The use of oxygen in medicine. Oxygen in medicine - oxygen cartridges for individual use - areas of activity - catalog of articles - intermo2 oxygen company. Ways to store oxygen

Indications and contraindications.

Indications for the use of oxygen are diverse. The main ones are general and local hypoxia of various genesis, as well as the tension of the compensatory reactions of the body to the fall of pO 2 in the surrounding gaseous environment (for example, low barometric pressure at high altitudes, a decrease in pO 2 in the atmosphere of an artificial habitat). In clinical practice, the most common indications for the use of oxygen are respiratory failure in diseases of the respiratory system and hypoxia caused by circulatory disorders in cardiovascular diseases (circulatory hypoxia). Clinical signs that determine the appropriateness of using inhaled oxygen therapy in these cases are cyanosis, tachypnea, metabolic acidosis; laboratory indicators - a decrease in pO 2 in the blood to 70 mm Hg. Art. and less, hemoglobin saturation with oxygen is less than 80%. Oxygen therapy is indicated for many poisoning, especially carbon monoxide.

The efficiency of oxygen use is not the same for different mechanisms of hypoxia. It has the best effect when the oxygen content in the atmosphere is low, for example, in high mountains, and when alveolocapillary oxygen diffusion in the lungs is impaired. A lesser effect is observed with hemic forms of hypoxia (for example, with anemia). Oxygen therapy is practically ineffective in histotoxic hypoxia, as well as in hypoxemia and hypoxia caused by venoarterial blood shunting (for example, with congenital defects of the heart septa).

Oxygen therapy is often given to patients with heart and respiratory failure in order to restore the therapeutic effect of a number of drugs that decrease under conditions of hypoxia (cardiotonic action of cardiac glycosides, diuretic effect of diuretics). It is also used for improve the function of the liver and kidneys with lesions of these organs, to enhance the effect of cytostatic and radiation therapy in malignant neoplasms. Indications for the local use of oxygen, in addition to local hypoxia, are local trophic disorders against the background of vascular lesions, sluggishly flowing inflammatory processes, wounds infected with anaerobic flora.

Absolute There are no contraindications for the use of oxygen, however, the choice of method and technique of its implementation should correspond to the individual characteristics of the patient (age, nature of the pathological process) in order to avoid complications.

Types and methods of oxygen therapy.

Depending on the route of oxygen administration, oxygen therapy is divided into two main types: inhalation (pulmonary) and non-inhalation.

Inhalation oxygen therapy includes all methods of introducing oxygen into the lungs through the respiratory tract.

Non-inhaled oxygen therapy combines all extrapulmonary methods of oxygen administration - enteral, intravascular (including using a membrane oxygenator), subcutaneous, intracavitary, intraarticular, subconjunctival, cutaneous (general and local oxygen baths).

A separate type of application of oxygen - hyperbaric oxygenation, which combines the features of inhalation and non-inhalation methods and is essentially an independent method of treatment.

Inhalation of oxygen and oxygen mixtures- the most common method of oxygen therapy, used in both natural and mechanical ventilation. Inhalations are carried out using various oxygen-respiratory equipment through nasal and oral masks, nasal catheters, endotracheal and tracheostomy tubes; one of the common methods of inhaling oxygen is through nasal cannulas inserted into the patient's nostrils. In pediatric practice, oxygen tents are used.

Depending on the nature of the disease, as well as on the conditions and duration of oxygen therapy, either pure oxygen or gas mixtures containing 30-80% oxygen are used for inhalation. Inhalation of pure oxygen or its 93-95% mixture with carbon dioxide (carbogen) is indicated for carbon monoxide poisoning.

Usually, oxygen therapy is used from cylinders in which it is stored in a compressed state, or from a centralized oxygen supply system to hospital wards, which allows oxygen to be supplied directly to breathing apparatus, with the help of which gas mixtures are selected that are optimal in terms of oxygen concentration.Medical oxygen generators CANGAS of the MHC series allow you not to depend on the supply of oxygen. Now it is possible to produce your own oxygen directly in medical facilities.

Oxygen pads are now rarely used (as a home emergency) for oxygen therapy. The safest and most effective inhalation of gas mixtures with an oxygen concentration of 40-60%. In this regard, many modern oxygen therapy inhalers have injection devices that suck in air and dosimeters that allow the use of an enriched oxygen mixture, rather than pure oxygen.

