Respironics Ever-Go: Rinse and completely dry the side gross particle filter weekly/bi-weekly depending on the use of the machine

Respironics Ever-Flo: Change internal hepa filter annually/bi-annually depending on the environment and use of he machine

SeQual Eclipse: A Preventative Maintenance (PM) service is recommended by the manufacturer. This includes replacing the 9-volt internal alarm battery, and bacteria, internal hepa and gross particle filters. This procedure can only be completed by an authorized service center because it involves opening up the unit.

Invacare XPO2: Remove unit from carry bag and lift up front face plate to access the gross particle filter. Rinse and completely dry weekly/bi-weekly depending on the use of the machine. Replace the Inlet/Herpa filter annually/bi-annually dependent upon use.

Invacare Perfecto 2: Rinse and completely dry the gross particle filter on the rear of the machine weekly/bi-weekly depending on the use of the machine. Replace internal hepa filter annually/bi-annually depending on the environment and the use of the machine.

Inogen One G1: Rinse and completely dry the gross particle filter located in the rear of the machine weekly/bi-weekly depending on the environment and the use of the machine.

Inogen One G2: Rinse and completely dry the screen filter located on the rear of the machine weekly/bi-weekly depending on the environment and the use of the machine.

Devilbiss I-GO: Rinse and completely dry the gross particle filter located on the top where the patients hand goes. Perform this task/duty weekly/bi-weekly depending on the environment and the use of the machine.

We have all filters in stock, feel free to give us a call if you have any questions or problems changing your filters. For our SeQual customers, we are an authorized repair center and are offering SeQual PM’s at a discount this month. See the coupon for details.

Passengers on U.S. commercial aircraft now may bring any of 11 different portable oxygen concentrators on board and use them, with the approval of the aircraft operator, thanks to an FAA final rule that was published and immediately effective Wednesday.

The rule signed by FAA Administrator Randy Babbitt amended Special Federal Aviation Regulation 106, Use of Certain Portable Oxygen Concentrator Devices on Board Aircraft, to allow the use of DeVilbiss Healthcare Inc.’s iGo, International Biophysics Corporation’s LifeChoice, Inogen Inc.’s Inogen One G2, and Oxlife LLC.’s Oxlife Independence Oxygen Concentrator.

POCs are small, FDA-regulated machines that separate oxygen from nitrogen and other gases contained in ambient air and dispense it in concentrated form to the user, with an oxygen concentration of about 90 percent. They can use rechargeable batteries or, if the aircraft operator obtains FAA approval, aircraft electrical power, and the Pipeline and Hazardous Materials Safety Administration has determined the four POCs are not hazardous materials. That means they do not require the same level of special handling as compressed oxygen and are safe for use on board aircraft, provided certain conditions for their use are met.

SFAR 106, originally published in July 2005, already allowed passengers to carry on and use AirSep Corporation’s LifeStyle and FreeStyle; Inogen’s Inogen One; SeQual Technologies’ Eclipse; Philips Respironics Inc.’s EverGo; Delphi Medical Systems’ RS-00400; and Invacare Corporation’s XPO2.

The contact for more information about this rule is David Catey of the Air Transportation Division, FAA Flight Standards Service, at 202-267-8166.

In the rule, FAA said it still intends to develop a performance-based standard for all future POC devices but wants to ensure such a standard does not hamper innovative technologies by the manufacturers. “This process is time-consuming and we intend to publish a notice in the Federal Register and offer the public a chance to comment on the proposal when it is complete. In the meantime, manufacturers continue to create new and better POCs, and several have requested that their product also be included as an acceptable device in SFAR 106,” the agency explained.

Breathing Pure Oxygen Effective in Treating Cluster Headaches, Study Finds

For Petru Russo, the headaches can occur up to 10 times a day. “It’s like a knife, somebody’s cutting in your brain,” he said.

Ruso says he tried all kinds of medication for this severe pain but nothing worked. The only thing that brought relief was breathing pure oxygen. “The pain is gone. The oxygen really changed my life,” he explained.

Pure oxygen also did the trick for Valerie Walker. “Oxygen has just made all the difference for me. I do not have the side effects and it has made all the difference for me,” she said.

Cluster headaches occur in cycles: sufferers can experience several headaches a day for weeks or even months on end. And cluster headaches are debilitating.

The typical treatment is an injection with the drug sumatriptan. But sumatriptan has side effects and overuse of medication can be hard on the body.

Dr. Peter Goadsby of the University of California and other researchers followed 76 patients in London for five years.

The doctors treated for cluster headaches in each patient using air and oxygen in separate trials.

“Our study showed for the first time a clear difference between oxygen and air in the treatment of acute cluster headache. It was properly powered, randomized and placebo-controlled and really provides evidence for the use of oxygen in cluster headaches,” Dr. Goadsby said.

The study found the most effective treatment was high doses of high-flow oxygen.

“Twenty percent of attacks were improved on placebo, which is air, and 78 percent of attacks were improved on oxygen, a clear difference in favor of oxygen,” Dr. Goadsby added.

Dr Joel Saper, Founder of the Michigan Headache and Neurological Institute says using oxygen also helps to avoid overuse of other medications. “Patients are so desperate that they will take anything and ending up hurting themselves in the process,” Dr. Saper said.

Researchers also found that oxygen could stop the headache pain and eliminate other symptoms associated with cluster headaches, such as red, swollen and watery eyes.

What is oxygen?
Air is a mixture of gases. Oxygen and nitrogen are the two main gases in the air we breathe. Oxygen accounts for about 21% of gas in air. The abbreviation for oxygen is O2. Every cell in our body needs oxygen to live. In order for oxygen to get to these cells, it must be transported through the airways of the lungs.
If there is a blockage in the airways from mucus or narrowing of the airways from swelling or constriction, air may not reach enough alveoli to deliver oxygen. In some COPD patients, adequate air is brought into the alveoli, but the oxygen contained in the air is not able to pass into the capillaries surrounding the alveoli. This results in low oxygen levels and is called hypoxemia. By breathing even small amounts of additional oxygen, the oxygen level in the air rises above 21% to 23 or 24%. This small amount is enough to help "push" the oxygen into the capillaries. Since the body cannot store oxygen, oxygen needs to be given whenever the body is low on oxygen. In some instances, this means that the COPD patient must use oxygen 24 hours a day. The need for continuous oxygen is called long term oxygen therapy (LTOT). Oxygen therapy is important to understand because oxygen is not useful for everyone with COPD. In fact, oxygen is probably one of the least understood and misused therapies for people with COPD.

