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Oxygen conserving devices

Brian L Tiep, MD
Rick Carter, PhD, MBA
Section Editor
James K Stoller, MD, MS
Deputy Editor
Helen Hollingsworth, MD


The functional disability experienced by patients with severe pulmonary disease relates both to their physiological impairment and their inability to adapt and maintain a normal lifestyle. As patients develop a medical need for supplemental oxygen, breathlessness and lack of energy are compounded by the increased demand of carrying oxygen equipment.

Oxygen conserving devices have been introduced as a means of making oxygen therapy more efficient, more portable, and less intrusive [1,2]. In addition, hypoxemia can be prevented more readily in those patients with high oxygen flow requirements by using oxygen conserving devices, such as reservoir cannulas and transtracheal catheters. Escalating costs and reduced reimbursement have also fostered the availability of these systems.

This review will compare traditional, continuous flow oxygen delivery by nasal cannula with a variety of oxygen conserving devices. The indications for long-term supplemental oxygen, the use of oxygen in hypercapnic patients, and issues regarding oxygen therapy during air travel are discussed separately. (See "Long-term supplemental oxygen therapy" and "The evaluation, diagnosis, and treatment of the adult patient with acute hypercapnic respiratory failure" and "Traveling with oxygen aboard commercial air carriers".)


Continuous flow nasal cannula oxygen delivery via nasal prongs is the standard against which all developments or improvements should be compared [3]. The nasal cannula is universal and generally well accepted by patients and the public alike, and its effectiveness in meeting the oxygen needs of the stable chronic lung disease patient is essentially unquestioned. However, it is inefficient, as only a small percentage of the oxygen delivered to the nose actually reaches the alveoli.

Oxygen flowing through the standard nasal cannula is nearly 100 percent pure. However, the patient actually receives a blend of pure oxygen and room air. In fact, a much larger volume of inspired atmospheric air, containing 20.9 percent oxygen, is entrained with the oxygen [4]. The resultant inspiratory oxygen concentrations via standard flow settings are approximated in the figure (figure 1).


