Options for Home Oxygen Therapy Equipment: Storage and Metering of Oxygen in the Home

Abstract

Home oxygen therapy equipment options have increased over the past several decades, in response to innovations in technology, economic pressure from third-party payers, and patient demands. The delivery of oxygen in the home has evolved from packaged gas systems containing 99% United States Pharmacopeia oxygen provided by continuous-flow delivery to intermittent-flow delivery, with oxygen concentrators delivering < 99% oxygen purity. The majority of published papers indicating the value of long-term oxygen therapy have been based on continuous-flow delivery of 99% United States Pharmacopeia oxygen. The lack of research on new home oxygen therapy devices requires more clinical involvement from physician and respiratory therapist to evaluate the performance of oxygen devices used in the home to ensure the patient is provided adequate oxygenation at all activity levels. New standards of care are required to address the need to have consistent titration of long-term oxygen therapy to meet the patient's home needs at all activity levels. Consistent labeling of metering devices on home oxygen equipment will need to be developed RESPIRATORY CARE • JANUARY 2013 VOL 58 NO 1 6 5 by professional medical societies to be implemented by standards organizations that direct industrial manufacturers. Home oxygen therapy will need professionally trained respiratory therapists reimbursed for skills and service to ensure that patients receive optimal benefits from home oxygen equipment to improve patient outcomes and prevent complications and associated costs.

Right Versus Left Prong Nasal Cannula Flow Delivery and the Effects of Nasal Cycling on Inspired FIO2in an Adult Anatomic Model

“…Adjustment of oxygen delivery based on physiologic variables (eg, saturation via pulse oximetry) is not a new idea but appears to be infrequently used. 24 Our results showed that a nasal cannula set at 3 L/min delivered 38% oxygen when the nares were patent. When we simulated nasal cycling, the 3 L/min setting delivered 34.3% with the left naris occluded (Table 3).…”

“…There are a variety of different ways that oxygen can be wasted into the external environment when using a nasal cannula. 24 This is the first publication to address nasal cycling as a source of oxygen delivery waste.…”

“…23 Other variables necessitating an adjustment in oxygen flow include patient tidal volume, nasopharyngeal volume, the delivery mechanism (eg, continuous flow or intermittent flow/pulsed flow), the patient's breathing frequency, and the inspiratory time. 24 The human nasal cycle may be another factor to consider when delivering oxygen via nasal cannula. The human nasal cycle appears to run on a schedule unrelated to activity and sleeping/waking schedules; therefore, adjustment in oxygen flow would need to occur based on physiological feedback from the patient.…”

Oxygen in Respiratory Care: A Personal Perspective from 40 Years in the Field

“…However, as brought out during the discussion at this conference, 40 the best data we have indicate that the average Medicare patient who receives LTOT stays on it for less than a year prior to death. This illustrates a big gap between what we know and what we do with respect to patient selection for and follow-up on this life-extending therapy.…”

“…Yet how much of its newness would represent genuine progress where the care of sick patients is concerned, and how much would just look new and different? In this commentary I will examine what has happened with respect to oxygen over the last 40 The history of oxygen and the genesis of our understanding of its importance and use are nicely summarized by John Heffner elsewhere in this issue. 11 Here, I will deal with developments of the last 40 years from a personal perspective, having been fortunate enough to be an active participant in the field during this time and to know some of its most important players.…”