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How to Deal with Oxygen Therapy Devices

“Oxygen therapy – by face mask, nasal cannula or nasal catheter – has been widely practised in medicine since the end of the eighteenth century. Most methods of administration do not permit control or knowledge of dosage. Indeed, it has been commented that oxygen ‘is still perhaps probably the most misused of all drugs’.”1

“Patients requiring long-term oxygen therapy (LTOT) must have access to clinically effective home oxygen equipment that is adaptable to their needs outside the hospital. Costing less and providing for a more normal lifestyle, home oxygen therapy has evolved to a standard of care for patients experiencing chronic hypoxemia. Going beyond stationary home devices, new oxygen equipment has been developed to meet the needs both of the patient who is more mobile and of the oxygen suppliers who are struggling to respond to economic pressures from payers. It is important to keep in mind that oxygen equipment only stores or produces oxygen in the home. Oxygen is a drug that requires a prescription, an effective delivery system, therapeutic dosing, and monitoring for effective therapy. Economics and patient demands are a secondary consideration to providing effective oxygen therapy.”2

Constantly living with an oxygen tank might be extremely inconvenient for the user.  Oxygen therapy devices are used by individuals with low levels of oxygen and come with a mask to allow them to get the additional amount of oxygen they need. People dealing with Chronic Obstructive Pulmonary Disease suffer from loss of some of the lung functions.  In some cases, one of those losses is the ability to breathe in and retain the amount of oxygen needed for the respiratory system to function properly.

“Oxygen therapy is the first-line treatment in hypoxemic patients. Oxygen can be delivered using low-flow devices (up to 15 L/min) such as nasal cannulas, non-rebreathing masks, and bag-valve masks. The fraction of inspired oxygen (FiO2) obtained using these devices varies with the patient’s breathing pattern, peak inspiratory flow rate, delivery system, and mask characteristics. Maximum flow rates are limited in part by the inability of these devices to heat and humidify gas at high flows. Also, if the patient has a high inspiratory flow rate, the amount of entrained room air is large and dilutes the oxygen, thereby lowering the FiO2.”3

Some people need to carry oxygen tanks to engage in their everyday activities without limitations, others need them to continue living. Although this might be a demanding and uncomfortable situation to find oneself in, these devices ensure an improvement to one’s overall quality of life.

“Long-term oxygen therapy is extended use of oxygen. Oxygen therapy is delivered as a gas from an oxygen source. Different oxygen sources are: 1) oxygen concentrators, electrical units delivering oxygen converted from room air; 2) liquid oxygen systems, which deliver gaseous oxygen stored as liquid in a tank; and 3) oxygen cylinders, which contain compressed gaseous oxygen. All are available in portable versions. Oxygen is breathed in through a nasal cannula or through a mask covering the mouth and nose. The treating clinician determines the flow rate, duration of use, method of administration, and oxygen source according to individual patient needs.”4

Drawbacks of Standard Oxygen Therapy

“Drawbacks of standard oxygen therapy that limit the effectiveness and tolerance of oxygen delivery:

1.   Oxygen is not humidified at low flow:

  • dry nose

  • dry throat

  • dry mouth

  • nasal pain

  • ocular irritation,

  • nasal and ocular trauma

  • discomfort related to the mask

  • gastric distension

  • aspiration

  • global discomfort

2. Insufficient heating leads to poor tolerance of oxygen therapy

3. Unwarmed and dry gas may cause bronchoconstriction and may decrease pulmonary compliance and conductance

4. With low/medium-flow devices, oxygen cannot be delivered at flows greater than 15 L/min, whereas inspiratory flow in patients with respiratory failure varies widely and is considerably higher, between 30 and more than 100 L/min

5. Given the difference between the patient’s inspiratory flow and the delivered flow, FiO2 is both variable and often lower than needed.”5

 The following general recommendations could be practiced, to make oxygen therapy an easier situation to deal with.

Check your device regularly

For any device to function how it should, the right measures and repairs have to be taken care of. It is important to keep the item in its original condition as long as possible, since it is this quality that helps to administer oxygen more effectively.

Depending on the type of device you have, its requirements will change. However, regardless of the type, they all need to be kept in the most hygienic of conditions. Usually, instructions are included in the package when the item is first purchased.  One should always read them thoroughly to determine the correct care the item needs.

Follow safety procedures

When you are not employing the oxygen machine, make sure to turn it off and keep it at a secure location.

Oxygen is extremely sensitive to heat, which is why one needs to take certain practices into account, to protect oneself from dangerous situations.  One shouldn’t engage in potentially harmful activities near the device. Objects that produce or radiate heat, should remain more than one meter apart from the oxygen. Additionally, items containing petrolatum should also remain at a safe distance.

“Oxygen is neither explosive or combustible, but because it does support combustion its potential fire hazards must be recognized. The principal fire hazards of long-term oxygen therapy are (1) the ignition potential of plastic delivery devices and (2) oxygen leaks, (a) from high-pressure cylinders and cryogenic reservoirs into nearby combustible materials; (b) from oxygen concentrators, which are electrical devices; and (c) within piping systems. We found that with 100% oxygen a nasal cannula ignited and burned in about 2 minutes. With 60% oxygen the burning rate was slower, and with 40% the cannula did not ignite.”6

Adhere to the physician’s recommendations

Some people need oxygen at different stages of their lives and for different periods of time. There are some who only need it momentarily and for short periods of time to engage in physical activities. However, there are others whose condition is life-threatening, who need additional oxygen for the rest of their lives and at all times.