How do I know I need oxygen?
The need for oxygen is found by measuring the amount of oxygen in your blood stream. If your oxygen level is below a critical level at rest, then you need oxygen close to 24 hours a day. Some people with COPD do not need oxygen when they are inactive, such as when sitting, but need oxygen when exercising, such as walking, or with eating and/or sleeping. Breathlessness is not a reliable way of determining if you need oxygen. Sometimes, you can be very short of breath and not need oxygen; other times your breathing may feel okay, but you are not getting enough oxygen. Oxygen is not given to treat breathlessness. Although some patients feel some relief in their breathlessness from the flow of oxygen on their face, less expensive ways of getting this same relief can be obtained with a fan.

Your healthcare provider will find out if you need oxygen therapy by taking a blood sample from your artery. This test is called an arterial blood gas (ABG) and it measures carbon dioxide and pH in addition to oxygen. This can be done in the office, clinic or hospital, wherever the arterial blood equipment is available. When making an important decision, such as who needs oxygen, the best evaluation is with an ABG. Measuring oxygen levels can also be done with a pulse oximeter. Oximetry is performed by attaching a clip to your finger that shines a light through it. A tiny computer in the oximeter then determines your oxygen level by the color of the light that shines through from the other side. Oximetry only measures one characteristic of the oxygen in your body and, since it is not as precise as an ABG, should only be used as a guide to oxygen therapy.

How much oxygen should I take?
Oxygen is a medication prescribed by your healthcare provider. Optimally, the amount is carefully decided based on an ABG and then guided by oximetry. Once the amount of oxygen you need is decided, your provider will advise you of the rate at which the oxygen should be set. It is very important that you only use the amount that your doctor or nurse has prescribed, no more or no less. The treatment goal is to keep your oxygen at a level that meets your body’s need for oxygen, usually above 89%. Taking too much oxygen sends a message to your brain to slow your breathing. Whereas too little may deprive the tissue in your brain and heart of oxygen and result in memory loss or changes in your heart.

How many hours a day will I need oxygen?
In some cases, you may only need to use oxygen when you are exercising or sleeping. However, in most cases, oxygen should be used as close to 24 hours a day as possible. If your oxygen level is found to be low, using less than 15 hours a day has not been shown to provide a benefit, and does not protect your heart, brain and other organs of the body. If you are instructed to use continuous oxygen and choose to go off oxygen temporarily, it is best to do so only while resting quietly, not while sleeping, walking or exerting yourself.

During exercise you use more energy and therefore need more oxygen. To find out how much oxygen is needed during exercise, an exercise stress test or a timed walk test is usually done. It is important that the test be performed while using the type of delivery device that is going to be used at home.

The immediate benefits of using oxygen during exercise may be relief of breathlessness (also called dyspnea) and an improvement in your ability to walk or do activities.

Will I need oxygen when I sleep?
During sleep, you slow down your breathing. People have low oxygen levels while awake are usually also lacking oxygen during sleep. In some cases, people that may not require oxygen while awake may require extra oxygen while sleeping. Your healthcare provider will determine if and how much oxygen you should take at night. Your needs may be determined by using an oximeter that will record your oxygen level while you sleep in your home or you may be asked to sleep at a sleep laboratory.

What kind of devices provide oxygen?
There are several types of oxygen devices. The type of device you are given will depend on where you live and on the purpose of your oxygen. Oxygen can be delivered by three types of devices: oxygen concentrator, liquid system or oxygen in a metal cylinder.

What are oxygen concentrators?
A concentrator draws in air from the room/environment (which contains 21% oxygen) and passes the air through a special filter collecting only the oxygen into a reservoir. When the machine is turned on, this process of collection takes place. The reservoir and the concentrator have limited storage, so virtually all the oxygen saved is released into the oxygen tubing for delivery to the patient. The concentration of oxygen delivered by a concentrator is 90-95%. The concentrator is run by electricity. The concentrator weighs about 50 pounds (23 kg) and is usually on wheels so that it can be easily moved in the home from room to room. The machine should be located where there is good circulation and away from furniture and walls. There is a compressor inside the machine that makes a regular noise that can be distracting to some. The device is not intended to be portable, however, recently, a new type of concentrator has been developed that makes it possible to fill portable cylinders from a concentrator. Also in development is a concentrator that weighs less than 10 pounds (5 kg) and runs off of a battery.

What maintenance do oxygen concentrators require?
Concentrators have an air inlet and a filter in front of the air inlet. Make sure that the air inlet is not covered and that it allows fresh air into the concentrator. This filter should be washed once a week in dishwasher detergent. After washing it should be thoroughly rinsed and completely dried before re-inserting. The instruction manual will outline how many filters your concentrator has and how often each of these should be changed. Your concentrator should be serviced after approximately 10,000 hours of use or annually. At that time it should be checked to assure that it is producing the right amount of oxygen. Improper maintenance may result in low concentrations of oxygen being delivered.

What is liquid oxygen?
Liquid oxygen is oxygen that is cooled to -183° C (-297°F), at which point it becomes a liquid. When in liquid form, the oxygen takes up much less room and can be stored in specially designed containers. The concentration of oxygen delivered from liquid oxygen is 100%. Most hospitals use oxygen in liquid form. The gas molecules in the container are in constant movement, allowing for the liquid to slowly turn into a gaseous form. This results in a build up of pressure in the container, which is either delivered to the patient or released by a ventilation valve. Liquid oxygen is stored in the home in large storage reservoirs. The patient uses a smaller tank to fill for portability. You will need to be instructed on how to fill the smaller tank from the larger storage tank. Your oxygen delivery service will routinely fill the larger tank, every 1-2 weeks, depending on the flow rate you use.

What maintenance do liquid oxygen devices require?
The stationary tank should be placed on a level surface so there is minimal chance of the tank tipping. Little maintenance is required. If a bottle is attached to the tank for collecting condensed water, it must be emptied and cleaned regularly. The outside of the tank can be cleaned with a damp cloth when necessary. In addition to instructions for transferring the oxygen from the large tank to the smaller tank, instruction should be received in what should be done if any part of the system should freeze.

What are oxygen cylinders?
This is the oldest method for delivering oxygen. Oxygen is compressed into a steel cylinder under high pressure, often a pressure of about 200 atmospheres. Like liquid oxygen, the concentration of oxygen delivered from cylinders is 100%. Oxygen is stored in large or small cylinders. Large cylinders are very heavy and have to be changed often as the contents are quickly used. Smaller cylinders are therefore emptied more quickly than larger cylinders, but are portable. Smaller aluminum cylinders are also available for portability. When using oxygen-sparing tubes or oxygen-conserving devices, these small cylinders can last for up to 8 hours. The small cylinders are usually used for portability when an oxygen concentrator is the main source of oxygen in the home.

What maintenance do oxygen cylinders require?
The pressure valves must be checked frequently. When the cylinders are empty, the regulator must be removed and placed on a full cylinder.

