OXYGEN THERAPY

Oxygen therapy is the administration of oxygen as a medical intervention, which can be for a variety of purposes in both chronic and acute patient care.Oxygen therapy benefits the patient by increasing the supply of oxygen to the lungs and thereby increasing the availability of oxygen to the body tissues.It helps in preventing heart failure in people with severe lung diseases, such as COPD. Some studies have shown an increase in survival rates in patients who use oxygen more than 15 hours a day. Moreover supplemental oxygen improves sleep, mood, mental alertness and stamina and allows individuals to carry out normal, everyday functions.

An injured or ill person can benefit greatly from receiving air with a higher oxygen concentration.The air a person normally breathes contains approximately 21 percent oxygen. The concentration of oxygen delivered to a victim through rescue breathing is 16 percent.Without adequate oxygen, hypoxia, a condition in which insufficient oxygen reaches the cells, will occur.

Signs and symptoms of hypoxia include

Increased breathing and heart rate.Changes in level of consciousness.
Restlessness.
Cyanosis (bluish lips and nailbeds).
Chest pain

Always provide emergency oxygen to a victim having difficulty breathing if it is available.

Emergency oxygen should be considered if

An adult is breathing fewer than 12 breaths per minute or more than 20 breaths per minute.

A child is breathing fewer than 15 breaths per minute or more than 30 breaths per minute.

An infant is breathing fewer than 25 breaths per minute or more than 50 breaths per minute.

Indications for Oxygen Therapy

Acute Diseases and Conditions

You may receive oxygen therapy if you're in the hospital for a serious condition that prevents you from getting enough oxygen. Once you've recovered from the condition, the oxygen will likely be stopped.

Some diseases and conditions that may require short-term oxygen therapy are:

• Severe pneumonia. Pneumonia is an infection in one or both of the lungs. If severe, the infection causes your lungs' air sacs to become very inflamed. This prevents the air sacs from moving enough oxygen into your blood.
• Severe asthma attack. Asthma is a lung disease that inflames and narrows the airways. Most people who have asthma, including many children, can safely manage their symptoms. But if you have a severe asthma attack, you may need hospital care that includes oxygen therapy.
• Respiratory distress syndrome (RDS) or bronchopulmonary dysplasia (BPD) in premature babies. Premature babies may develop one or both of these serious lung conditions. As part of their treatment, they may receive extra oxygen through a nasal continuous positive airway pressure (NCPAP) machine or a ventilator, or through a tube in the nose.

Chronic Diseases and Conditions

Long-term home oxygen therapy might be used to treat some diseases and conditions, such as:

• COPD (chronic obstructive pulmonary disease). This is a progressive disease in which damage to the air sacs prevents them from moving enough oxygen into the bloodstream. "Progressive" means the disease gets worse over time.
• Late-stage heart failure. This is a condition in which the heart can't pump enough oxygen-rich blood to meet the body's needs.
• Cystic fibrosis (CF). CF is an inherited disease of the secretory glands, including the glands that make mucus and sweat. People who have CF have thick, sticky mucus that collects in their airways. The mucus makes it easy for bacteria to grow. This leads to repeated, serious lung infections. Over time, these infections can severely damage the lungs.
• Sleep-related breathing disorders that lead to low levels of oxygen in the blood during sleep, such as sleep apnea.

Treatment 

COPD Treatment

Chronic obstructive pulmonary disease is actually a group of lung diseases, such as emphysema and chronic bronchitis. Because of damaged airways, there isn't a proper oxygen/carbon dioxide exchange in breathing. This makes your heart work harder to pump needed oxygen to your organs. Oxygen therapy eases the strain of breathing on the patient. COPD as a leading cause of death worldwide.The positive effects of oxygen therapy with COPD as improves heart function, the ability to exercise, relief from depression, improved mental clarity and overall better quality, and sometimes length, of life.

Interstitial Lung Disease Treatment

Oxygen is used in treatment of interstitial lung disease, which refers to a range of maladies that result in scarring of the lungs. It can be due to trauma, toxic intake, drugs or other unknown causes. It is reported that oxygen therapy can't reverse the progression, it aids the sufferer in breathing. It can make sleep easier for the patient and reduce blood pressure on the right side of the heart, protecting you from pulmonary hypertension, a weakening and sometimes fatal failing of the right ventricle heart muscle.

Accidental Poisoning Treatment

Oxygen therapy is part of the treatment for alcohol and carbon monoxide poisoning. While alcohol poisoning often happens during binge drinking, it can also occur accidentally when household products with alcohol content are ingested. Carbon monoxide, or CO, poisoning due to poor venting, appliances or faulty auto exhaust systems is the most common cause of death from poisoning Oxygen therapy is used to replace the carbon monoxide in the blood in the case of CO poisoning. With alcohol poisoning, oxygen therapy is used along with intravenous hydration, airway protection and careful monitoring.