  • “Oxygen should be considered as a drug that is prescribed and administered for specific indications, with a documented target oxygen saturation range and with regular monitoring of the patient’s response.
  • Oxygen is prescribed for the relief of hypoxemia, not breathlessness.
  • Hypoxemia is both a marker of risk of a poor outcome due to the severity of the underlying disease(s) that has caused hypoxemia, and an independent risk factor of poor outcome.
  • There are risks associated with both hypoxemia and hyperoxemia, which underlie the importance of prescribing oxygen only if required, and to within a target oxygen saturation range.”7

     

Even though living with a mask attached to one’s mouth might not be ideal, its proper usage can enhance one’s daily life. It is important to be clear about the correct balance of this chemical element that is needed. If the additional oxygen does not fulfill the body’s needs or if it is taken in an excessive amount, the central nervous system and cardiovascular system might suffer.  A physician should be able to design the patient’s oxygen therapy and set the interval or recommend circumstances under which one will be taking it.

“The potential risks due to hyperoxemia with high concentration oxygen therapy include respiratory (increased PaCO2, absorption atelectasis and direct pulmonary toxicity), cardiovascular (increased systemic vascular resistance and blood pressure, reduced coronary artery blood flow, reduced cardiac output), cerebrovascular (reduced cerebral blood flow) effects and increased reperfusion injury due to increased reactive oxygen species.

The physiological response of an increase in PaCO2 due to high concentration oxygen therapy has been demonstrated not only in stable and acute exacerbations of COPD, but also in severe asthma, community-acquired pneumonia and obesity hypoventilation syndrome. Proposed mechanisms for oxygen-induced hypercapnia include increased ventilation perfusion mismatch due to reduced hypoxic pulmonary vasoconstriction, reduced ventilatory drive, atelectasis and the Haldane effect, with the contribution of each likely to depend on the clinical situation.”8

Select your device correctly

There are different types of machines available that provide additional oxygen, in the forms of liquid oxygen and compressed oxygen. Liquid oxygen devices are more portable, since they occupy limited space. However, after being constricted for a long time, the oxygen in a liquid oxygen device dries up. Large compressed oxygen machines are great if one plans to use them solely at one’s house, since they come in a metal tank. Nevertheless, there are smaller versions of compressed oxygen devices that are useful to carry around when one has to go out.

As an alternative to traditional liquid or compressed oxygen devices, there are concentrators.  Concentrators fill up oxygen automatically by themselves and do not need tank replacements. However, they occupy a considerable amount of electric power and can be very loud. In addition, these devices come in both travel-friendly and home-friendly options.

“Now there are combinations of compressed gas, LOX (liquid oxygen), concentrator, concentrators that fill compressed gas, LOX portables, and battery-operated concentrator systems available for home oxygen therapy. Each new home oxygen system has a different performance characteristic, with capabilities and applications that are unique to the product. Clinicians need be aware of product variability in performance when prescribing and placing a home oxygen patient on a specific system. Home oxygen therapy equipment should not be considered a commodity for which any home oxygen product can be used, regardless of the therapeutic objectives for the individual patient.”9

 

References:

(1) Variation in performance of oxygen therapy devices. Leigh, J.M. Anesthesia. 1970. https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-2044.1970.tb00192.x

(2, 9) Options for Home Oxygen Therapy Equipment: Storage and Metering of Oxygen in the Home. McCoy, R.W. Respiratory Care January. 2013. http://rc.rcjournal.com/content/58/1/65.full

(3, 5) High-flow nasal oxygen vs. standard oxygen therapy in immunocompromised patients with acute respiratory failure: study protocol for a randomized controlled trial. Azoulay, E., Lemiale, V., Mokart, D., Nseir, S., Argaud, L., Pène, F., Kontar, L., Bruneel, F., Klouche, K., Barbier, F., Reignier, J., Stoclin, A., Louis,G., Constantin, J.M., Mayaux, J., Wallet, F.,  Kouatchet, A., Peigne, V., Perez, P., Girault, C., Jaber, S., Oziel, J., Nyunga, M., Terzi, N., Bouadma, L., Lebert,  C., Lautrette, A., Bigé, N., Raphalen, J.H., Papazian, L., Rabbat, A., Darmon, M., Chevret, S. & Demoule, A. Trials Journal. 2018. https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-018-2492-z

(4) Long-Term Oxygen Therapy for Patients With Chronic Obstructive Pulmonary Disease (COPD)An Evidence-Based Analysis. COPD Working Group. Ontario Health Technology Assessment Series. 2012. http://www.hqontario.ca/en/mas/tech/pdfs/2012/rev_COPD_LTOT_March.pdf

(6) Nonmedical hazards of long-term oxygen therapy. West, G.A & Primeau, P. Respiratory Care. 1983. https://europepmc.org/abstract/med/10315398

 (7, 8) Thoracic Society of Australia and New Zealand oxygen guidelines for acute oxygen use in adults: ‘Swimming between the flags’*. Beasley, R., Chien, J., Douglas, J., Eastlake, L., Farah, C., King, G., Moore, R., Pilcher, J., Richards, M., Smith, S. & Walters, H. Respirology. 2015. https://onlinelibrary.wiley.com/doi/full/10.1111/resp.12620

 

María Laura Márquez
13 October, 2018

Written by

María Laura Márquez, general doctor graduated from The University of Oriente in 2018, Venezuela. My interests in the world of medicine and science, is focused on surgery and its greatest advances. Nowadays I practice my...read more:

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