What about hoses or tubes attached to the oxygen device?
The main tubing attached to the different systems can be up to 15 meters/50 feet long to allow for mobility. The length of the tubing should only be as long as necessary in order to be mobile, for example long enough to get from one end of the house to the other. Having excess tubing may become a hazard to yourself and others. Long tubing also increases chances of knotting and cutting off the flow of oxygen. The tubes should be changed every 6-12 months. The tubing must be the right dimension. The inner diameter should be at least 5 mm to ensure the resistance is minimal.

What is a nasal cannula?
A nasal cannula is a dual-pronged tube attached to the oxygen device for delivering oxygen through the nose. These tubes come in different sizes and lengths. Make sure that the one you have fits you well. The typical length of the tubing is about 2 meters (6 feet). The nasal cannula should be changed approximately once a month due to the plastic nasal cannula becoming hard and stiff. The part of the cannula that is situated in the nose may be washed and the rest of the cannula may be wiped with a damp cloth.

What are oxygen sparing/conserving devices?
Oxygen-sparing/conserving devices are devices used to reduce the amount of oxygen needed from the oxygen source (liquid, concentrator or cylinder). These devices improve the efficiency of the delivery of oxygen, reducing the amount of oxygen that is used. This is accomplished by increasing the flow of oxygen on inhalation and limiting the flow of oxygen on exhalation. By increasing the delivery of oxygen when you breathe in, and reducing or stopping the delivery when you are breathing out, less of the oxygen is wasted. This makes it possible to use smaller and lighter ambulatory systems or standard systems. In addition, the delivery systems (liquid or cylinders) last longer. There are three types of oxygen-sparing/conserving devices: the on-demand device, reservoir cannula and transtracheal oxygen.

What is an on-demand device?
On-demand oxygen delivery devices deliver a small amount of oxygen, usually when you begin to take a breath in through your nose. The delivery device is connected to the oxygen source by the nasal cannula. The device senses the start of inhalation (through the nasal cannula) and immediately gives a short pulse of oxygen.

Nose congestion and mouth breathing may make it hard for the delivery device to sense inhalation. If the level of inspiration through the nose is very low, no oxygen may be delivered. Some types of devices have an alarm that goes off if no breathing activity is detected. Most of the on-demand devices are battery driven and the batteries need to be replaced every couple of weeks.

What are reservoir cannulas?
A reservoir cannula operates by storing oxygen in a small chamber. Storage of oxygen takes place while you are breathing out. This stored oxygen is available when you breathe in. This may allow you to require lower oxygen flow rates while still receiving the same amount of oxygen. There are two types of reservoir devices, the Oxymizer and the Pendant Oxymizer. The differences in the two devices are the location where the storage chamber is located.

What is transtracheal oxygen?
Transtracheal oxygen is oxygen delivered through a catheter placed directly through the neck into the trachea (windpipe). Delivery of oxygen directly into the trachea provides higher amounts of oxygen to be delivered because little is wasted. Flow rates of oxygen can often be reduced by close to 50% at rest and 30% during exercise, as compared with oxygen delivered via a standard nasal cannula. A cosmetic advantage of transtracheal oxygen therapy is that the tubing is not as visible as with standard devices.

Not everyone is a candidate for transtracheal oxygen delivery (TTOD). Candidates must be evaluated, educated and monitored by a trained team of healthcare providers. Complications from TTOD are not frequent, but can be serious.

Do I need a humidifier on my oxygen system?
If you use transtracheal oxygen, humidification of the oxygen is important. With other delivery systems at less than 4 liters per minute, humidification is not usually necessary or beneficial. If you have dryness in your nose, you can use a saline (salt water) spray. If this does not help, a humidifier can be attached to the oxygen system. The humidifier is a bottle filled with sterile or distilled water. The oxygen passes through the water to gather moisture. Water from the humidifier should be changed every 1-2 days.

What should I watch for while I am on oxygen?
In some cases too much oxygen may lead to an increase of carbon dioxide in your blood. This can give symptoms like drowsiness and difficulty keeping awake. Receiving too much oxygen while sleeping can also result in a morning headache. A sign of receiving too little oxygen is a general feeling of fatigue. If any of these problems occur, contact your healthcare provider.

What safety precautions should I use when on oxygen?
Oxygen used properly is safe. DO NOT SMOKE NEAR OXYGEN! Also, stay away from open flames. It is important that no oil or grease is used on any of the oxygen equipment. Oxygen cylinders should be secured and placed in an area where they will not fall. Cylinders are under high pressure and a crack in the cylinder can be lethal. Remember to turn off all equipment when not in use. Oxygen containers should not be stored near water heaters, furnaces, or other sources of heat or flame. Oxygen containers and the storage room should be properly marked/labeled. There should be good ventilation around oxygen equipment. Your oxygen supplier should provide you with a complete list of instructions and safety precautions.

Do I have to worry about oxygen exploding or burning?

* Oxygen alone will not explode and does not burn but oxygen will feed a flame.
* Keep oxygen at least 2 meters or 6 feet away from an open flame.
* Do not smoke while using oxygen, as clothing and hair can easily be ignited.
* Stabilize all cylinders by placing carts in a safe area or by securing them to a wall.

In case of an accident what should I do?
In case of fire, evacuate immediately. Contact the fire department. Understand your oxygen system and what you need to do if there is a problem. Also, you should always have emergency telephone numbers in a central location, such as on the refrigerator. Emergency numbers should include 911 (or country code), your healthcare provider and your oxygen supplier.

Can I travel with oxygen?
It is safe to travel with oxygen, however, various transports have different regulations about their use with oxygen. Contact the appropriate business (airport, boat, train, bus) about their regulations well in advance of travel. Make sure that you have plenty of oxygen with you in case of delays or emergencies. Carry the contact numbers of your healthcare provider and oxygen supplier; you never know when you might need them. General information is listed below. More specific information on traveling with oxygen is available at .

When traveling by car, oxygen equipment must be fastened securely in an upright position so that the equipment is stable during the trip.

When traveling by boat, ferry, train or bus take the same considerations as traveling by car. Contact the boat, ferry, train or bus company a few weeks before traveling to find out which rules apply.

When traveling by plane you should plan your trip weeks in advance and inform the airline and check their regulations. Obtain an oxygen prescription from your doctor that provides your diagnosis, your present condition, a statement that it is safe for you to travel and your oxygen prescription. Your oxygen company can help to arrange for oxygen at the airport and travel destinations. You should book a direct flight for several reasons: some airlines charge for oxygen by each leg of the trip, you will be off oxygen during part of your layover and travel is much less tiring when you do not have to make a connection. Make sure you keep a copy of your oxygen prescription, medication prescriptions, know the health facilities and healthcare providers at each travel destination, and take extra medicines on the plane with you, Your oxygen company can be a great source of help for travel.

Migraine headaches are severely painful and usually occur with other symptoms such as nausea, vomiting and painful sensitivity to light. Cluster headaches cause sharp, burning pain on one side of the head.