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Literature review current through: Aug 2015. | This topic last updated: Nov 14, 2014.
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  1. McCoy R. Oxygen-conserving techniques and devices. Respir Care 2000; 45:95.
  2. Keller RR. Long-term oxygen therapy: advances and perspectives in technical devices. Monaldi Arch Chest Dis 1999; 54:75.
  3. Rees PJ, Dudley F. Provision of oxygen at home. BMJ 1998; 317:935.
  4. Tiep BL. Continuous flow oxygen therapy and basis for improving the efficiency of oxygen delivery. In: Portable Oxygen Therapy: Including Oxygen Conserving Methodology, Tiep BL (Ed), Futura Publishing, Mt Kisco, New York 1991. p.205.
  5. Mithoefer JC, Keighley JF, Karetzky MS. Response of the arterial Po2 to oxygen administration in chronic pulmonary disease. Interpretation of findings in a study of 46 patients and 14 normal subjects. Ann Intern Med 1971; 74:328.
  6. Soffer M, Tashkin DP, Shapiro BJ, et al. Conservation of oxygen supply using a reservoir nasal cannula in hypoxemic patients at rest and during exercise. Chest 1985; 88:663.
  7. Gloeckl R, Heinzelmann I, Matthaei M, et al. Benefits of an oxygen reservoir cannula versus a conventional nasal cannula during exercise in hypoxemic COPD patients: a crossover trial. Respiration 2014; 88:399.
  8. Gonzales, S, Huntington, D, Remo, R, Light, R. Efficacy of the Oxymizer Pendant in reducing oxygen requirements of hypoxemic patients. Respir Care 1986; 31:681.
  9. Collard P, Wautelet F, Delwiche JP, et al. Improvement of oxygen delivery in severe hypoxaemia by a reservoir cannula. Eur Respir J 1989; 2:778.
  10. Sheehan, JC, O'Donohue, WJ. Use of a reservoir nasal cannula in hospitalized patients with refractory hypoxemia. Chest 1996; 110:s1.
  11. Heimlich HJ. Respiratory rehabilitation with transtracheal oxygen system. Ann Otol Rhinol Laryngol 1982; 91:643.
  12. Christopher KL, Spofford BT, Petrun MD, et al. A program for transtracheal oxygen delivery. Assessment of safety and efficacy. Ann Intern Med 1987; 107:802.
  13. Christopher KL, Spofford BT, Brannin PK, Petty TL. Transtracheal oxygen therapy for refractory hypoxemia. JAMA 1986; 256:494.
  14. Tiep BL, Nicotra MB, Carter R, et al. Low-concentration oxygen therapy via a demand oxygen delivery system. Chest 1985; 87:636.
  15. Tiep BL, Christopher KL, Spofford BT, et al. Pulsed nasal and transtracheal oxygen delivery. Chest 1990; 97:364.
  16. Fuhrman C, Chouaid C, Herigault R, et al. Comparison of four demand oxygen delivery systems at rest and during exercise for chronic obstructive pulmonary disease. Respir Med 2004; 98:938.
  17. Tiep BL, Barnett J, Schiffman G, et al. Maintaining oxygenation via demand oxygen delivery during rest and exercise. Respir Care 2002; 47:887.
  18. Palwai A, Skowronski M, Coreno A, et al. Critical comparisons of the clinical performance of oxygen-conserving devices. Am J Respir Crit Care Med 2010; 181:1061.
  19. Martí S, Pajares V, Morante F, et al. Are oxygen-conserving devices effective for correcting exercise hypoxemia? Respir Care 2013; 58:1606.
  20. Tiep, BL, Murray, R, Barnett, M, Carter, R. Auto-adjusting demand oxygen delivery system that minimizes SaO2 swings between rest and exertion. Chest 2004 (Abstract).
  21. Rice KL, Schmidt MF, Buan JS, et al. AccuO2 oximetry-driven oxygen-conserving device versus fixed-dose oxygen devices in stable COPD patients. Respir Care 2011; 56:1901.
  22. Tiep BL, Nicotra B, Carter R, et al. Evaluation of a low-flow oxygen-conserving nasal cannula. Am Rev Respir Dis 1984; 130:500.
  23. Pesce, L, Lauro, S, Testi, R, et al. Effetti della somministrazione de ossigeno attraverso un nuovo dispositivo economizzatore in 20 pazienti affetti da insufficcienza respiratoria. Min Pneum 1987; 25:143.
  24. Carter R, Williams JS, Berry J, et al. Evaluation of the pendant oxygen-conserving nasal cannula during exercise. Chest 1986; 89:806.
  25. Hagarty EM, Skorodin MS, Stiers WM, et al. Performance of a reservoir nasal cannula (Oxymizer) during sleep in hypoxemic patients with COPD. Chest 1993; 103:1129.
  26. Cuvelier A, Muir JF, Czernichow P, et al. Nocturnal efficiency and tolerance of a demand oxygen delivery system in COPD patients with nocturnal hypoxemia. Chest 1999; 116:22.
  27. Hoffman LA, Wesmiller SW, Sciurba FC, et al. Nasal cannula and transtracheal oxygen delivery. A comparison of patient response after 6 months of each technique. Am Rev Respir Dis 1992; 145:827.
  28. Benditt J, Pollock M, Roa J, Celli B. Transtracheal delivery of gas decreases the oxygen cost of breathing. Am Rev Respir Dis 1993; 147:1207.
  29. Garrod R, Bestall JC, Paul E, Wedzicha JA. Evaluation of pulsed dose oxygen delivery during exercise in patients with severe chronic obstructive pulmonary disease. Thorax 1999; 54:242.
  30. Carter R, Tashkin D, Djahed B, et al. Demand oxygen delivery for patients with restrictive lung disease. Chest 1989; 96:1307.
  31. Franco, MA, Conner, SA, Gougenheim, C. Pulse dose oxygen delivery during exercise. Respir Care 1985; 30:888.
  32. Bower JS, Brook CJ, Zimmer K, Davis D. Performance of a demand oxygen saver system during rest, exercise, and sleep in hypoxemic patients. Chest 1988; 94:77.
  33. Yaeger ES, Goodman S, Hoddes E, Christopher KL. Oxygen therapy using pulse and continuous flow with a transtracheal catheter and a nasal cannula. Chest 1994; 106:854.