The group of 10 completed a 5-mile hike near Idaho Springs, Colorado. Supplemental oxygen in tow, they left the trailhead at Summit Lake (elevation 12,840 feet) at 9 a.m. and summited scenic Mount Evans (elevation 14,264 feet) at 1:30 p.m.

AMSR customer service manager John More said it was a challenge for him to keep up with customers Lyn Cole and Mike McBride, whose normal oxygen use rates are 3 to 4 liters per minute. On the high-altitude hike, they needed about 15 liters per minute, but as long as their supplemental oxygen needs were being met, they were able to hike safely and have fun.

Of course, oxygen users should seek physician clearance before attempting such a hike, as Lyn and Mike did.

“It just goes to show what oxygen users can do if they plan carefully and have access to the extra oxygen they might need,” said John.

Here are several things you can do:

1. Break In New Batteries

New batteries are “dead batteries” when they arrive at your home. This just means you need to charge them before you use them. We recommend that you fully charge your battery then use it until it “dies,” then fully charge it again. Do this for 2 to 4 cycles to prime the battery to reach its maximum-rated capacity.

2. Keep Your Batteries Clean

Clean dirty battery contacts with a cotton swab and alcohol. This helps maintain a good connection between the battery and the portable device.

3. Exercise Your Battery

Don’t leave batteries dormant for long periods of time. We recommend using your battery at least once every 2 to 3 weeks. If a battery hasn’t been used for a long time, re-perform the new battery break-in procedure described above.

4. Battery Storage

If you don’t plan on using your battery for a month or more, store it in a clean, dry, cool place away from heat and metal objects. NiCad, NiMH and Li-Ion batteries will self-discharge during storage; remember to break them in before use.

The Inogen One G2 Universal Power Supply is specifically designed for use with the Inogen One G2 Oxygen Concentrator. The Universal Power Supply provides the precise current and voltage required to safely power the Inogen G2, and is designed to operate from specified AC and DC power sources. When used with AC power sources, the supply automatically adapts to input voltages from 100V to 240V permitting use with most power sources throughout the world.

The Universal Power Supply will charge the Inogen One G2 Battery when used with AC input power or when used with a DC power supply, such as the one found in your car. Due to aircraft power limitations, the Universal Power Supply cannot be used to charge the Inogen One G2 Battery when used on an aircraft.

The Universal Power Supply is used with the following components:

• Power Supply with attached power output cable to connect to the Inogen One G2
• Auto DC cigarette lighter power input cable
• AC power input cable

Mobile Cart
The mobile cart has wheels and a telescoping handle to provide easy transport of the Inogen One G2. The G2 can be operated while using the mobile cart. The mobile cart is easy to use, just place the carry bag over the cart, and make sure the cart handle is inserted between the elastic strap in the back of the carry bag and in the front of the carry bag and its ready to be used.

24 Cell Rechargeable Lithium Ion Battery
The Ion battery powers the Inogen One G2 without having to connect it to an external power source. When fully charged, the will can provide between 4 and 8 hours of operation depending on flow setting. The battery recharges when properly installed in the G2 and the concentrator in connected to a AC or DC power source. Recharging time is up to 8 hours for a fully charged battery.

Nasal Cannula
A nasal cannula must be used with the Inogen One G2 to provide oxygen from the concentrator to the patient. A single lumen cannula up to 25 feet in length to ensure proper breath detection and oxygen delivery is recommended.
Airline DC 4-Pin Power Input Cable
DC 4-Pin Power Plug is for using during flights to charge the Inogen One G2. Some airlines don’t have the port or will not allow it, so please check with the airline for power port availability.

Warm up time is another significant improvement of the G2. The old unit could take up to 30 minutes to warm up. The G2 only takes a mere 2 minutes to warm up. That could save the patient 28 minutes of waiting for the unit to warm up and be ready to use.

The biggest improvement of the Inogen One G2 is battery life. The original Inogen had a battery life of only 2 to 3 hours depending on the flow setting; this could provide a huge inconvenience for the patient especially if they were planning a long flight or trip. The patient would have to bring extra batteries to replace the depleted ones. The Inogen G2 has battery times of up to 8 hours depending on the flow settings. This will let the patient to take extended flights without replacing for charging the battery.
Inogen designed the G2 to make life easier for the patient to use and operate. These improvements will make living with a concentrator more enjoyable.

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.

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.

“They said that I had 35 interruptions of my sleep per hour. So that meant that I was never getting fully asleep,” says Lou.

Because he was deprived of oxygen at night, Lou’s heart was being damaged, which is why he started using a continuous positive airway pressure mask, or a C-PAP mask. Doctors have known for sometime that it helps patients breathe better.

“What we haven’t known as well, is, whether or not C-PAP benefits the heart,” says Doctor Subha Raman, MD at the Ohio State University Medical Center.

So doctors at the Ohio State University Medical Center decided to find out. They took MRI’s of patients to get a good idea of the size and shape of their hearts when they were first diagnosed. Then patients were given C-PAP masks to sleep in. After several weeks they came back for another MRI, and doctors were surprised by what they saw.

“We saw that before treatment, the heart was enlarged. But after three months of careful use of their CPAP, we saw a reduction in the enlargement of the heart,” says Dr. Raman.

In all, experts say of the 13 patients who tried it, there were “significant” changes in the right ventricle of the heart.* Which means this mask not only helps with sleep disorders, but may be helping doctors get to the heart of a much more serious problem, as well.

Doctors say if left untreated, sleep apnea can lead to high blood pressure, and increase your risk of diabetes or having a stroke. If someone complains that you snore loudly and often you may want to get checked out by your doctor.