Gangrene Treatment

Hyperbaric oxygen therapy is part of the treatment for gangrene, where interrupted blood flow has caused the death of living tissue, especially in the extremities like fingers and toes in frostbite. A chamber with 2.5 times atmospheric pressure of pure oxygen is used to help your blood carry more oxygen to your affected tissue and inhibit bacteria growth.

Pneumonitis Treatment

Pneumonitis refers to an inflammation of lung tissue including pneumonia. It could also refer to illness as a result of exposure to asbestos, chemotherapy, radiation therapy to the chest, over-exposure to poultry and certain types of mold. Besides antibiotics to fight infection and corticosteroids to reduce inflammation,oxygen therapy is prescribed for use as needed, during exercise or sleep, depending on the patient.

Oxygen Therapy at Home

One great benefit of oxygen therapy is it can be delivered at home as well as in the hospital.Home oxygen therapy might be prescribed for a number of illnesses in which your blood doesn't get enough oxygen, called hypoxemia. While atmospheric air contains only 21 percent oxygen, oxygen therapy delivers pure oxygen. This can reduce shortness of breath and strain on your heart. It also improves quality of life by making independent activities of daily living possible with portable oxygen tanks.

Potential Complications and Hazards

• CO2 Narcosis - This occurs in patients who have chronic respiratory obstruction or respiratory insufficiency which results in them developing hypercapnia (i.e. raised PaCO2). In these patients the respiratory centre relies on hypoxaemia to maintain adequate ventilation. If these patients are given oxygen this can reduce their respiratory drive, causing respiratory depression and a further rise in PaCO2. Resulting in increased CO2 levels in the blood and CO2 narcosis. Supplemental oxygen improves oxygenation but does not change ventilation. Monitoring of SpO2 or SaO2 informs of oxygenation only. Therefore, beware of the use of high FiO2 in the presence of reduced minute ventilation.
• Pulmonary Atelectasis (alveolar collapse)
• Pulmonary oxygen toxicity - High concentrations of oxygen (>60%) may damage the alveolar membrane when inhaled for more than 48 hours resulting in pathological lung changes.
• Retrolental fibroplasia (premature/newborns) & ocular effects for older patients
• Substernal pain
• Supports combustion- be alert to safety/fire precautions

Oxygen safety

• Oxygen is not a flammable gas but it does support combustion (rapid burning). Due to this the following rules should be followed:
• Do not smoke in the vicinity of oxygen equipment.
• Do not use aerosol sprays in the same room as the oxygen equipment.
• Oxygen is heavier than air and will pool in fabric making the material more flammable. Therefore, never leave the nasal cannula or mask under or on bed coverings or cushions whilst the oxygen is being supplied.
• Oxygen cylinders should be secured safely to avoid injury.
• Do not store oxygen cylinders in hot places.
• Keep the oxygen equipment out of reach of children
• Do not use any petroleum products or petroleum byproducts e.g. petroleum jelly/Vaseline whilst using oxygen

Please Note-

Oxygen is a basic human need. Without it, we would not survive. The air that we breathe contains approximately 21% oxygen. For most people with healthy lungs, this is sufficient, but for some people with certain health conditions whose lung function is impaired, the amount of oxygen that is obtained through normal breathing is not enough. Therefore, they require supplemental amounts to maintain normal body function.

COLLAGEN VASCULAR DISEASE

Collagen is a tough, fiber-like protein that makes up 30% of body protein. It contributes to the structure of tendons, bones, and connective tissues.Collagen vascular disease occurs when problems with the immune system affect collagen.

Collagen vascular diseases,sometimes called connective tissue diseases(CTDs)or autoimmune diseases,cover a wide array of disorders in which the body's natural immune or self-protection system fails to recognize its own tissues and goes on attack against itself.Some of these diseases limit their damage to a single organ,and others spread problems throughout the body.These can include 

