Oxygen Administration Through a Two-pronged Tube is Called a

Oxygen Administration Through a Two-pronged Tube is Called a

  • Journal List
  • Exhale (Sheff)
  • 5.15(3); 2019 Sep
  • PMC6876135

Breathe (Sheff).
2019 Sep; 15(3): e108–e116.

Oxygen devices and commitment systems

Georgia Hardavella

110th Dept of Respiratory Medicine, Athens Breast Diseases Hospital “Sotiria”, Athens, Greece

Ioannis Karampinis

iiDept of Thoracic Surgery, Full general Hospital “Sismanogleio”, Athens, Greece

Armin Frille

3Dept of Respiratory Medicine, University of Leipzig, Leipzig, Germany

4Integrated Research and Treatment Center (IFB) Adiposity Diseases, Academy Medical Heart Leipzig, Leipzig, Germany

Katherina Sreter

fiveThe Royal Marsden, NHS Foundation Trust, London, United kingdom

Ilona Rousalova

61st Dept of Tuberculosis and Respiratory Diseases, General University Hospital and Starting time Kinesthesia of Medicine, Charles University, Prague, Czech Republic

Abstruse

Oxygen use has extended from inpatient to outpatient settings for patients with chronic pulmonary diseases and complications of hypoxaemia. This article presents an overview of oxygen devices (oxygen concentrators, compressed gas cylinders and liquid oxygen) and commitment systems (loftier- and low-menstruum). The indications, advantages and disadvantages of each device and commitment system are presented, aiming to offer updated knowledge to the multidisciplinary team members managing patients with respiratory failure, and therefore allowing appropriate pick of devices and delivery systems that are tailored to the needs of each patient.

Short abstruse

Consolidated cognition of all oxygen devices and delivery systems is essential to devise tailored patient-based plans for oxygen therapy
http://flake.ly/2kh5f2G

Introduction

Oxygen use has extended from inpatient to outpatient settings for patients with chronic pulmonary diseases and complications of hypoxaemia. The Nocturnal Oxygen Trial and a study published by the British Medical Research Council are the landmark studies that have consolidated bear witness for domiciliary oxygen employ [i, 2]. The following three groups of patients with chronic hypoxaemic lung diseases are suitable for long-term oxygen therapy (LTOT) [3, 4]:

  • 1) Patients with arterial oxygen tension (P
    aO2
    ) ≤55 mmHg at rest in nonrecumbent position, despite optimal treatment of underlying condition.

  • 2) Patients with
    P
    aO2

    >55 mmHg associated with evidence of central nervous system dysfunction, cor pulmonale, secondary pulmonary hypertension or polycythaemia.

  • 3) Patients with demonstrable autumn in
    P
    aO2

    below 55 mmHg and desaturation during sleep and/or exercise.

Present, LTOT use is higher in women, and this is projected to increase farther in the about hereafter due to the high number of middle-aged female smokers [five]. There is a big diverseness of available oxygen-conserving devices and, considering the high costs of LTOT and the impact on patients’ health-related quality of life, optimal device selection and prescribing requires a clear agreement of these devices [iii, vi–8]. In this review, we will nowadays unlike oxygen devices and delivery systems.

Oxygen concentrators

How practise they work?

Oxygen concentrators provide a safe source of oxygen-enriched air. Oxygen concentrators (sometimes referred to as oxygen generators) are devices that draw room air through a series of filters that remove dust, leaner and other particulates. In the first footstep of the concentration process, the automobile forces air into one of the two cylinders containing a molecular “sieve” cloth or semi-permeable membranes, where nitrogen is absorbed, leaving full-bodied oxygen (90% or higher) and a small percentage of other gases found in room air. At the same time, in the other cylinder, nitrogen is desorbed and drawn out into the atmosphere. In the second pace, the role of the cylinders is reversed in a timed bike, providing a continuous flow of oxygen to the patient. A typical oxygen concentrator may deliver oxygen flows of 0.five–5 L·min−1
(low-period oxygen concentrators), while some models may generate upward to 10 50·min−1
(high-flow oxygen concentrators) [9, 10].

Types of oxygen concentrators and oxygen commitment

There are 2 types of oxygen concentrators: stationary and portable [9, 10]. Stationary (home) concentrators provide an uninterrupted oxygen supply with a catamenia ranging from 0.5 to ten–15 50·min−1. They take a mean weight of about 10 kg. They have several ergonomic handles built in, to offer options for lifting or rolling the device (figure 1a). New miniature concentrators have recently entered the market, making stationary concentrators more mobile than ever. The concentrator plugs into the chief electricity supply at home, using 300 Due west (or beneath) per hour (nigh the same as four light bulbs). A back-upwardly compressed gas cylinder is sometimes provided, to use in case of a power failure.


a) Stationary oxygen concentrator. b) Portable oxygen concentrator.

