Once the critical level of oxygen is determined, oximetry may be used to adjust oxygen flow settings over time (see Symptoms and Diagnosis of Lung Disorders: Arterial Blood Gas (ABG) Analysis). Oximetry is painless and uses a simple device that is attached to a finger or ear to measure the concentration of oxygen in the blood.

Oxygen for long-term home use is available from three different delivery systems: electrically driven oxygen concentrators, liquid systems, and compressed gas. Inside the home, liquid and compressed gas systems use large tanks to store oxygen. Small, portable tanks of compressed oxygen also may be needed for brief periods—a few hours—outside the home. Each system has advantages and disadvantages.

Oxygen is typically administered with continuous flow through a two-pronged nasal tube (cannula), even though this system is highly wasteful of oxygen. To improve efficiency and increase the person’s mobility, several devices, including reservoir cannulas, demand-type systems, and transtracheal catheters, can be used. Usually, a respiratory therapist or physician instructs the person about proper oxygen use.

While using oxygen therapy at home, it is important to stabilize the tank (possibly using a stand) and store it in an area that is out of the way so it will not fall. Tanks should be closed tightly when not in use. Because oxygen can cause an explosion, it is also important to keep tanks away from any flammable source, such as matches, heaters, or hair dryers. No one in the house should smoke when oxygen is in use.

Oxygen may be classified as an element, a gas, and a drug. Oxygen therapy is the administration of oxygen at concentrations greater than that in room air to treat or prevent hypoxemia (not enough oxygen in the blood). Oxygen delivery systems are classified as stationary, portable, or ambulatory. Oxygen can be administered by nasal cannula, mask, and tent. Hyperbaric oxygen therapy involves placing the patient in an airtight chamber with oxygen under pressure.

Purpose

The body is constantly taking in oxygen and releasing carbon dioxide. If this process is inadequate, oxygen levels in the blood decrease, and the patient may need supplemental oxygen. Oxygen therapy is a key treatment in respiratory care. The purpose is to increase oxygen saturation in tissues where the saturation levels are too low due to illness or injury. Breathing prescribed oxygen increases the amount of oxygen in the blood, reduces the extra work of the heart, and decreases shortness of breath. Oxygen therapy is frequently ordered in the home care setting, as well as in acute (urgent) care facilities.

Some of the conditions oxygen therapy is used to treat include:

* documented hypoxemia
* severe respiratory distress (e.g., acute asthma or pneumonia)
* severe trauma
* chronic obstructive pulmonary disease (COPD, including chronic bronchitis, emphysema, and chronic asthma)
* pulmonary hypertension
* cor pulmonale
* acute myocardial infarction (heart attack)
* short-term therapy, such as post-anesthesia recovery

Oxygen may also be used to treat chronic lung disease patients during exercise.

Hyperbaric oxygen therapy is used to treat the following conditions:

* gas gangrene
* decompression sickness
* air embolism
* smoke inhalation
* carbon monoxide poisoning
* cerebral hypoxic event

Helium-oxygen therapy is a treatment that may be used for patients with severe airway obstruction. The combination of helium and oxygen, known as heliox, reduces the density of the delivered gas, and has been shown to reduce the effort of breathing and improve ventilation when an airway obstruction is present. This type of treatment may be used in an emergency room for patients with acute, severe asthma.

Description
Oxygen delivery (other than mechanical ventilators and hyperbaric chambers)

In the hospital, oxygen is supplied to each patient room via an outlet in the wall. Oxygen is delivered from a central source through a pipeline in the facility. A flow meter attached to the wall outlet accesses the oxygen. A valve regulates the oxygen flow, and attachments may be connected to provide moisture. In the home, the oxygen source is usually a canister or air compressor. Whether in home or hospital, plastic tubing connects the oxygen source to the patient.

Oxygen is most commonly delivered to the patient via a nasal cannula or mask attached to the tubing. The nasal cannula is usually the delivery device of choice since it is well tolerated and doesn’t interfere with the patient’s ability to communicate, eat, or drink. The concentration of oxygen inhaled depends upon the prescribed flow rate and the ventilatory minute volume (MV).

Another delivery option is transtracheal oxygen therapy, which involves a small flexible catheter inserted in the trachea or windpipe through a tracheostomy tube. In this method, the oxygen bypasses the mouth, nose, and throat, and a humidifier is required at flow rates of 1 liter (2.1 pt) per minute and above. Other oxygen delivery methods include tents and specialized infant oxygen delivery systems.

