Improving lifestyle choices for oxygen patients with portable oxygen concentrators
For patients with severe resting hypoxemia, the prescription of long term oxygen therapy (LTOT) to improve survival is supported by historical trials in patients with chronic hypoxemia.1 Ambulatory oxygen acutely improves exercise capacity and may reduce breathlessness during exercise testing.1 However the treatment can also be disruptive to everyday life. Understanding the full range of available oxygen delivery solutions is critical to prescribing patients with therapies that meet their medical needs while ensuring that the patient can maintain an active lifestyle.
The Philips S.A.V.E. approach for understanding oxygen therapy
This process provides clinical guidance on how to ensure respiratory patients are properly screened, assessed and treated for hypoxemia. It can be applied in the hospital, out-patient clinics or in home environments.
S
Screen for hypoxemia in every patient with a respiratory or cardiac disorder Analyse patient oxygen levels at rest, with activity and during sleep.
A
Assess the patient, including clinical history and physical examination Look for signs and symptoms that suggests the presence of respiratory impairments.
V
Validate the need for oxygen therapy
Consider the patient’s clinical needs, lifestyle and capabilities, and decide whether the patient needs a stationary system, portable system, or both.
E
Educate the patient on the use of oxygen therapy Always customize education based on each patient’s needs, abilities and risk factors.
Understanding the options for oxygen delivery
There are a variety of stationary and portable technologies available for delivering supplemental oxygen. It is important to understand the advantages and disadvantages of each type of technology. Systems can vary through their dose pattern – continuous or pulse – as well as through size, weight, flow rate and ease of use.
Oxygen concentrators
Uses an advanced technology to separate oxygen from air by compressing pressurized air through sieve material made of zeolite. Nitrogen sticks to the outside of zeolite after which the pressure drops and the remaining oxygen accumulates in a reservoir. The reservoir is connected to a flowmeter that may be adjusted to deliver the oxygen to the patient at a set liter flow. Oxygen concentrators may be low flow units that deliver oxygen flows of 0.5 -5Lpm or high flow systems that deliver up to 10Lpm.
Oxygen concentrators may be stationary or portable
Stationary concentrator
Large, heavier units that are designed to be used inside the home. Due to their larger size, they are capable of providing continuous oxygen flow. Units may deliver oxygen up to 5 liters per minute (LPM) or high flow units that deliver flows up to 10 LPM.
Portable oxygen concentrators (POCs)
Smaller and lighter in weight. A patient may use these units for ambulatory purposes only or both as a stationary and ambulatory oxygen unit. POCs may also be classified according to flow requirements (continuous flow or intermittent), while others are capable of operating in both modes.
Pulse dose or intermittent flow (IF) - these systems deliver oxygen during the inspiratory phase of the breathing cycle – oxygen is NOT delivered during exhalation. Because the system must sense when a patient is inhaling, they must be instructed to “sniff” in through their nose. Because these units do not deliver flow continuously, they are calibrated to deliver in either milliliters (mL) per breath, which is known as a fixed bolus volume or in milliliters (mL) per minute, known as fixed minute volume. Continuous flow (CF) – these systems deliver oxygen throughout the respiratory cycle (i.e. inhalation and exhalation). These units are calibrated to deliver flow in liters per minute.
Understanding portable oxygen concentrator (POC) settings
Fixed bolus volume:
a predetermined bolus size is calculated for each POC setting and regardless of breathing rate the same size will be delivered with each breath.
Fixed minute volume:
a predetermined volume of oxygen is produced for each POC setting over the course of a minute and since the amount of O2 produced for each minute remains steady the amount of O2 will be different for each breath.2
Numerical settings on intermittent flow and continuous flow devices:
Several studies have been published to demonstrate that pulse dose methods from either a portable oxygen concentrator or an oxygen conserving device can safely deliver oxygen to the COPD patient, but that the IF setting is not equivalent to the CF settings due to the differences in the design and calibration of the methods of delivery. There is widely held misconception that the numerical settings on the IF and CF products are equivalent, such that a setting of 1 is equal to a 1 L/min. This is not the case and can lead to incorrect O2 therapy.3
Portable oxygen concentrators: driving real quality of life improvements for oxygen patients
Oxygen concentrators have seen many technological advancements in recent years. With portable oxygen concentrators, today’s oxygen patients can enjoy an active lifestyle without being weighed down by heavy and impractical equipment. Portable oxygen concentrators (POCs) function in the same way as stationary oxygen concentrators, but with the added benefit of being lightweight, and able to function using rechargeable batteries. POCs free users from the sedentary lifestyle often associated with oxygen patients. People using this technology can continue with daily life with far fewer obstacles than with other oxygen solutions. By restoring more mobility to patients, POCs can play a role in promoting an active lifestyle – and all the health benefits that can bring - and offer clear improvements to quality of life for both people new to oxygen therapy, and those on long-term oxygen therapy. In a recent study that included patients with COPD and interstitial lung disease that evaluated preference between 2 ambulatory oxygen systems (Philips SimplyGo mini POC vs small cylinder), the patients expressed a greater preference for the POC (73.3%), basing their choice mainly on ease of transport and lower weight.4
Scripting for success
Scripting for home oxygen therapy: the prescription should include:
Philips end-to-end solutions for people with COPD and other chronic respiratory conditions
The Philips difference Unlike some competitors, Philips offers both pulse dose and continuous flow oxygen solutions, meaning that Philips oxygen solutions can support your patients seamlessly as their oxygen requirements increase. Philips is the number one respiratory brand of choice by US pulmonary physicians5. With over 35 years of experience in producing oxygen therapy solutions, Philips Respironics has sold over 3 million oxygen concentrators worldwide6. Philips oxygen concentrators are just one part of our end-to-end range of solutions for people with COPD and other chronic hypoxemia.
Is pulse dose delivery equivalent to continuous flow?
Read our discussion sheet on how long-term oxygen therapy (LTOT) in the home often follows the model of "non-delivery LTOT"
References 1. Susan S. Jacobs, Jerry A. Krishnan, David J. Lederer, Marya Ghazipura, Tanzib Hossain, Ai-Yui M. Tan, Brian Carlin, M. Bradley Drummond, Magnus Ekstro¨m, Chris Garvey, Bridget A. Graney, Beverly Jackson, Thomas Kallstrom, Shandra L. Knight, Kathleen Lindell, Valentin Prieto-Centurion, Elisabetta A. Renzoni, Christopher J. Ryerson, Ann Schneidman, Jeffrey Swigris, Dona Upson, and Anne E. Holland; on behalf of the American Thoracic Society, Home Oxygen Therapy for Adults with Chronic Lung Disease An Official American Thoracic Society Clinical Practice Guideline, Am J Respir Crit Care Med, 2020 November 15, 202(10):121-141 2. Giordano, Sam P., A guide to portable oxygen concentrators, produced by the American Association for Respiratory Care. 3. Dunne, P.J., Long-term oxygen therapy (LTOT) revisited: In defense of non-delivery LTOT technology, Portuguese Journal of Pulmonology, 2012;18(4): 155-157 4. Pasquale Moretta, Antonio Molino, Michele Martucci, Salvatore Fuschillo, Alberto De Felice, Pietro Guida, Andrea Motta, Michele Vitacca, and Mauro Maniscal, Subject Preferences and Psychological Implications of Portable Oxygen Concentrator Versus Compressed Oxygen Cylinder in Chronic Lung Disease, Respiratory Care, 2021 January, 66(1)33-40 5. Ventilators and oxygen *Philips Respironics
