Time and time again in my practice as an RT I see that there are many nurses that don’t have a clue about oxygen modalities, how to use them or what is appropriate for their patients. Even some critical care nurses. In my nursing classes we did not spend a lot of time on this maybe a day if that. So it is understandable that nurses may not know about oxygen modalities. This is not to say that every nurse doesn’t know about oxygen modalities.

The nasal cannula is a LOW FLOW system which generally speaking can be run up to 6 liters per minute. While u cannot get a specific FIO2 because the FIO2 depends on the rate and debts of the patients breathing, there is the general “rule of 4’s”. 1 liter = 24% 2 liters = 28%, 3 liters = 32% and so on. The nasal cannula can deliver approximately 24 to 45%. It is generally better to humidify flows of 3 or more with a bubbler.

A more recent development is the high flow nasal cannula can be run up to approximately 15 liters and must be humidified with a large refillable water bottle. This is useful for patients who cannot tolerate a mask.

There is also a heated high flow nasal cannula which can provide I believe 45 liters of flow and provides some CPAP like effects. I am not terribly familiar with this modality because we don’t use it in our facility.

The Simple O2 mask is very rarely used in the hospital setting but can deliver between 45 and 60% FIO2 with flows between 6-10 liters respectively. It is a low flow system.

The O2 face tent can deliver approximately 40% FIO2 at 10-12 liters. It is open and well tolerated.

The Venturi mask is a high flow system. High flow system means that the flow can meet a patients inspiration demand. It is an air entrainment device A Venturi mask can deliver an accurate FIO2 due to this air entrainment. It can deliver between 24% and 50% FIO2. With 6-12 liters of oxygen flow.

A partial rebreather mask is basically a non rebreather mask that has had its one way valve removed to the reservoir bag and the flaps taken from the sides of the mask. These masks can deliver approximately 40%- 70% FIO2 with a flow of 10-15 liters

A non rebreather mask can deliver approximately 60-90% FIO2. It is not 100% due to air being sucked in from around the mask. The flow should be at least 10-12 liters per minute although it can be higher. The Non rebreather mask has a reservoir which is approximately 1.5 liters and is covered with a one way valve or flap. A patient on a nonrebrearher cannot rebreathe his own CO2 provided the flow is high enough. I’ve seen patients in non rebreathers in a flow of 5 and the nurse tells me that she is trying to wean the oxygen. Um, no.

CPAP – continuous positive airway pressure. This machine provides continuous positive airway pressure which the patient must breathe out against and it keeps the airways open and provides some PEEP to keep alveoli open. This machine is useful in obstructive sleep apnea and oxygenation issues. depending on the model of the machine oxygen can be bled in or an internal blender can provide up to 100% FIO2.

Bipap. The bipap is a ventilators assist device that can also assist in oxygenation when needed. Bipap provides positive pressure on inhalation and exhalation to augment ventilation
And Oxygenation is non invasive. Some hospitals consider it is life support. Like the CPAP certain models and most modern models can provide up to 100% FIO2. Mask must be snug in order for it to provide benefit. Removing and replacing the mask in the first couple of hours, the patient will not see the alveoli opening benefit. Should be left on for a couple of hours to recruit as many alveoli as possible. This is very useful in the acute phase of CHF until the patient can be helped with a diuretic. It can also be the last step prior to intubation for some patients.