Inhalation of oxygen mixtures is carried out continuously or in sessions of 20-60 minutes. A continuous regimen of oxygen therapy is preferable with the obligatory provision of sufficient ventilation, as well as warming and humidifying the inhaled mixture, because. normal drainage and protective functions of the respiratory tract occur only in conditions of almost 100% humidity. If oxygen is inhaled under a tent or through a nasal mask, i.e. gas passes through the mouth, nose and nasopharynx, then additional moisturizing is not required, because. it is sufficiently moistened in the respiratory tract.

With prolonged oxygen therapy, especially if oxygen is supplied through deeply inserted nasal catheters or an endotracheal tube or tracheostomy cannula, as well as when the patient is dehydrated, special humidification of the respiratory mixture is required. To do this, it is desirable to use aerosol inhalers that create a suspension of small water droplets (about 1 micron in size) in the gas mixture, the evaporation of which in the respiratory tract saturates the gas with water vapor up to 100%. The passage of oxygen through a vessel with water is less efficient, because. large bubbles of oxygen do not have time to be saturated with water vapor.

Objective criteria for the adequacy of inhaled oxygen therapy for patients with respiratory and heart failure are the disappearance of cyanosis, normalization of hemodynamics, acid-base state and arterial blood gas composition. The efficiency of oxygen use in these patients can be increased by the simultaneous use of pathogenetic therapy. In case of hypoxia and hypoxemia caused by hypoventilation of the pulmonary alveoli, oxygen therapy is combined (depending on the nature of hypoventilation) with the use of bronchodilators, expectorants, special modes of arbitrary and artificial ventilation of the lungs.

In circulatory hypoxia, oxygen therapy is carried out against the background of the use of agents that normalize hemodynamics; with pulmonary edema, oxygen is inhaled along with vapors of alcohol and aerosols of other defoamers.

Oxygen therapy for chronic hypoxia, especially in the elderly, is more effective with the simultaneous administration of vitamins and coenzymes (vitamins B2, B6, B15, cocarboxylase), which improve the use of oxygen by tissues.

Enteral oxygenation, i.e. the introduction of oxygen into the gastrointestinal tract through a probe is carried out using dosimeters or the mode of administration is selected according to the number of oxygen bubbles passing through the jar of the Bobrov apparatus in 1 min. Oxygen absorbed in the gastrointestinal tract oxygenates its walls, as well as the blood of the portal vein entering the liver. The latter determines the indications for the use of enteral oxygenation in the complex therapy of acute liver failure. Sometimes the so-called tubeless enteral oxygenation is used - the patient swallows oxygen in the form of foam or a special mousse. The effectiveness of this method of using oxygen, which was used for the treatment of toxicosis of pregnant women, gastritis, the prevention of aging, etc., has not yet been sufficiently confirmed.

Extracorporeal membrane oxygenation is an oxygen therapy method close to cardiopulmonary bypass. Designed for use in temporary inability of the lungs to provide adequate gas exchange, for example, in respiratory distress syndrome, postperfusion pulmonary syndrome, fat embolism, total pneumonia. Its fundamental difference from the method of extracorporeal cardiopulmonary bypass is that a membrane oxygen generator with blood pumping is used only for its oxygenation, but not for blood circulation. Only a fraction of the volume of circulating blood passes through the membrane oxygen generator, which allows it to be used for several days and even weeks without significant injury to blood cells.

Complications and their prevention.

Inhalation of pure oxygen less than 1 day. or long-term inhalation of a 60% oxygen mixture does not cause such sharp disturbances in the body that would be more dangerous than hypoxia itself. However, when using high concentrations of oxygen, as well as during long-term oxygen therapy, especially in the elderly, some pathophysiological effects can be observed, leading to complications. Respiratory arrest or significant hypoventilation with hypercapnia may occur already at the beginning of oxygen therapy in patients with a decrease in the sensitivity of the respiratory center to an increase in the concentration of CO 2 in the blood. In these cases, respiration is stimulated from carotid chemoreceptors by hypoxemia, which is eliminated during oxygen therapy.

The development of hypercapnia when using highly concentrated oxygen mixtures is also facilitated by a significant decrease in the level of reduced hemoglobin in the blood, with which a significant amount of CO 2 is normally removed from the body. To prevent this complication, it is recommended, in conditions with the presence or threat of respiratory center depression (especially in the presence of respiratory arrhythmia), to begin oxygen therapy with a 25% oxygen mixture and gradually increase the oxygen concentration in it to 60% against the background of the use of agents for pathogenetic therapy of central respiratory disorders.

In case of hypoventilation that cannot be eliminated by pharmacological agents, oxygen therapy in order to avoid the development of hypercapnia should be carried out only under the condition of artificial ventilation of the lungs.