Physicians commonly rely on a number of drug therapies to both treat and prevent migraine and cluster headaches, but some also prescribe oxygen therapy. The aim of the systematic review — comprising nine small studies involving 201 participants — was to determine whether inhaling oxygen actually helps.

“We wanted to locate and assess any evidence from randomized trials that oxygen administration was a safe and effective treatment for migraine or cluster headaches,” said lead reviewer Michael Bennett, of Diving and Hyperbaric Medicine at Prince of Wales Hospital in Sydney. “We hoped this would assist physicians to make effective treatment decisions in this area.”

The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.

The Cochrane reviewers examined studies that evaluated normobaric oxygen therapy and hyperbaric oxygen therapy. Normobaric therapy consists of patients inhaling pure oxygen at normal room pressure, and hyperbaric therapy involves patients breathing oxygen at higher pressure in a specially designed chamber.

Five studies compared hyperbaric versus sham (placebo) therapy for migraine; two compared hyperbaric versus sham therapy for cluster headache; and two investigated the use of normobaric therapy for cluster headache. Length of treatment varied with each study.

Three studies reported the number of patients who had significant relief from their migraines within 40 to 45 minutes of hyperbaric therapy. Although the studies did not specify each patients’ response to treatment, they reported a significant increase in the proportion of patients who had relief with hyperbaric oxygen compared to sham therapy.

For cluster headaches, two studies (69 patients) found a significantly greater proportion of patients had relief of their headaches after 15 minutes of normobaric compared to sham therapy.

The reviewers concluded that hyperbaric treatment might give some relief for migraine headache and that normobaric therapy might provide similar relief for cluster headache, but there is no evidence that these therapies will prevent future attacks.

“We believe that hyperbaric oxygen is also a reasonable measure for migraineurs who have not responded to other measures to treat an acute attack,” Bennett said. “However, the poor availability of hyperbaric chambers makes this an option only in a minority of health facilities. Most physicians treating headaches will continue to rely on established and emerging pharmacological options for treating and preventing acute attacks.”

Estimates indicate that 6 percent to 7 percent of men and 15 percent to 18 percent of women suffer from severe migraine headaches, and cluster headaches effect about 0.2 percent of the population.

John Kirchner, M.D., of the Kirchner Headache Clinic in Omaha, Neb., has treated thousands of patients suffering from a variety of headaches, including migraine and cluster, and said he does not include oxygen therapy in his patients’ treatment plans.

“This [oxygen therapy] would not be practical as the headache comes on fast and does not last long,” he said. “So there would not be time to get the patient to the chamber.”

Kirchner’s treatment for migraine includes avoiding triggers, taking preventive and symptomatic medications and undergoing behavior modification.

There are three ways to dispense oxygen in the home. Compressed oxygen gas and liquid oxygen are two ways to have oxygen delivered to the home. Oxygen gas can be compressed and stored in tanks or cylinders of steel or aluminum. These tanks come in many sizes; larger ones are usually left in the bedroom, and smaller ones are used for leaving the house. Liquid oxygen is made by cooling the oxygen gas, which changes it to a liquid form. It is often used by people who are more active because larger amounts of oxygen can be stored in smaller, more convenient containers than compressed oxygen. The disadvantage is that it cannot be kept for a long time because it will evaporate.

In addition, oxygen concentrators are available to deliver higher concentrations in the home. An oxygen concentrator is an electric device about the size of an end table. It produces oxygen by concentrating the oxygen that is already in the air and eliminating other gases. This method is less expensive, easier to maintain, and doesn’t require refilling, but it is not portable. Some oxygen concentrators, however, give off heat and are noisy. Back-up methods are necessary in case of a power failure, and the electric bill may rise. For some patients, oxygen concentrators may not deliver adequate oxygen.

For people who do not get enough oxygen naturally, supplements of oxygen can have several benefits. Supplemental oxygen can improve their sleep and mood, increase their mental alertness and stamina, and allow their bodies to carry out normal functions. It also prevents heart failure in people with severe lung disease. Oxygen at very high levels over a long period of time can be toxic and very harmful to one’s health; therefore, a doctor’s prescription is required.

Oxygen is also being dispensed for recreational purposes at oxygen bars to patrons who believe that inhaling the pure oxygen will cause their bodies to function even better than normal. Inhaling oxygen recreationally is unlikely to have a beneficial physiological effect. Oxygen at high levels can be toxic; however, there is no evidence that oxygen at the low flow levels used in bars can be dangerous to a normal person’s health.

More and more people are using oxygen therapy outside the hospital, permitting them to lead active, productive lives. People with asthma, emphysema, chronic bronchitis, occupational lung disease, lung cancer, cystic fibrosis, or congestive heart failure may use oxygen therapy at home.

The Prescription
A physician must write a prescription for oxygen therapy. The prescription will spell out the flow rate, how much oxygen you need per minute — referred to as liters per minute (LPM or L/M) — and when you need to use oxygen. Some people use oxygen therapy only while exercising, others only while sleeping, and still others need oxygen continuously. Your physician will order a blood test that will indicate what your oxygen level is and help determine what your needs are.

The Equipment
There are three common ways of providing oxygen therapy. Oxygen can be delivered to your home in the form of a gas in various-sized cylinders or as a liquid in a vessel. The third way to provide oxygen therapy is by using an oxygen concentrator. Each method is examined in more detail below.

Compressed Gas – Oxygen is stored under pressure in a cylinder equipped with a regulator that controls the flow rate. Because the flow of oxygen out of the cylinder is constant, an oxygen-conserving device may be attached to the system to avoid waste. This device releases the gas only when you inhale and cuts it off when you exhale. Oxygen can be provided in a small cylinder that can be carried with you, but the large tanks are heavy and are only suitable for stationary use.

Liquid Oxygen – Oxygen is stored as a very cold liquid in a vessel very similar to a thermos. When released, the liquid converts to a gas and you breathe it in just like the compressed gas. This storage method takes up less space than the compressed gas cylinder, and you can transfer the liquid to a small, portable vessel at home. Liquid oxygen is more expensive than the compressed gas, and the vessel vents when not in use. An oxygen conserving device may be built into the vessel to conserve the oxygen.

Oxygen Concentrator – This is an electrically powered device that separates the oxygen out of the air, concentrates it, and stores it. This system has a number of advantages because it doesn’t have to be resupplied and it is not as costly as liquid oxygen. Extra tubing permits the user to move around with minimal difficulty. Small, portable systems have been developed that afford even greater mobility. You must have a cylinder of oxygen as a backup in the event of a power failure. You should advise your electric power company in order to get priority service when there is a power failure.

