Documentos de Académico
Documentos de Profesional
Documentos de Cultura
Entropy
Life
n n
1/25/2011
CO2
O2 CnHnOn
1/25/2011 Oxygen Monitoring 3
159 150
149
100
50
I n s p i r e d
100
T ra c h ea
92
A r t e r y
A l v e o l u s
Tissue
40 2
Vein
40
Mitochondria
1/25/2011 Oxygen Monitoring 4
Oxygen analyser Calculated from FIO2 Calculated: Alveolar air equation End tidal oxygen analyser
1/25/2011
Oxygen Monitoring
1/25/2011
Oxygen Monitoring
Oxygen Analysers
n n n
1/25/2011
Oxygen Monitoring
1/25/2011
Oxygen Monitoring
Oxygram
Inspired 30% 20% 10% 0% Expired
1/25/2011
Oxygen Monitoring
PAO2 = FIO2 * (Pb- 47) - PaCO2 PAO2 = FIO2 * (Pb- 47) - PaCO2 /R PAO2 = FIO2 * (Pb- 47) - PaCO2 /R(1-FIO2(1-R))
n n
1/25/2011
Oxygen Monitoring
10
159 150
149
100
50
I n s p i r e d
100
T ra c h ea
92
A r t e r y
A l v e o l u s
Tissue
40 2
Vein
40
Mitochondria
1/25/2011 Oxygen Monitoring 11
100 90 80 70 60 50 40 30 20 10 0 10
20
Vein P50
15
10
20
40
60
80
100
200
300
400
500
600
12
Artery
n n n n n n n
1/25/2011
Arterial tension
Blood gas analyser Trans cutaneous Calculated from tension Co-oximeter Pulse oximeter
Arterial saturation
1/25/2011
Oxygen Monitoring
14
1/25/2011
Oxygen Monitoring
15
Functional Saturation
= 7/(7+1) = 87%
16
1/25/2011
Oxygen Monitoring
Problems
Delicate Heated Repositioning Recalibrating
Oxygen Monitoring 17
1/25/2011
Co oximeters
n n
Measures haemoglobin types by absorption of light To measure 4 types of Haemoglobin measure absorption at 4 different wavelengths OHb reducedHb COHb metHb
1/25/2011
Oxygen Monitoring
18
Fractional Saturation
= 7/(7+1+2) = 70%
19
1/25/2011
Oxygen Monitoring
Oximeters
1875 vonVierordt 1972 Takuo Aoyagi - "Pulse Oximetry" 1980's Nellcor 1988 pulse oximetry mandatory in Australia
1/25/2011
Oxygen Monitoring
20
Systole
Diastole
Light absorption due to tissues Artery (pulsatile tissue) Non-arterial, (non-pulsatile) tissue
1/25/2011
Oxygen Monitoring
21
10
Red
Infrared
Extinction coefficient
1.0
Oxyhaemoglobin
.1
Deoxyhaemoglobin
.01 600 640 680 720 760 800 840 880 920 960 1000
R=
3.0
3.4
23
1/25/2011
Oximeter errors
n n
1/25/2011
Oxygen Monitoring
24
Signal artefact
Ambient light Poor perfusion Movement artefact If R = 1 pulse oximeter shows 85%
n n n n
1/25/2011
Oxygen Monitoring
25
carboxyHb metHb
1/25/2011
Oxygen Monitoring
26
10
Red
Infrared
Extinction coefficient
1.0
Oxyhaemoglobin
.1
Deoxyhaemoglobin Carboxyhaemoglobin
720 760 800 840 880 920 960 1000
10
Red
Infrared
Extinction coefficient
1.0
Methaemoglobin Oxyhaemoglobin
.1
Deoxyhaemoglobin
.01 600 640 680 720 760 800 840 880 920 960 1000
carboxyHb
error showing low functional saturation error showing high fractional saturation
metHb
error toward 85%
1/25/2011
Oxygen Monitoring
29
carboxyHb
reads low functional, high fractional
metHb
error toward 85%
n n n n n
1/25/2011
Monitoring oxygen
1/25/2011
Oxygen Monitoring
31
Monitoring Oxygen
Oxygen supply is critical No single monitor of oxygen supply Oxygen tension versus haemoglobin saturation Functional versus fractional saturation
1/25/2011
Oxygen Monitoring
32