With prolonged inhalation of mixtures with a high concentration of oxygen or pure oxygen, oxygen intoxication may develop. Excess oxygen disrupts the normal chains of biological oxidation, interrupting them and leaving a large amount of free radicals that irritate the tissues. In the respiratory tract, hyperoxia causes irritation and inflammation of the mucous membranes, the ciliated epithelium is damaged, the drainage function of the bronchi is impaired, and their resistance to gas flow increases. In the lungs, the surfactant is destroyed, the surface tension of the alveoli increases, micro- and then macro-atelectases, pneumonitis develop. The vital capacity decreases and the diffuse capacity of the lungs decreases, the unevenness of ventilation and blood flow increases.

The development of disorders associated with hyperoxia is promoted by insufficient hydration of inhaled mixtures and the effects of denitrogenation - nitrogen leaching from the body. Denitrogenation leads to edema and plethora of mucous membranes in various cavities (frontal sinuses, etc.), the occurrence of absorption microatelectasis in the lungs. The leading manifestations of oxygen intoxication are signs of damage to the respiratory system and central nervous system. Initially, patients develop dry mouth, dry cough, burning behind the sternum, chest pain. Then there are spasms of peripheral vessels, acroparesthesia. Hyperoxic lesion of the c.n.s. most often manifested by a convulsive syndrome and violations of thermoregulation, mental disorders are also possible, sometimes a coma develops.

In order to prevent oxygen intoxication, it is necessary to use well-moistened mixtures with a low oxygen concentration and, with prolonged oxygen therapy, periodically switch to air inhalation.

In case of bronchial obstruction and in patients with pulmonary atelectasis, pneumonia, edema of the subglottic space (II-III degree stenoses), an oxygen-helium mixture with an oxygen content of 25 to 50% is used, which, if necessary, is fed into the respiratory tract under high pressure in pressure chambers.

Non-inhalation extrapulmonary methods of oxygen therapy in children are used to a limited extent, mainly in the treatment of helminthic invasions. Oxygen is injected into the stomach and small intestine with ascariasis, into the rectum - with enterobiasis, trichuriasis, as well as with exudative-catarrhal diathesis, nocturnal urinary incontinence, chronic colitis.

Hyperbaric oxygenation is especially indicated for newborns born in asphyxia with signs of cerebrovascular accident, as well as with respiratory failure due to pulmonary atelectasis, hyaline membranes and diffuse disorders of a different nature. Methods of conducting oxygen barotherapy are different.

In young children, oxygen therapy often causes a negative reaction, which is manifested by the child's anxiety (due to irritation and dryness of the respiratory tract, reflex disturbances in cardiac activity, rhythm and respiratory rate). Often, with prolonged oxygen therapy, children experience weakness, dizziness, and sometimes headache. In general, the complications of oxygen therapy in children are due to prolonged inhalation of oxygen at a concentration above 60%. These include retrolental fibroplasia, fibrosis of the lung tissue, respiratory depression, decreased systolic pressure, impaired tissue respiration due to the blockade of certain enzymes. These complications can be prevented by the use of low oxygen concentrations and intermittency of oxygen therapy - conducting it in the form of sessions (from 20 minutes to 2 hours) with breaks of various durations, determined by the child's condition.

The most common element on our planet is oxygen: it is 89% in water, about 21% in air, and 65% in the human body. It is synthesized artificially and is widely used in medicine in the treatment of various forms of oxygen starvation, as well as in case of poisoning with nitrites, CO (displaces it from its biocompounds with blood hemoglobin). it is also indicated for large blood loss, tuberculosis, shallow breathing, pulmonary edema, prolonged stay in, etc.

What is the composition of oxygen? Its molecule (O2) consists of two atoms linked by a covalent bond. To date, there are many laboratory methods for the synthesis of this gas. Innovative technologies allow it to be produced on an industrial scale. The main raw materials for the industrial synthesis of oxygen are water and air. To obtain O2 from air, it is first liquefied at high pressure and abrupt cooling, after which rectification is carried out in distillation columns in which the air is repeatedly evaporated and condensed. This method makes it possible to obtain oxygen with an admixture of inert gases (xenon, krypton) and nitrogen (about 1.5%). When using the electrolytic method, O2 is obtained from water without the above gas impurities.

Properties of oxygen

O2 is a gas that has neither taste nor smell, supports combustion well, but does not burn itself. The specified substance reacts with almost any elements, except for inert gases. Oxygen is perfectly soluble in water and 95-degree ethanol.

