Current respiratory care, part 1: Oxygen therapy, oximetry, bronchial hygiene - Among many devices and methods, how to choose those that meet therapeutic goals

For therapy with low to moderate concentrations of oxygen, the nasal cannula is usually the delivery device of choice. For acute exacerbations of chronic obstructive pulmonary disease with elevated arterial carbon dioxide tension, it is better to start with a fraction of inspired oxygen (FIO₂) of 0.24 to 0.28, using an air-entrainment mask. FIO₂ can then be rapidly titrated to achieve an oxygen saturation (measured by pulse oximetry) of 88% to 90%. Air-entrainment nebulizers and aerosol face masks can be used to administer an FIO₂ of 0.28 to 0.40 to critically ill patients. For FIO₂ of 0.50 and higher, consider the new class of high-flow, high-FIO₂ nebulizers. Oxygen masks are generally reserved for short-term use to deliver a moderate to high FIO₂. Arterial blood gas analysis remains the benchmark method of assessing oxygenation, but pulse oximetry can improve the monitoring of critically ill patients. For bronchial hygiene, no one method is superior. In acute care, chest physiotherapy and postural drainage are generally considered first.