Oxygen Delivery Devices
There are three common means of oxygen delivery. A nasal cannula is a two-pronged device inserted in the nostrils that is connected to tubing carrying the oxygen. The tubing can rest on the ears or be attached to the frame of eyeglasses.

People who need a high flow of oxygen generally use a mask. Some people who use a nasal cannula during the day prefer a mask at night or when their noses are irritated or clogged by a cold.

Transtracheal oxygen therapy requires the insertion of a small flexible catheter in the trachea or windpipe. The transtracheal catheter is held in place by a necklace. Since transtracheal oxygen bypasses the mouth, nose, and throat, a humdifier is absolutely required at flow rates of 1 LPM or greater.

Safety
You should never smoke while using oxygen. Warn visitors not to smoke near you when you are using oxygen. Put up no-smoking signs in your home where you most often use the oxygen. When you go to a restaurant with your portable oxygen source, ask to be seated in the nonsmoking section. Stay at least five feet away from gas stoves, candles, lighted fireplaces, or other heat sources. Don’t use any flammable products like cleaning fluid, paint thinner, or aerosol sprays while using your oxygen.

If you use an oxygen cylinder, make sure it is secured to some fixed object or in a stand. If you use liquid oxygen, make sure the vessel is kept upright to keep the oxygen from pouring out; the liquid oxygen is so cold it can hurt your skin. Keep a fire extinguisher close by, and let your fire department know that you have oxygen in your home. If you use an oxygen concentrator, notify your electric company so you will be given priority if there is a power failure. Also, avoid using extension cords if possible.

Care of Equipment
The home medical equipment and services company that provides the oxygen therapy equipment you use should provide you with instructions on user care and maintenance of your particular equipment. Here are some general guidelines for your cleaning procedures. You should wash your nasal prongs with a liquid soap and thoroughly rinse them once or twice a week. Replace them every two to four weeks. If you have a cold, change them when your cold symptoms have passed.

Check with your health care provider to learn how to clean your transtracheal catheter. The humidifier bottle should be washed with soap and warm water and rinsed thoroughly between each refill. Air dry the bottle before filling with sterile or distilled water. The bottle and its top should be disinfected after they are cleaned.

If you use an oxygen concentrator, unplug the unit, then wipe down the cabinet with a damp cloth and dry it daily. The air filter should be cleaned at least twice a week. Follow your home medical equipment and services company’s directions for cleaning the compressor filter.

Do’s and Don’ts

* Don’t ever change the flow of oxygen unless directed by your physician.
* Don’t use alcohol or take any other sedating drugs because they will slow your breathing rate.
* Make sure you order more oxygen from your dealer in a timely manner.
* Use water-based lubricants on your lips or nostrils. Don’t use an oil-based product like petroleum jelly.
* To prevent your cheeks or the skin behind your ears from becoming irritated, tuck some gauze under the tubing. If you have persistent redness under your nose, call your physician.

Trouble
Call your physician if you experience frequent headaches, anxiety, blue lips or fingernails, drowsiness, confusion, restlessness, anxiety, or slow, shallow, difficult, or irregular breathing. Also, call your physician if you feel any symptoms of illness.

Medicare, Medicaid, and Commercial Insurance
Certain insurance policies may pay for all your oxygen, but payment is based on laboratory results, diagnosis, and other information. Your physician or medical equipment and services provider may be able to answer your questions about coverage.

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.

Several therapeutic principles are made use of in HBOT:

* The increased overall pressure is of therapeutic value when HBOT is used in the treatment of decompression sickness and air embolism.
* For many other conditions, the therapeutic principle of HBOT lies in a drastically increased partial pressure of oxygen in the tissues of the body. The oxygen partial pressures achievable under HBOT are much higher than those under breathing pure oxygen at normobaric conditions (i.e. at normal atmospheric pressure).
* A related effect is the increased oxygen transport capacity of the blood. Under atmospheric pressure, oxygen transport is limited by the oxygen binding capacity of hemoglobin in red blood cells and very little oxygen is transported by blood plasma. Because the hemoglobin of the red blood cells is almost saturated with oxygen under atmospheric pressure, this route of transport cannot be exploited any further. Oxygen transport by plasma, however is significantly increased under HBOT.

Uses

The United States, the Undersea and Hyperbaric Medical Society, known as UHMS, approved for reimbursement diagnoses for application of HBOT in hospitals. The following indications are approved uses of hyperbaric oxygen therapy as defined by the UHMS Hyperbaric Oxygen Therapy Committee.

* Air or gas embolism
* Carbon monoxide poisoning
o Carbon Monoxide Poisoning Complicated by Cyanide Poisoning
* Clostridal Myositis and Myonecrosis (Gas gangrene)
* Crush Injury, Compartment syndrome, and other Acute Traumatic Ischemias
* Decompression sickness
* Enhancement of Healing in Selected Problem Wounds
* Exceptional Blood Loss (Anemia)
* Intracranial Abscess
* Necrotizing Soft Tissue Infections (Necrotizing fasciitis)
* Osteomyelitis (Refractory)
* Delayed Radiation Injury (Soft Tissue and Bony Necrosis)
* Skin Grafts & Flaps (Compromised)
* Thermal Burns

In the United States, HBOT is recognized by Medicare as a reimbursable treatment for 14 UHMS “approved” conditions. An HBOT session costs anywhere from $100 to $200 in private clinics, to over $1,000 in hospitals. U.S. physicians may lawfully prescribing HBOT for “off-label” conditions such as Lyme Disease, stroke and migraines. Such patients are treated in outpatient clinics. In the United Kingdom most chambers are financed by the National Health Service, although some, such as those run by Multiple Sclerosis Therapy Centres, are non-profit.

Other reported applications include:

* Diabeticaly derived illness, such as diabetic foot, diabetic retinopathy, diabetic nephropathy
* Epidural abscesses
* Certain kind of hearing loss
* Radiation-induced hemorrhagic cystitis
* Inflammatory bowel disease

HBOT is controversial and health policy regarding its uses is politically charged. Both sides of the controversy on the effectiveness of HBOT is available in the form of Cochrane Library reviews.

Structure

Traditional

The traditional type of hyperbaric chamber used for HBOT is a hard shelled pressure vessel. Such chambers can be run at absolute pressures up to 600 kilopascals or 85 PSI (lbf/in²), nearly six atmospheres.

Navies, diving organizations and hospitals typically operate these. They range in size from those which are portable and capable of treating just one patient to those which are fixed, very heavy and capable of treating eight or more patients.