TYPES OF OXYGEN DELIVERY SYSTEMS. The types of oxygen delivery systems include:

* Compressed oxygen—oxygen that is stored as a gas in a tank. A flow meter and regulator are attached to the oxygen tank to adjust oxygen flow. Tanks vary in size from very large to smaller, portable tanks. This system is generally prescribed when oxygen is not needed constantly (e.g., when it is only needed when performing physical activity).
* Liquid oxygen—oxygen that is stored in a large stationary tank that stays in the home. A portable tank is available that can be filled from the stationary tank for trips outside the home. Oxygen is liquid at very cold temperatures. When warmed, liquid oxygen changes to a gas for delivery to the patient.
* Oxygen concentrator—electric oxygen delivery system approximately the size of a large suitcase. The concentrator extracts some of the air from the room, separates the oxygen, and delivers it to the patient via a nasal cannula. A cylinder of oxygen is provided as a backup in the event of a power failure, and a portable tank is available for trips outside the home. This system is generally prescribed for patients who require constant supplemental oxygen or who must use it when sleeping.
* Oxygen conserving device, such as a demand inspiratory flow system or pulsed-dose oxygen delivery system—uses a sensor to detect when inspiration (inhalation) begins. Oxygen is delivered only upon inspiration, thereby conserving oxygen during exhalation. These systems can be used with either compressed or liquid oxygen systems, but are not appropriate for all patients.

Preparation

A physician’s order is required for oxygen therapy, except in emergency use. The need for supplemental oxygen is determined by inadequate oxygen saturation, indicated in blood gas measurements, pulse oximetry, or clinical observations. The physician will prescribe the specific amount of oxygen needed by the patient. Some patients require supplemental oxygen 24 hours a day, while others may only need treatments during exercise or sleep. No special patient preparation is required to administer oxygen therapy.

Patient education

SELECTING AN OXYGEN SYSTEM. A health care provider will meet with the patient to discuss the oxygen systems available. A system recommendation will be made, based on the patient’s overall condition and personal needs, as well as the system’s ease of use, reliability, cost, range of oxygen delivery, and features. The health care provider can give the patient a list of medical supply companies that stock home oxygen equipment and supplies. The patient can meet with home care representatives from these companies to evaluate the product lines that best fit his or her needs. Patients in the home setting are directed to notify the vendors when replacement oxygen supplies are needed.

OXYGEN SAFETY. Patients will receive instructions about the safe use of oxygen in the home. Patients must be advised not to change the flow rate of oxygen unless directed to do so by the physician.

Oxygen supports combustion, therefore no open flame or combustible products should be permitted when oxygen is in use. These include petroleum jelly, oils, and aerosol sprays. A spark from a cigarette, electric razor, or other electrical device could easily ignite oxygen-saturated hair or bedclothes around the patient. Explosion-proof plugs should be used for vaporizers and humidifier attachments. The patient should be sure to have a functioning smoke detector and fire extinguisher in the home at all times.

Care must be taken with oxygen equipment used in the home or hospital. The oxygen system should be kept clean and dust-free. Cylinders should be kept in carts, or have collars for safe storage. If not stored in a cart, smaller canisters may be lain on the floor. Knocking cylinders together can cause sparks, so bumping them should be avoided. In the home, the oxygen source must be placed at least 6 ft (1.8 m) away from flames or other sources of ignition, such as a lit cigarette. Oxygen tanks should be kept in a well–ventilated area. Oxygen tanks should not be kept in the trunk of a car. “No Smoking—Oxygen in Use” signs should be used to warn visitors not to smoke near the patient.

Special care must be given when administering oxygen to premature infants because of the danger of high oxygen levels causing retinopathy of prematurity, or contributing to the construction of ductus arteriosis. PaO2 (partial pressure of oxygen) levels greater than 80 mm Hg should be avoided.

Patients who are undergoing a laser bronchoscopy should receive concurrent administration of supplemental oxygen to avoid burns to the trachea.

Insurance clearance

The patient should check with his or her insurance provider to determine if the treatment is covered and what out-of-pocket expenses may be incurred. Oxygen therapy is usually fully or partially covered by most insurance plans, including Medicare, when prescribed according to specific guidelines. Usually test results indicating the medical necessity of the supplemental oxygen are needed before insurance clearance is granted.

