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