The chamber may consist of:

* a pressure vessel that is generally made of steel and aluminium with the view ports (windows) or hull made of acrylic.
* one or more human entry hatches—these could be small and circular or wheel-in type hatches for patients on trolleys
* an airlock allowing human entry—a separate chamber with two hatches, one to the outside world and one to the main chamber, which can be independently pressurized to allow patients to enter or exit the main chamber while it is still pressurized
* an airlock allowing medicines, instruments and food to enter the main chamber
* glass ports or closed-circuit television allowing the technicians and medical staff outside the chamber to monitor the inside of the chamber
* an intercom allowing two-way communications inside and outside the chamber
* a carbon dioxide scrubber—consisting of a fan that passes the gas inside the chamber through a soda lime canister
* a control panel outside the chamber is used to open and close valves allowing air to enter or leave the chamber and oxygen to be supplied to oxygen helmets or masks

Oxygen breathing

Breathing 100% oxygen from an aviators’ oxygen mask.
A recompression chamber for a single diving casualty

In today’s larger “multiplace” chambers, both patients and medical staff inside the chamber breathe from “oxygen helmets”, flexible, transparent soft plastic helmets with a seal around the neck similar to a space suit helmet, or tightly fitting aviators oxygen masks, which supply pure oxygen and remove the exhaled gas from the chamber. During treatment patients breathe 100% oxygen most of the time but have periodic air breaks to minimize the risk of oxygen toxicity. The exhaled gas must be removed from the chamber to prevent the build up of oxygen, which could provoke a fire. Medical staff may also breathe oxygen to reduce the risk of decompression sickness. Administration of 100% breathing oxygen maximizes the patient’s treatment. The pressure inside the chamber is increased by opening valves allowing high-pressure air to enter from storage cylinders, similar to diving cylinders. A gas compressor is used to fill these cylinders.

Smaller “monoplace” chambers can only accommodate the patient. No medical staff can enter. The chamber is flooded with pure oxygen or compressed air. The cost of using pure oxygen in a monoplace chamber is much higher than using compressed air. If pure oxygen is used no oxygen breathing mask or helmet is needed. If compressed air is used then an oxygen mask or helmet is needed as in a multiplace chamber. In monoplace chambers that are compressed with pure oxygen a mask is available to provide the patient with “air breaks,” periods of breathing normal air, in order to reduce the risk of hyperoxic seizures.

Effects of Pressure

Patients inside the chamber will notice discomfort inside their ears as a pressure difference develops between their middle ear and the chamber atmosphere. This can be relieved by the Valsalva maneuver or by “jaw wiggling”. As the pressure increases further, mist may form in the air inside the chamber and the air may become warm. When the patient speaks, the pitch of the voice may increase to the level that they sound like cartoon characters.

To reduce the pressure, a valve is opened to allow gas out of the chamber. As the pressure falls, the patient’s ears may “squeak” as the pressure inside the ear equalizes with the chamber. The temperature in the chamber will fall.

Home treatment

There are portable HBOT chambers, which are used for home treatment. These are usually referred to as “mild chambers”, which is a reference to the lower pressure of soft-sided chambers. Those commercially available in the USA go up to 4 PSI (1.27 ATA 8.92 FSW). International portable chambers can go to 7.35 psi (1.5 ATA 16.38 FSW) or higher. These chambers are operated with oxygen concentrators (typically 95% oxygen) or with 100% oxygen as the breathing gas. Total concentration of oxygen should not exceed 25% as this can increase the risk of fire.

These chambers are often used in a clinical settings, but are also used in homes. Mild hyperbaric chambers use standard 120 volt outlets and can also be configured for 220 volt use. Ranging in size from 21″ up to 40″ in diameter these chambers measure between 84″ to 120″ in length. The soft chambers are FDA approved only for the treatment of altitude sickness but are commonly used off label primarily for the treatment of autism and other neural conditions though there is no proof that it is effective and hospitals refuse to allow their chambers to be used for this purpose. The FDA has a specific warning that supplemental oxygen is not to be used.

Treatments

Initially, HBOT was developed as a treatment for diving disorders involving bubbles of gas in the tissues, such as decompression sickness and gas embolism. The chamber cures decompression sickness and gas embolism by increasing pressure, reducing the size of the gas bubbles and improving the transport of blood to downstream tissues. The high concentrations of oxygen in the tissues are beneficial in keeping oxygen-starved tissues alive, and have the effect of removing the nitrogen from the bubble, making it smaller until it consists only of oxygen which is then re-absorbed into the body. After elimination of bubbles, the pressure is gradually reduced back to atmospheric levels.

Protocol

The slang term for a cycle of pressurization inside the HBOT chamber is “a dive”. An HBOT treatment for longer-term conditions is often a series of 20 to 40 dives.

Emergency HBOT for diving disorders typically follows one of two forms. For most cases, a shallow “dive” to a pressure the equivalent of 18 meters / 60 feet of water for 3 to 4.5 hours with the casualty breathing pure oxygen with air breaks every 20 minutes to reduce oxygen toxicity. For extremely serious cases, a deeper “dive” to a pressure the equivalent of 37 meters / 122 feet of water for 4.5 hours with the casualty breathing air.

In Canada and the United States, the U.S. Navy Dive Charts are used to determine the duration, pressure and breathing gas of the therapy. The most frequently used tables are Table 5 and Table 6. In the UK the Royal Navy 62 and 67 tables are used.

The Undersea and Hyperbaric Medical Society[57] (UHMS) publishes a report which compiles the latest research findings and contains information regarding the recommended duration and pressure of the longer-term conditions.

Possible complications

There are risks associated with HBOT, similar to some diving disorders. Pressure changes can cause a “squeeze” or barotrauma in the tissues surrounding trapped air inside the body, such as the lungs[58], behind the eardrum[59][60], inside paranasal sinuses[59], or trapped underneath dental fillings[61]. Breathing high-pressure oxygen for long periods can cause oxygen toxicity. Temporarily blurred vision can be caused by swelling of the lens, which usually resolves in two to four weeks.[62][63]

There are reports that cataract may progress following HBOT.[64] Also a rare side effect has been blindness secondary to optic neuritis (inflammation of the optic nerve).[citation needed]

Contraindications

The only absolute contraindication to hyperbaric oxygen therapy is untreated pneumothorax.[65] Also, the treatment may raise the issue of Occupational safety and health (OHS), which has been encountered by the therapist.[66][clarification needed]

Patients should not undergo HBO therapy if they are taking or have recently taken the following drugs:

* Doxorubicin (Adriamycin) – A chemotherapeutic drug.
* Disulfiram (Antabuse) – Used in the treatment of alcoholism.
* Cis-platinum – A cancer drug.
* Mafenide acetate (Sulfamylon) – Suppresses bacterial infections in burn wounds

The following are relative contraindications:

* Upper respiratory infections – These conditions can make it difficult for the patient to clear their ears, which can result in what is termed sinus squeeze.
* High fevers – In most cases the fever should be lowered before HBO treatment begins.
* Emphysema with CO2 retention – This condition can lead to pneumothorax during HBO treatment.
* History of thoracic (chest) surgery – This is rarely a problem and usually not considered a contraindication. However, there is concern that air may be trapped in lesions that were created by surgical scarring. These conditions need to be evaluated prior to considering HBO therapy.
* Malignant disease: Since cancers both thrive in blood rich environments and may be suppressed in high oxygen environments, cancer and HBO poses a dilemma since HBO both increases blood flow via angiogenesis and also raises oxygen levels. Taking an anti-angiogenic supplement may provide a solution to this problem.
* Middle ear barotrauma (MEBT) is always a consideration in treating both children and adults in a hyperbaric environment, but most children currently being treated with HBOT are being pressurized to 1.3 ATA which reduces the risks of potential side effects.

