Home Oxygen

Last updated 20.09.12

Index

Definition

- Continuous or intermittent administration of oxygen for patient use

Features

- Improves longevity & quality of life

- Only prescribed for patients for whom there is evidence of benefit

- In absence of hypoxaemia unlikely to be of benefit in dyspnoea

- Most benefit if PaCO2 >45mmHg

- Should be used whenever physical restriction of using it is not onerous

- As many hrs out of 24 as possible (within reason)

- Continuous or intermittent

- Extra soft nasal prongs recommended for continous use

- Funding

- Respiratory physicians & cardiologist are authorised prescribers for state based funding

- Any registered medical practitioners may prescribe if patient meets costs

Indications

- Continuous

- Stable daytime PaO2 <55mmHg at rest, awake & breathing air

- OR Stable daytime PaO2 56-59mmHg & evidence of complications

- Polycythemia (Hct >0.55)

- Clinical or ECG evidence of pulmonary HTN

- Episodes of right heart failure

- Intermittent

- Desaturation <88% during exercise

- Rapid improvement in dyspnoea or exercise capacity from oxygen

Medical Indications

- Continuous

- COPD: Most common cuase of chronic hypoxaemia in Australia

- Cor Pulmonale

- Cyanotic congenital heart disease

- Severe CCF

- Diffuse interstitial lung disease

- Advanced lung cancer

- CF

- Intermittent

- Severe asthma prone to sudden life threatening episodes

- Rehabilitation awaiting lung transplant ro reduction surgery

- Severe hypoxameia during air travel

- Intracable dyspnoea due to terminal illness

Contraindications

- Severe airflow limitation with PaO2 >60mmHg & no complications of chronic hypoxaemia

- Smokers (fire risk)

- Patient who have not received adequate prior therapy (bronchodilators, corticosteroids)

Ix

- Spirometry: COPD

- ABG

- PaCO2: hypercapnia (careful of O2 retainers)

- PaO2: hypoxaemia

- CXR: COPD, CCF

- ECG: right heart failure, pulmonary HTN

- Echo: right heart failure, pulmonary HTN

- FBE: RBC, Hct

- Anaemia: reversible cause of dyspnoea

- Polycythemia: chronic hypoxaemia

Delivery Devices

- Oxygen Concentrators

- Electrically driven device which entrains room air, extracts nitrogen & delivers oxygen

- Runs on domestic electrical supply

- 92%+/-3% at 4L/min

- Small, portable, light weight, battery driven of up to 5L/min available

- Cylinders

- Compressed pure O2 delivered at 100%

- Size G: 7.6-8.8m3, only in hospital

- Size E: 3.8-5.2m3 = around 30hrs, 2L/min

- Size D: 1.5m3 = around 11hrs, 2L/min

- Size C: 0.55m3

- Used with conservation device which senses inspiration & only delivers oxygen at that time

- Liquid Oxygen Systems

Procedure

- Reversible factors remediated

- Anaemia

- Nutrition

- Bodyweight

- Exercise rehab

- Infection control

- Cor Pulmonale Mx

- Ensure pharmacotherapy optimised & stable over 4 weeks

- Establish need

- 6 minute walk test

- ABG

- Referral to Resp or Cardio

- Determine delivery device

- Usually commenced at 2L/min

- Flow rate to maintain PaO2 >60mmHg (>90% O2Sat)

- Typically increase by 1L/minduring exercise & sleep

- F/U 1-2 months

- Monitor for effect

- ABG

- Monitor hypercapnia

- Ensure compliance

- Ensure not smoking

- If on intermittent assess ongoing need

- Subsequent R/V at least annually

References

Adult Domiciliary Oxygen Therapy. Position Statement of the Thoracic Society of Australia & New Zealand, MJA Vol 182 No 12, June 2005