A relatively new pick is a super small domicile concentrator, which can weigh approximately 4.v kg. These units run on both alternating current (AC;
due east.g.
from a wall socket) and direct current (DC;
e.g.
from a cigarette lighter socket) and are mobile (e.m.
they tin be hands moved from one room to the other or they can be transported by car for travel). They currently back up oxygen flow rates up to 2 L·min−i.

Portable oxygen concentrators are the latest technology for LTOT users who desire a small, lightweight and portable oxygen solution in a compact and mobile unit (figure 1b). Portable concentrators vary in weight, size, oxygen menses settings, range of L·min−1
and bombardment life, besides equally other specifications.

The primal differences between stationary and portable concentrators can be summarised by four major factors: ane) oxygen output, two) size and weight, 3) ability options and 4) toll. Stationary oxygen concentrators take higher oxygen output and lower costs. Portable oxygen concentrators offering smaller size and less weight equally well as greater flexibility with power sources. For patients who live active lives and are often away from an AC (wall socket) power source, a portable oxygen concentrator is the best selection [9, ten]. Nigh portable oxygen concentrators use lithium ion batteries, which degrade over time. About of these batteries can exist recharged approximately 300 times without significant degradation.

Generally, there are two types of oxygen commitment in oxygen concentrators: continuous flow dose delivery and pulse mode delivery. Continuous menses dose commitment supplies a constant, steady and reliable oxygen flow based on the setting number in Fifty·min−i, while pulse mode delivery delivers a pulsed “bolus” of oxygen when the user begins to accept a breath. Initially, the private menstruum setting should exist adjusted.

Indications

Stationary oxygen concentrators are commonly used by patients on LTOT, every bit they are cost-effective and are safer than using compressed gas cylinders. Oxygen concentrators are recommended for patients using oxygen for >1.4 h·day−1
[x]. Guidelines do not give indications for the choice of the delivery device merely only suggest the use of a portable device in subjects on LTOT who regularly go outside [9]. Portable oxygen concentrators for ambulatory oxygen therapy are offered to people already on LTOT who want to apply oxygen outside the home. Convalescent oxygen therapy tin can better exercise tolerance and breathlessness, although in that location is no do good from oxygen before and after do in most patients with chronic obstructive pulmonary disease (COPD). Furthermore, convalescent oxygen therapy may let increased daily oxygen utilise and/or ameliorate compliance.

Advantages and disadvantages

Evidence arising from both prospective and ­retrospective trials and randomised controlled trials (with a minimum 12-month follow-up) suggests that oxygen concentrator use where appropriate improves survival rates for respiratory ­conditions, improves mental attentiveness, increases stamina and improves mood. The majority of ­studies have been performed in patients with COPD and it is of note that the duration of ­oxygen supply
per se
affects survival. In hypoxaemic chronic obstructive lung disease, continuous oxygen ­therapy is associated with a lower mortality than is nocturnal oxygen therapy [ane–v].

Advantages

Oxygen concentrators do not need to be refilled. The concentrators run on electrical power and thus supply an unlimited amount of oxygen. Portable concentrators tin can exist used in an “on-the-go” fashion with a battery pack, resulting in up to 12 h of continuous use for some models. From a long-term view, concentrators are more than cost-effective than compressed gas cylinders, and they are known to last for up to 1500 h of continuous use [eleven, 12].

Disadvantages

The significant disadvantage of oxygen concentrators is the demand for electrical power to office. It is necessary to prepare for unscheduled ability outages by setting up a fill-in power generator at home. Patients using stationary oxygen concentrators need to consider changing filters weekly, regular servicing and the warm-up menstruation of the automobile, also equally racket and vibration from the older models of device [eleven, 12].

Related costs

The global market for medical oxygen concentrators was valued at USD ane.75 billion in 2018 [13]. The market is anticipated to expand at a compound annual growth rate of seven.4% between 2019 and 2025 [13]. The prices of new domicile oxygen concentrators depend on batteries and other accessories, and range from USD 595 to USD 2000. Used oxygen concentrators are cheaper (USD 595–1500), depending on the hours, warranty, and condition of the unit. Even so, the rental of a stationary oxygen concentrator can run from USD 35 per mean solar day to over USD 200 per calendar week, but extended rental contracts may permit for a discount [13].

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Compressed gas cylinders

Compressed gas cylinders have certain differences when compared to oxygen concentrators, and these are summarised in
tabular array ane.
Figure 2a
shows a compressed gas cylinder and
effigy 2b
shows a patient in bed receiving oxygen from information technology
via
a nasal cannula.