Neuro-rehabilitation
The Collet (Quebec) trial that was published in the Lancet in 2001 was the largest randomized trial of Hyperbaric Oxygen Therapy (HBOT) for children with cerebral palsy (CP); it followed the McGill pilot study on the same subject.

The evidence showed both groups of children treated with two very different hyperbaric treatment dosages improved significantly. The motor improvements that were seen and measured with the gross motor function measure were greater, more generalized, and were obtained in a shorter period of time than most of the changes found in any other studies of recognized conventional therapies in the treatment of children with cerebral palsy. The children in both groups improved an average of ten times more during the two months of HBOT (whilst all other therapies and medication were stopped) than during the three months follow-up (when medication and all the ancillary treatments were restarted). This impressive change in the rate of improvements clearly indicates the probable effectiveness of hyperbaric treatment. Both the Lancet commentary and the tech report by the Agency for Healthcare Research and Quality (AHRQ) concluded that the hypothesis of both treatments being equally effective should be retained.

Since the Quebec study of HBOT for children with CP, many reports have been made on the possible efficacy of a low pressure hyperbaric treatment and all the trials conducted with HBOT in CP have demonstrated positive results.

An editorial on CP published by the Undersea and Hyperbaric Medical Society in 2007 called for further research that will include “basic science research to determine a reasonable mechanism of action” for hyperbaric oxygenation as well as “clinical studies of the highest possible methodological rigor”.

Some medical practitioners recommend the use of HBOT for the treatment of acute tinnitus but this treatment has not been verified by independent evidence and the treatment was withdrawn from support by the German health insurance. There is evidence that the therapeutic effects could be greatly due to psychological mechanisms triggered by the patients attitude towards therapy prior to the treatment.

The earliest randomized, placebo-controlled, double-blind study on multiple sclerosis patients treated with HBOT suggested the therapy could improve balance and bladder function. However, by 2004 a Cochrane review assessing ten trials and 21 analyses “found no consistent evidence to confirm a beneficial effect of hyperbaric oxygen therapy for the treatment of multiple sclerosis and do not believe routine use is justified.

For more informaton on Hyperbaric Chambers

Oxygen first aid specifically refers to the use of oxygen in a first aid setting. Oxygen will assist patients with myocardial infarction and hypoxia (low blood oxygen levels). Care needs to be exercised in patients with chronic obstructive pulmonary disease, especially in those known to retain carbon dioxide (type II respiratory failure) who lose their respiratory drive and accumulate carbon dioxide if administered oxygen in moderate concentration. However the risk of the loss of respiratory drive are far outweighed by the risks of withholding emergency oxygen, and therefore emergency administration of oxygen is never contraindicated.

Home or domiciliary oxygen therapy

This refers to the administration of oxygen as ongoing therapy, either continuously or intermittently. Most commonly patients on home oxygen therapy have severe chronic obstructive pulmonary disease caused by smoking. High concentration (approaching 100%) oxygen is used as home therapy to abort cluster headache attacks, due to its vaso-constrictive effects.[1] It is indicated in COPD patients with PaO2 ≤ 55mmHg or SaO2 ≤ 88% and has been shown in a Medical Research Council study to increase survival.

Oxygen sources and delivery
Gas canisters containing oxygen to be used at home. When in use a pipe is attached to the top of the can and then to a mask that fits over the patient’s nose and mouth.
A home oxygen concentrator in situ in an Emphysema patient’s house. The model shown is the DeVILBISS LT 4000.

There are three typical sources of oxygen used therapeutically:

1. Liquid oxygen is contained in thermally insulating tanks. The liquid has to boil changing into a gas for breathing. Large tanks are used by hospitals. Small tanks can be used domestically. Liquid oxygen tanks are refilled by liquid oxygen suppliers.

2. Cylinders contain compressed gaseous oxygen. Small cylinders are used for first aid and for home oxygen patients when mobility is required. Cylinders are refilled by a gas supplier.

3. Oxygen concentrators are electrically powered devices which remove nitrogen from air. They are most commonly used in a domestic situation, because they do not need refilling. However, a number of manufacturers have introduced portable oxygen concentrators. These have replaced[2] the need to use liquid or gas cylinders for mobility for many patients. Portable Oxygen Concentrators allow patients to freely travel without the need of gas or liquid. The FAA has approved portable oxygen concentrators for the use on many commercial airlines. Most major airlines allow the three major portable oxygen concentrators; it is necessary to check in advance if a particular brand or model is permitted on a particular airline. These can typically use AC, DC, or battery power. Some portable concentrators have only pulse or demand flow capabilities, while continuous flow portables are available. Pulse or demand flow is similar to the way an oxygen conserving device delivers oxygen from liquid oxygen or a gas cylinder only during inhalation, but on a concentrator, the oxygen made in between pulses is stored for the next pulse. Where a conserving device can make a liquid or gas container last longer, pulse or demand settings on oxygen concentrators can make a certain flow appear as a higher effective flow, or reduce power consumption and/or extend battery life.

First aid kits have been produced that create oxygen gas as the result of a chemical reaction between lightweight or widely available substances such as sodium percarbonate and water, although the rate and duration of oxygen supply is not high.

Oxygen is most often delivered as continuous gaseous flow, measured in litres per minute (lpm).

Low-Flow Devices

Low-flow systems deliver oxygen at flows that are less than the patient’s inspiratory flowrate (ie, the delivered oxygen is diluted with room air) and, thus, the oxygen concentration inhaled may be low or high, depending on the specific device and the patient’s inspiratory flowrate.

1. The nasal cannula (NC) is a thin tube with two small nozzles that protrude into the patients nostrils. It can only comfortably provide oxygen at low flow rates, 0.25-6 litres per minute (LPM), delivering a concentration of 24-40%. Flow rates greater than 4 liters per minute can cause discomfort and dry out the nasal passages and should also be used with a humidifcation system.