Authenticity test

To identify O2, the gas must be collected in a test tube and brought to it a smoldering splinter. In the presence of oxygen, the splinter will flare up and burn with a bright flame. How to differentiate oxygen from its impurities together with O2 form nitrogen oxides, which are emitted in the form of orange smoke.

Mechanism of action and use of oxygen

With a deficiency of this gas in the body, it occurs. As a result of this pathology, the functional activity of the nervous, respiratory, cardiovascular systems is disrupted, shortness of breath, cyanosis manifests itself, blood pressure decreases, and asphyxia occurs. With the introduction of oxygen into the body, these phenomena disappear.

The use of oxygen mixed with CO2. Methods of its introduction into the body

There are several ways to introduce oxygen into the body: by inhalation through the nose (using a catheter), through the mouth (inhalation through the mouthpiece from the pillow), under the skin. Subcutaneous administration is practiced, for example, in the treatment of elephantiasis, gangrene, trophic ulcers. So-called oxygen cocktails are also widely used - oxygen-enriched drinks in the form of foam. This use of oxygen is recommended in the treatment of cardiovascular and metabolic diseases. Prolonged inhalation of pure O2 has an irritating effect on the mucous membranes of the respiratory tract.

In medical practice, a mixture of oxygen and CO2 is often used - carbon dioxide, which has a stimulating effect on the respiratory center. Today, various mixtures of oxygen with CO2 are used (most often with a carbon dioxide content of up to 10 percent). These drugs include carbogen (not to be confused with carbolen - activated carbon). It is stored in special pressure cylinders. The use of oxygen mixed with carbolen is indicated in the treatment of glaucoma, as well as in carbon monoxide poisoning.

Ways to store oxygen

Oxygen is stored in special seamless steel cylinders, which are painted blue. The specified container is made only at specialized factories and enterprises. It should be remembered that in order to avoid a fire or explosion, taps, as well as cuts, must not be lubricated with oils.

The role of oxygen for humanity, as well as for all life on the planet, is difficult to overestimate. Thanks to its presence in the atmosphere we live. Just five minutes without oxygen is enough for a person to die. That is why oxygen is very popular in medicine. This simple gas, which chemists refer to as O 2 , takes part in the processes of energy synthesis, due to which our cells can function.

Oxygen became known only in the second half of the 18th century, when Joseph Priestley was able to isolate it in its pure form. Its significance in human life began to be explored a little later, but from that moment on, its use has become so widespread that it is now impossible to do without it.

Oxygen was first used in medicine in 1810. Since that time, its action on the body has been thoroughly studied, people have learned to use it correctly and rationally, and thereby save the lives of patients.

Today, oxygen is used in almost all areas of medicine. It has its place in the treatment of both acute and chronic conditions. Oxygen is the cornerstone in the treatment of critically ill patients. It is especially important during cardiopulmonary resuscitation, artificial ventilation of the lungs and in seriously ill patients.

Insufficient amount of oxygen in the blood doctors refer to as hypoxemia. One of the readily available parameters for its assessment is the blood saturation indicator - the amount of oxygen saturation of hemoglobin, a protein in red blood cells that is responsible for transporting oxygen from the lungs to the tissues. In all conditions, when blood saturation falls, the appointment of oxygen inhalation is mandatory.

Inhalation of pure oxygen leads to an increase in its content in the respiratory tract, which increases the concentration of oxygen in the blood. All these processes improve the delivery of oxygen to the tissues, and, accordingly, the body's metabolism improves.

Oxygen in medicine is used very much in cardiac and pulmonary pathologies, when its intake into the body or delivery to tissues is impaired. Then oxygen inhalation, or rather an air mixture with a high oxygen content, can significantly alleviate the patient's condition.

Oxygen in medicine, and especially in intensive care units, is used in large quantities. It is supplied to the wards from the central oxygen station, or from bulky cylinders.

But the use of oxygen is not limited to the ward in the hospital, inhalations are useful for a longer time than a person stays on treatment.

Currently, oxygen is available in portable bottles that can be used at home. In addition, the size and weight of the balloon allows you to carry it with you in your purse. Such a device will be useful both for patients who have been discharged from the hospital and for conditionally healthy people, because inhalation of pure oxygen causes constriction of cerebral vessels, which is important in the treatment of so-called cluster headaches and migraines. The use of portable oxygen cylinders is completely safe.

Medicine today has learned to use oxygen very competently and correctly where it can be beneficial. And if it became available, then why not?

Most importantly, don't forget to breathe.