Travel guidelines

Traveling with oxygen requires advanced planning. The patient needs to obtain a letter from his or her health care provider that verifies all medications, including oxygen. In addition, a copy of the patient’s oxygen prescription must be shown to travel personnel. Home health care companies can help the patient make travel plans, and can arrange for oxygen when the patient arrives at his or her destination. Patients cannot bring or use their own oxygen tanks on an airplane; therefore the patient must leave his or her portable oxygen tank at the airport before boarding. Oxygen suppliers can pick up the oxygen unit from the airport if necessary, or a family member can take it home.

Aftercare

Once oxygen therapy is initiated, periodic assessment and documentation of oxygen saturation levels is required. Follow-up monitoring includes blood gas measurements and pulse oximetry tests. If the patient is using a mask or a cannula, gauze can be tucked under the tubing to prevent irritation of the cheeks or the skin behind the ears. Water-based lubricants can be used to relieve dryness of the lips and nostrils.

Risks

Oxygen is not addictive and causes no side effects when used as prescribed. Complications from oxygen therapy used in appropriate situations are infrequent. Respiratory depression, oxygen toxicity, and absorption atelectasis are the most serious complications of oxygen overuse.

A physician should be notified and emergency services may be required if the following symptoms develop:

* frequent headaches
* anxiety
* cyanotic (blue) lips or fingernails
* drowsiness
* confusion
* restlessness
* slow, shallow, difficult, or irregular breathing

Oxygen delivery equipment may present other problems. Perforation of the nasal septum as a result of using a nasal cannula and non–humidified oxygen has been reported. In addition, bacterial contamination of nebulizer and humidification systems can occur, possibly leading to the spread of pneumonia. High-flow systems that employ heated humidifiers and aerosol generators, especially when used by patients with artificial airways, also pose a risk of infection.
Normal results

A normal result is a patient that demonstrates adequate oxygenation through pulse oximetry, blood gas tests, and clinical observation. Signs and symptoms of inadequate oxygenation include cyanosis, drowsiness, confusion, restlessness, anxiety, or slow, shallow, difficult, or irregular breathing. Patients with obstructive airway disease may exhibit “aerophagia” (air hunger) as they work to pull air into the lungs. In cases of carbon monoxide inhalation, the oxygen saturation can be falsely elevated.

History

The trend started in the late 1990s in Japan and quickly spread east to California and Las Vegas. Oxygen bars can now be found in many venues such as nightclubs, salons, spas, health clubs, resorts, tanning salons, restaurants, coffee houses, bars, airports, ski chalets, yoga studios, chiropractors, and casinos. They can also be found at trade shows, conventions and corporate meetings, as well as at private parties and promotional events.

Provision of oxygen

Oxygen Bar guests will normally pay $1.00 USD per minute to inhale an increased percentage of oxygen compared to the normal atmospheric content of 21% oxygen. This oxygen is produced from the ambient air by an industrial (non-medical) oxygen concentrator and inhaled through a nasal cannula from a few minutes to about 20 minutes. The FDA has warned against the use of industrial generators, as they do not have the proper filtration, and high concentrations may cause difficulties in breathing for some people with medical conditions. Many bars offer oxygen flavored with an aroma, produced by passing the oxygen through an aromatic liquid.

Claims

Proponents claim this practice is not only safe, but enhances health and well-being, including strengthening the immune system, enhancing concentration, reducing stress, increasing energy and alertness, lessening the effects of hangovers, headaches, and sinus problems, and generally relaxing the body. It has been alleged to alleviate hangovers and help with migraines, but no long-term, well-controlled scientific studies have yet confirmed any of these claims.

Precautions

The medical profession warns that individuals with respiratory diseases such as asthma and emphysema should not inhale too much oxygen. The FDA warns that some flavoring methods use oils, which if used improperly, and droplets are inhaled, might contribute to an inflammation of the lungs. Some oxygen bar companies offer safe water-based aromas for flavoring in order to maintain compliance and stay within FDA guidelines. Also, concentrated oxygen is a flame accelerant which should be kept away from cigarettes and other sources of ignition. Oxygen may also cause serious side effects at excessive doses. The effects of oxygen toxicity at atmospheric pressure can cause lung damage, and due caution should be exercised when consuming oxygen. In the UK, the Health and Safety Executive publishes guidance on equipment (including tubing) and on staff training, as well as warning on potential hazards, and makes several recommendations to ensure safe practice, principally to minimise fire risks.