2. The simple face mask (SFM) is a basic mask used for non-life-threatening conditions but which may progress in time, such as chest pain (possible heart attacks), dizziness, and minor hemorrhages. It is often set to deliver oxygen between 5-15 LPM. The final oxygen concentration delivered by this device is dependent upon the amount of room air that mixes with the oxygen the patient breathes. The general oxygen concentration is between 35% and 50%

1. The Partial rebreathing mask is a simple mask with a reservoir bag. Oxygen flow should always be supplied to maintain the reservior bag at least one third to one half full on inspiration, usually 5-15 LPM. At a flow of 6-10 L/min the system can provide 40-70% oxygen.

High-Flow Devices

High-flow systems deliver a prescribed gas mixture — either high or low FDO2 at flowrates that exceed patient demand.

1. The non-rebreather mask (NRB) is similar to the partial rebreathing mask except it has a series of one-way valves. One valve is placed between the bag and the mask to prevent exhaled air from returning to the bag. There should be a minimum flow of 10 L/min. The delivered FIO2 of this system is 60-80%, depending on the oxygen flow and breathing pattern.

1. Air-entrainment masks, also known as Venturi masks, can accurately deliver predetermined oxygen concentration to the trachea up to 40%. Jet-mixing masks rated at 35% or higher usually however do not deliver flowrates adequate to meet the inspiratory flowrates of adults in respiratory distress. Aerosol masks, tracheostomy collars, T-tube adapters, and face tents can be used with high-flow supplemental oxygen systems. A continuous aerosol generator or large-volume reservoir humidifier can humidify the gas flow. Some aerosol generators however, cannot provide adequate flows at high oxygen concentrations.

Filtered Oxygen Masks

Filtered oxygen masks have the ability to prevent exhaled, potentially infectious particles from being released into the surrounding environment. These masks are normally of a closed design such that leaks are minimized and breathing of room air is controlled through a series of one-way valves. Filtration of exhaled breaths is accomplished either by placing a filter on the exhalation port, or through an integral filter that is part of the mask itself. These masks first became popular in the Toronto (Canada) healthcare community during the 2003 SARS Crisis. SARS was identified as being respiratory based and it was determined that conventional oxygen therapy devices were not designed for the containment of exhaled particles. Common practices of having suspected patients wear a surgical mask was confounded by the use of standard oxygen therapy equipment. In 2003, the HiOx80 oxygen mask was released for sale. The HiOx80 mask is a closed design mask that allows a filter to be placed on the exhalation port. Several new designs have emerged in the global healthcare community for the containment and filtration of potentially infectious particles. Other designs include the ISO-O2 oxygen mask,the Flo2Max oxygen mask, and the O-Mask. The use of oxygen masks that are capable of filtering exhaled particles is gradually becoming a recommended practice for pandemic preparation in many jurisdictions.

Because filtered oxygen masks use a closed design that minimizes or eliminates inadvertent exposure to room air, delivered oxygen concentrations to the patient have been found to be higher than conventional non-rebreather masks, approaching 99% using adequate oxygen flows. Because all exhaled particles are contained within the mask, nebulized medications are also prevented from being released into the surrounding atmosphere, decreasing the occupational exposure to healthcare staff and other patients.

Resuscitation/Specialized Devices

1. The bag-valve-mask (BVM) is used for patients in critical condition who are either breathing extremely inefficiently, or not breathing at all (respiratory arrest). An oxygen reservoir bag is attached to a central cylindrical bag, attached to a valved mask that administers almost 100% concentration oxygen at 8-15 lpm. The central bag is squeezed manually to deliver a “breath” to the patient, or assist them in inspiration by overcoming airway resistance or thoracic constriction. This is the standard administration method for acute respiratory distress or respiratory arrest.

2. The pocket mask is a small device that can be carried on one’s person. It is used for the same patients who the BVM is indicated for, but instead of delivering breaths by squeezing a reservoir, the care provider must exhale into the mask. Exhaled air from the provider can provide up to 16% oxygen to the patient, or higher if used with supplemental oxygen.

3. The anaesthetic machine is a machine used during anesthesia that allows a variable amount of oxygen to be delivered, along with other gases including air, nitrous oxide and inhalational anaesthetics.

4. Aviator type and other specialized tight fitting oxygen masks are used in hyperbaric oxygen chambers and to provide oxygen to carbon monoxide victims.

Related devices

1. A pressure regulator is used to control the high pressure of oxygen delivered from a cylinder to a low pressure controllable by the flowmeter.

2. A flowmeter is used to control and indicate the flow of oxygen. Typiclal flow range is 0-15 lpm.

3. A nebulizer can be used deliver nebulizable drugs such as albuterol or epinephrine into the airways by creating a vapor-mist from the liquid form of the drug. Nebulizers are also commonly used with room air in the home with an electric air pump.

Negative effects

Although most EMS jurisdictions hold that oxygen should not be withheld from any patient, there are certain situations in which oxygen therapy can have a negative impact on a patient’s condition.

Oxygen has vasoconstrictive effects on the circulatory system, reducing peripheral circulation and was once thought to potentially increase the effects of stroke. However, when additional oxygen is given to the patient, additional oxygen is dissolved in the plasma according to Henry’s Law. This allows a compensating change to occur and the dissolved oxygen in plasma supports embarrassed (oxygen-starved) neurons, reduces inflammation and post-stroke cerebral edema. Since 1990, hyperbaric oxygen therapy has been used in the treatments of stroke on a worldwide basis. In rare instances, hyperbaric oxygen therapy patients have had seizures. However, because of the afformentioned Henry’s Law effect of extra available dissolved oxygen to neurons, there is usually no negative sequel to the event. Such seizures are thought to be caused by hypoglycemia and the risk can be eradicated or reduced by carefully monitoring the patient’s nutritional intake prior to oxygen treatment.

Some jurisdictions require that oxygen should not be given to children or people suffering from certain long-term lung conditions by first-responders without medical consultation.

Oxygen first aid has been used as an emergency treatment for diving injuries for years. The success of recompression therapy as well as a decrease in the number of recompression treatments required has been shown if first aid oxygen is given within four hours after surfacing. There are suggestions that oxygen administration may not be the most effective measure for the treatment of DCI/DCS and that Heliox may be a better alternative. Recompression in a hyperbaric chamber with the patient breathing 100% oxygen is the standard hospital and military medical response to decompression illness and decompression sickness.

Oxygen should never be given to a patient who is suffering from paraquat poisoning unless they are suffering from severe respiratory distress or respiratory arrest, as this can increase the toxicity. (Paraquat poisoning is rare – for example 200 deaths globally from 1958-1978).

Oxygen therapy while on aircraft

In the United States, most airlines restrict the devices allowed on board aircraft. As a result passengers are restricted in what devices they can use. Some airlines will provide cylinders for passengers with an associated fee. Other airlines allow passengers to carry on approved portable concentrators. However the lists of approved devices varies by airline so passengers need to check with any airline they are planning to fly on. Passengers are generally not allowed to carry on their own cylinders. In all cases, passengers need to notify the airline in advance of their equipment.