• Scleroderma: 
  This progressive and systemic sclerosis causes skin to thicken and tough fibrous tissue to form in the internal organs of the digestive tract,kidneys,heart,and lungs.
• Sjogren's syndrome:
  This causes dry mouth,dry eyes,and other symptoms.
• Polymyositis and dermatomyositis: 
  These are inflammatory muscle disorders that may also affect the skin,the heart,and the lungs.
• Mixed connective tissue diseases: 
  These combine features of lupus,scleroderma,and polymyositis.
• Polyarteritis nodosa: 
  This disorder can damage small and medium-sized arteries of almost any organ,including the kidneys, heart,and intestines.
• Rheumatoid arthritis: 
  Rheumatoid arthritis is a chronic inflammatory* disease that causes stiffness in the joints (places where bones meet) and can lead to disfigurement.
  In rheumatoid arthritis, the autoimmune process begins in connective tissue and the cushiony membranes that surround joints and the ends of bones.Rheumatoid arthritis is thought to begin when T cells mistake the body's own collagen cells for foreign antigens and alert B cells to produce antibodies to fight the invader. The leukocytes rush in and produce cytokines, small proteins that are essential in healing the body but which can cause serious damage in large doses. The inflammation and joint damage that result can lead to joint deformities and can spread throughout the body to other sites of connective tissue.
• Raynaud's Disease: 
  Often,people who have collagen vascular diseases are also diagnosed with Raynaud's disease,although not everyone who has Raynaud's disease has a collagen vascular disease.Raynaud's disease is a disorder in which the vessels that supply blood to the fingers and toes respond to cold or other stimuli by going into spasm (contracting),which reduces the supply of blood and causes the digits to turn white,feel numb,tingle,or burn. In rare severe cases,the restriction of the arteries may cause the fingers to thicken, which can lead to ulcerations (loss of tissue) at the finger tips as well as changes in the fingernails.Sometimes,gangrene (tissue death)can occur.

Symptoms

Symptoms differ depending on the illness, but they often include joint pain, fever, rash, recurrent infections, fatigue, mouth ulcers, dry mouth and dry eyes, hair loss, difficulty swallowing, swollen glands, or fingers and toes that get overly cold when exposed to cooler temperatures. 

Fever

Damage to internal body structures that contain collagen induces an inflammatory response by the immune system. This inflammatory signal can result in an increase in a person's body temperature. Consequently, people with collagen vascular disease can develop a fever as a sign of this condition,People with fever can appear flushed and may begin to sweat. Additional symptoms associated with fever can include chills and headaches. A fever can also be a sign of alternate medical conditions, such as the flu or common cold. People who develop an unusually high or persistent fever should seek care from a medical professional.

Anemia

People with collagen vascular disease can develop anemia as a symptom.Anemia occurs when a person has an unusually low level of blood cells within the body. Symptoms of anemia can include pale skin, excessive fatigue, dizziness, headache, heart rate irregularities, breathing difficulties or unusually cold extremities. Without treatment, the symptoms of anemia can become progressively more severe.

Inflamed Joints

Collagen vascular disease can result in collagen degradation within a person's joints. As the collagen degrades, affected people can develop symptoms of severe joint inflammation. Joint inflammation can cause affected joints to appear unusually swollen or tender to the touch. People with this type of disease can have difficulty bending and flexing the affected joint normally. Persistent joint inflammation can also cause chronic pain symptoms in people with collagen vascular disease.

Fatigue or Weakness

People with this type of disease can experience excessive fatigue as a symptom.Increased fatigue may be accompanied by muscle or body weakness in certain people. Affected people can have difficulty performing normal daily tasks associated with work or school due to fatigue symptoms. Additionally, excessive fatigue can make it difficult for people to concentrate and remain alert throughout the day.

Diagnosis

The doctor can sometimes detect a particular connective tissue disease simply by the physical examination. Frequently, blood testing, X-ray examination, and other tests can help in making a diagnosis of connective tissue disease.

Treatment

Treatment for collagen vascular disease varies according to your individual condition. However, corticosteroid and immunosuppressant medications commonly treat many connective tissue diseases.

Corticosteroids

Corticosteroids reduce inflammation throughout the body. This class of drugs also helps normalize your immune system. Corticosteroids can carry major side effects in some people, including weight gain and mood changes. Some people may see a rise in blood sugar while taking corticosteroid medications.

Immunosuppressants

Immunosuppressant medication works by lowering your immune response. When your immune response is lower, your body will no longer attack itself as much. However, having a lowered immunity can increase your risk of becoming sick at times. Protect yourself from simple viruses by staying away from family and friends with colds or flu.

Physical Therapy

Physical therapy or gentle exercise can also treat collagen vascular disease. Range of motion exercises help you retain your mobility and may reduce joint and muscle pain.

Long-Term Outlook

The outlook for collagen vascular disease varies in each person, and really depends on the specific disease. However, they do have one thing in common: all autoimmune diseases are chronic conditions. They have no cure, and you must manage them throughout your life. Luckily, there are effective treatments to help keep even severe symptoms at bay.

Warning

• In severe cases of collagen disease, the organs become involved. Serious complications can lead to death.