mosquito coils, oil stoves, electric stoves, etc.
Be cautious about oxygen inhalationSide effectsas,Premature babyInRetinopathy of prematurityBlindness, chronicRespiratory failureIn the patientCarbon dioxide narcosisIf you have spontaneous breathing and consciousness disorder. In addition, oxygen intoxication and absorbable atelectasis due to long-term inhalation of high concentration oxygen may occur,Active oxygenThere is also a theory that there are adverse effects in some cases in order to increase. For this reason, medical institutions strictly control the oxygen concentration to prevent an excessive blood oxygen concentration.
- ^ Oxygen windowThe term means that there is a difference between the total pressure of alveolar air and arterial/venous blood due to the oxygen consumption in the tissue. This increases in proportion to the partial pressure of oxygen breathing, so oxygen inhalation When the oxygen window between the lung and the tissue increases due to the increase in the pressure gradient between the bubble and the tissue, the diffusion of gas is promoted and the bubble shrinks.
- ^ "What is the purpose of oxygen therapy? What kind of patients are indicated?”. Nursing roo! (December 2016, 12). 2020/3/25Browse.
- ^ Kallstrom TJ (2002). “AARC Clinical Practice Guideline: Oxygen thrapy for adults in the acute care facility-2002 revision & update.”. Respir Care 47 (6): 717-720. PMID 12078655.
- ^ a b c "How do I choose an oxygen therapy device (mask, cannula, etc.)?”. Nursing roo! (December 2017, 1). 2020/3/25Browse.
- ^ Japan Palliative Care Society Palliative Care Guideline Development Committee “Guidelines for Relief of Respiratory Symptoms in Cancer Patients (2016 Edition)” p.37 Published June 2016, 6, Kanehara Publishing Co., Ltd.
- ^ [Broken link]
- ^ "Rental of portable liquid oxygen device "Hotaru" for home oxygen therapy started”. Gaspedia (February 2016, 2). 2020/3/25Browse.
- Hironori Oiwa "New Diving Medicine" Underwater Modeling Center, 2003