Aggiornamento
L'ossigenoterapia
Oxygen therapy
Arianna Traunero1, Beatrice Lorenzon1, Alessandro Amaddeo2, Egidio Barbi2
1Scuola di Specializzazione in Pediatria, Università di Trieste
2IRCCS Materno-Infantile “Burlo Garofolo”, Trieste
Febbraio 2023 - pagg. 85 -95 | DOI: 10.53126/MEB42085
Abstract
Oxygen supplementation represents a fundamental therapy in several clinical conditions, both acute and chronic. Starting from some concepts of respiratory physiopathology, this paper discusses the approach to a child with respiratory distress and respiratory failure, focuses on the main signs and symptoms of hypoxia, hypercapnia and increased work of breathing and explains the methods to assess the severity of the clinical status, highlighting the relevance of the SpO2/FiO2 ratio (peripheral oxygen saturation/inspiratory oxygen fraction). Furthermore, this work aims to summarize the main methods of oxygen delivery, their relative indications, by underlining advantages and possible complications such as blow-by oxygen, low flow nasal cannula and face mask (simple, Venturi, rebreathing and non-rebreathing). The focus is on two new oxygen delivery devices, High Flow Nasal Cannula (HFNC) and Continuous Positive Airway Pressure (CPAP), which in recent years have more and more been used not only in emergency units but also in paediatric wards.
Riassunto
La supplementazione di ossigeno rappresenta una terapia di supporto fondamentale in molteplici condizioni cliniche, sia in acuto che in cronico. Partendo da alcuni concetti di fisiopatologia respiratoria, in questo articolo discutiamo dell’approccio al bambino con distress o insufficienza respiratoria: ci focalizziamo sui principali segni e sintomi di ipossia, ipercapnia e aumentato lavoro respiratorio ed esponiamo i metodi per valutare la severità del quadro clinico, sottolineando la rilevanza del rapporto SpO2/FiO2 (saturazione periferica di ossigeno/frazione inspiratoria di ossigeno).
Questi lavoro si propone inoltre di riassumere i principali metodi di erogazione dell’ossigeno, le loro relative indicazioni, sottolineandone punti di forza e svantaggi: discutiamo dell’ossigeno a flusso libero, delle cannule nasali, delle maschere faciali (semplice, Venturi, rebreathing e non-rebreathing), e ci concentriamo in particolare su due presidi relativamente nuovi, gli alti flussi (High Flow Nasal Cannnula - HFNC) e la CPAP (Continuous Positive Airway Pressure), che negli ultimi anni stanno trovando sempre maggior impiego sia nei reparti di emergenza sia in quelli di degenza.
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Classificazione MeSH
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Corrispondenza: arianna.traunero@gmail.com