Oxygen therapy is the administration of the oxygen for treatment of the conditions resulting from oxygen deficiency.
Purposes
- To increase the oxygen tension of blood plasma
- To restore the oxyhemoglobin in the red blood cells (RBCs) to the normal proportion
- To manage the condition of the hypoxia
- To maintain the ability of the cells to carry out the normal metabolic function
- To reduce the risk of complications
Indications for Oxygen Therapy
The indications for administering the oxygen are to correct:
- Hypoxemia (reduction in the oxygen content of the blood below physiologic levels
- Hypoxia or anoxia (absence of adequate tissue oxygenation)
The conditions are as follows: - Deficiency of 0, in atmospheric air
- Ventilation perfusion abnormalities
- Impaired diffusion
- Inadequate tissue oxygenation, for example, abnormal tissue demand
- Poisoning with chemicals that alter the tissues ability to utilize oxygen, for example, cyanide poisoning
- Hemorrhage
- Shock and circulatory failure
- Children who are under anesthesia
- Asphyxia, for example, drowning, foreign body aspiration, strangulation, etc.
Principles
- The choice of system will depend upon the clinical status of the patient and desired dose of oxygen. For example, child with irregular respiration needs bag-mask ventilation with as high dose of 02 as possible.
- Oxygen should be humidified, whenever possible to prevent dried secretions from obstructing the smaller airways.
- The effectiveness of the oxygen delivery should be monitored with pulse oximeter.
- Young children may become frightened or agitated when O2 is administered, causing their clinical conditions to deteriorate.
Therefore they should remain in a position of comfort whenever possible. A caregiver can often hold the O, source in proximity to or over the child’s face. - The is a drug and as such should be prescribed accordingly.
Methods of Administration
It is important to consider both the nature of respiratory illness and also the age of the child when determining the method of administration.
Methods of oxygen administration are majorly divided into two types:
- Low-flow delivery method: It provides oxygen at flow rates that are lower than patients’ inspiratory demand:
- Simple face mask
- Non-rebreather face mask (mask with oxygen reservoir bag and one-way valves, which aims to prevent/reduce room air entrainment)
- Nasal prongs (low flow)
- Tracheotomy mask
- Venturi mask
- Oxyhood
- High-flow delivery method (discussed in later sections)
- Ventilators
- continuous positive airway pressure (CPAP)/bilevel positive airway pressure (BiPAP) drivers
Delivery Methods by Age & Need
| Device | Age Group | FiO₂ Range | Notes |
|---|---|---|---|
| Nasal cannula | All ages | 24–45% | Comfortable; flow: 0.5–2 L/min in infants |
| Simple face mask | >6 months | 35–50% | Minimum 6 L/min to avoid CO₂ rebreathing |
| Non-rebreather mask | Older children | Up to 95% | Emergency use; reservoir bag must remain inflated |
| Oxygen hood | Neonates | 21–100% | Precise FiO₂; requires humidification |
| High-flow nasal cannula | Infants & children | Up to 100% | Heated, humidified; reduces work of breathing |
| CPAP/BiPAP | Neonates & older | Variable | For moderate to severe respiratory distress |
Nursing Responsibilities
- Monitor SpO₂ continuously; target ≥ 92–94% (unless otherwise specified).
- Use humidification to prevent mucosal drying.
- Check for skin breakdown around nasal prongs or mask.
- Educate caregivers on device use and safety.
- Document flow rate, FiO₂, and patient response.
Special Considerations
- Avoid hyperoxia—especially in preterm infants (risk of retinopathy of prematurity).
- Use pulse oximetry and clinical signs to guide therapy.
- Titrate oxygen to the lowest effective dose.
- Ensure fire safety—oxygen supports combustion.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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