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How to Deal with Oxygen Therapy Devices

Living with an oxygen tank might be inconvenient for the user, but also an improvement to their quality of life. Oxygen therapy devices are designed to provide patients the additional amount of oxygen they require through a mask. 

“Oxygen therapy – by face mask, nasal cannula or nasal catheter – has been widely practiced 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

Long-Term Oxygen Therapy

“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 

People dealing with Chronic Obstructive Pulmonary Disease suffer from loss of certain lung functions, including the ability to breathe in and retain the amount of oxygen for the proper functioning of the respiratory system. This impairment makes them candidates for LTOT.

“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.”3 

Some patients 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, these devices ensure an improvement to the overall quality of life.

Disadvantages 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
  1. Insufficient heating leads to poor tolerance of oxygen therapy
  2. Unwarmed and dry gas may cause bronchoconstriction and may decrease pulmonary compliance and conductance
  3. 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
  4. Given the difference between the patient’s inspiratory flow and the delivered flow, FiO2 is both variable and often lower than needed.”4

Recommendations for Oxygen Therapy

The following are recommendations to deal with oxygen therapy.

Check your device regularly

Look after any repairs and measures to ensure the device works properly. Keep the item in its original condition, as its quality helps administer the oxygen effectively.

The requirements will change depending on the type of device. However, keep all types in the most hygienic conditions. Read the instructions when purchasing the item and follow them thoroughly to provide the correct care that the item requires.

Follow safety procedures

When you are not using the oxygen machine, turn it off and store it at a fresh and secure location. Oxygen is sensitive to heat, so you must follow certain practices to protect yourself from dangerous situations. Objects that produce or radiate heat should remain over one meter apart from the oxygen. Also, maintain items containing petrolatum 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.”5

Adhere to the physician’s recommendations

Some people need oxygen at different stages of their lives and for different periods of time. Some people only need it temporarily to engage in physical activities. However, other patients with life-threatening conditions need additional oxygen for the rest of their lives, 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.
  • Hypoxaemia 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 hypoxemia, which underlie the importance of prescribing oxygen only if required, and to within a target oxygen saturation range.”6

Although living with a mask attached to the mouth might be impractical, its proper usage can enhance the patient’s daily life. 

Adhere to the dosage indications. If the additional oxygen does not fulfill the body’s needs or if the patient exceeds the recommended amount, the central nervous system and the cardiovascular system might suffer.  

“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.”7

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.

Potential Consequences of Hyperoxaemia with High Concentration Oxygen Therapy

“The potential risks due to hyperoxaemia 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

Various types of machines provide additional oxygen, in the forms of liquid and compressed oxygen. Liquid oxygen devices are more portable and occupy limited space. However, the oxygen in a liquid oxygen device dries up after some time. Large compressed oxygen machines are suitable for domestic use since they come in a metal tank. Nevertheless, smaller versions of compressed oxygen devices are useful to carry around when going out.

As an alternative to traditional liquid or compressed oxygen devices, Concentrators fill up oxygen automatically and do not require tank replacements. However, they consume excessive power and can be very loud. In addition, concentrators 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

Oxygen therapy treats or prevents the symptoms and indicators of hypoxia. Oxygen therapy devices aim to deliver the required amount of therapeutic oxygen proficiently to maintain oxygenation at all activity levels. Follow your physician’s recommendations for effective oxygen therapy, do not exceed or reduce the amount in the prescription.

 

References

(1) Variation in performance of oxygen therapy devices. Leigh, J.M. Anaesthesia. 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) 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  (4, 7) 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., et al. Trials Journal. 2018. https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-018-2492-z 

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

(6, 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, are focused on surgery and its breakthroughs. Nowadays I practice my profession...read more:

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