Portable oxygen delivery and oxygen conserving devices
- Brian L Tiep, MD
Brian L Tiep, MD
- Director of Pulmonary Rehabilitation, City of Hope National Medical Center
- Associate Professor of Medicine, Western University of Health Sciences
- Rick Carter, PhD, MBA
Rick Carter, PhD, MBA
- Lamar University, Beaumont, TX
Patients with chronic lung disease and other conditions who require long-term oxygen therapy are often mobile outside of the home and need access to a portable supply of oxygen to maintain a normal lifestyle. For patients with advanced lung disease who require long-term supplemental oxygen, exertional breathlessness, hypoxemia, and lack of energy are compounded by the increased demand of carrying or dragging portable oxygen equipment when they are away from home.
Portable oxygen sources can be heavy, cumbersome, and limited in the duration of oxygen supply, so oxygen conserving devices have been introduced as a means of making oxygen therapy more efficient, more portable, and less intrusive [1,2].
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
Continuous flow oxygen delivery through nasal cannula is the usual prescription for long-term oxygen delivery in hypoxemic patients and, thus, is the standard against which all oxygen-conserving techniques should be compared . An important consideration for patients who are hypoxemic at rest is that their oxygen demands increase, sometimes abruptly, with exertion such as during activities of daily living, walking, and climbing stairs. As a result, higher oxygen flows are often necessary during exertion. Engineering technologies are making portable high-flow delivery possible for those individuals requiring high-flow supplemental oxygen. (See "Long-term supplemental oxygen therapy", section on 'Prescribing oxygen'.)
While the combination of continuous flow and the nasal cannula interface is widely used for long-term supplemental oxygen, the system 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, as atmospheric air (20.9 percent oxygen) is entrained with the oxygen . The resultant inspiratory oxygen concentrations of standard nasal cannula flow settings are approximated in the figure (figure 1).
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- CONTINUOUS FLOW NASAL CANNULA
- METHODS OF OXYGEN CONSERVATION
- Reservoir cannulas
- Transtracheal catheters
- Demand oxygen pulse devices
- - How demand oxygen pulse devices work
- - Types of devices
- - Variability in oxygenation
- - Future innovations
- PRESCRIBING OXYGEN CONSERVING DEVICES
- PORTABLE OXYGEN SYSTEMS
- Lightweight compressed gas cylinders
- Liquid oxygen systems
- Portable oxygen concentrators
- - Air travel
- PRESCRIBING PORTABLE OXYGEN SYSTEMS
- SUMMARY AND RECOMMENDATIONS