Home oxygen therapy: re-thinking the role of devices

Abstract

A range of devices are available for delivering and monitoring home oxygen therapy (HOT). Guidelines do not give indications for the choice of the delivery device but recommend the use of an ambulatory system in subjects on HOT whilst walking. Areas covered: We provide a clinical overview of HOT and review traditional and newer delivery and monitoring devices for HOT. Despite relevant technology advancements, clinicians, faced with many challenges when they prescribe oxygen therapy, often remain familiar to traditional devices and continuous flow delivery of oxygen. Some self-filling delivery-less devices could increase the users' level of independence with ecological advantage and, perhaps, reduced cost. Some newer portable oxygen concentrators are being available, but more work is needed to understand their performances in different diseases and clinical settings. Pulse oximetry has gained large diffusion worldwide and some models permit long-term monitoring. Some closed-loop portable monitoring devices are also able to adjust oxygen flow automatically in accordance with the different needs of everyday life. This might help to improve adherence and the practice of proper oxygen titration that has often been omitted because difficult to perform and time-consuming. Expert commentary: The prescribing physicians should know the characteristics of newer devices and use technological advancements to improve the practice of HOT.

Contemporary portable oxygen concentrators and diverse breathing behaviours -- a bench comparison

“…This test offers far greater trigger challenge than typical for POC bench evaluations, so discussion is warranted. First, the scenario depicted is that of sleep, where the efficacy and appropriateness of pulsed oxygen devices has been questioned [2, 19, 24, 25]. Yet the efficacy of the ‘reference’ nocturnal oxygen therapy, continuous flow oxygen via nasal cannula, also shows high variability during sleep [26].…”

“…For those with severe COPD prescribed long-term oxygen therapy, ambulatory oxygen can promote exercise tolerance and facilitate social interaction [1]. Given the choice, most subjects would prefer the lightest-weight system that provides effective oxygen therapy over a sufficient duration [2]. Efficient dispensing of oxygen may facilitate this.…”

“…It is understandable then that a recent expert review into home oxygen therapy relayed concerns that pulsed oxygen delivery by portable concentrators may not be effective during sleep or at high respiratory rates [2]. Investigating these concerns through clinical study is complicated by heterogeneity of oxygen users’ condition and behaviour, and by measurement difficulties.…”

“…The focus of our bench study was to explore the reliability POC triggering across a broad range of breathing behaviours which are common in COPD patients, including the identified areas of concern of shallow breathing and high respiratory rates [2]. In designing our tests, we emphasised the use of credible adult COPD breathing patterns to maximise clinical relevance, applied to 3 representative modern POCs.…”

Short term home oxygen therapy COVID-19 patients: The COVID-HOT algorithm

“…Transportable and portable concentrators are similar to home concentrators, but generally smaller in size and weight. [ 71 72 73 ] Cylinder oxygen comes in a reinforced metal container with compressed gas under high pressure which is safely and steadily released via its regulator (tap). Liquid oxygen is oxygen that is cooled such that it condenses from gaseous to liquid form and can be stored in appropriately insulated containers; however, this approach requires training to reduce problems with gas leakage and burns.…”