Table 1

Differences between oxygen concentrators and compressed gas cylinders

Oxygen concentrators Compressed oxygen cylinders
Power source required Yes, continuously (according to model: 100–600 W) No
Send required Just at the fourth dimension of installation Yep, regularly; heavy and costly to ship
Exhaustible oxygen supply No, continuous supply as long as ability remains uninterrupted Yeah, depending on the size, storage force per unit area, and patient needs
User care Moderate: cleaning of filters and device exterior, and minimise fire take chances Minimal: regular checking, minimise burn take a chance (no grease or flammables)
Operational costs Small: electricity and maintenance High: cylinder refills and ship from refilling station to a hospital
Maintenance Moderate: bank check for low oxygen output with analyser Moderate: bank check for force per unit area leaks with judge


An external file that holds a picture, illustration, etc.
Object name is EDU-0204-2019.02.jpg

a) Compressed gas cylinder with an attached flowmeter, and b) a patient receiving oxygen from this device.

Properties, classification and appearance

A cylinder is a metal container filled with compressed gas and held under high pressure. Oxygen cylinders are available in a range of sizes that determine the capacity for oxygen. For compressed oxygen cylinders, at that place are three methods of delivering portable oxygen: a portable cylinder, lightweight cylinder, and abode fill cylinder [fourteen]. When fully filled with oxygen, cylinders range from small portable cylinders for ambulatory utilise (east.1000.
53 cm top, 3 kg weight, 430 L of oxygen) to large static cylinders (e.k.
71 cm pinnacle, xviii kg weight, 2122 L of oxygen) [14]. A haversack, trolley or wheeled cart may exist necessary for locomotion, depending on cylinder size and weight too equally the patient’s action and fitness level. The oxygen cylinders are colour coded with a white body to distinguish them from other medical gases.

How exercise they work?

A regulator is attached to the cylinder’s top and works like a tap, assuasive the safe adjustment of oxygen period rate provided, in L·min−1. When the tap is manually opened, the oxygen takes the line of to the lowest degree resistance to the patient
via
an oxygen delivery device (due east.thousand.
tube with a mask or nasal cannula). A force per unit area reading (barometer) displays the remaining oxygen pressure in the cylinder, to estimate the corporeality of oxygen available for supply.

The capacity of a compressed oxygen cylinder is comparatively low:
e.g.
with 200 bar filling pressure and 400 L of oxygen, the patient’s oxygen supply will suffice for 2.v h, depending on flow rate [fifteen].

At dwelling or in the hospital, cylinders are changed by the gas provider. The frequency of deliveries depends on the cylinder’due south size and oxygen consumption. Home fill cylinders tin be refilled by an oxygen concentrator [xiv].

Compared to continuous oxygen flow, oxygen-­conserving devices evangelize pulsed oxygen during inspiration only, triggered by the patient’s ­inspiration. These “need” oxygen delivery systems enable cylinders to last longer, since the oxygen waste during expiration is reduced. It has been shown that conservers can reduce oxygen usage past l%, leading to a reduced number of abode deliveries and thus lower costs [fourteen, fifteen]. Withal, oxygen-conserving devices vary in their ability to maintain arterial oxygen saturation levels during do, and some patients struggle to trigger them due to the advanced phase of their lung disease [xiv].

Indications

For patients requiring supplemental oxygen at dwelling, compressed gas cylinders are commonly combined with an oxygen concentrator. These patients are less mobile, spend the bulk of time at home and are rarely in need of mobile oxygen, which is why compressed gas cylinders may serve every bit a back-upwardly if a ability cutting or concentrator failure occurs [14, 15].

In hospital, mobile compressed gas cylinders find their main use as a temporary oxygen supply for invasively ventilated patients when they need to undergo diagnostic or therapeutic procedures outside the intensive care unit [14, fifteen].

Correlation with clinical outcomes

When standard portable cylinders were compared with lightweight cylinders in patients with COPD, in a prospective, randomised, clinical, multicentre trial conducted past the COPD Clinical Research Network, no differences were plant in action levels, oxygen saturation, Borg score or 6-min walk test [16].

A randomised multi-arm repeated-measures prospective report compared the use of liquid oxygen, home make full cylinder, portable concentrator and lightweight cylinder in 39 patients with stable severe COPD. At that place were no differences between oxygen saturation, distance walked, or time used [14, 17]. Another prospective, randomised clinical report performed in COPD patients compared liquid oxygen and cylinders for domiciliary portable use and found that neither of them improved the quality of life [18].

Advantages and disadvantages

Advantages

Present, compressed oxygen cylinders are comparatively the to the lowest degree convenient oxygen supply modality. Notwithstanding, depending on the demand of the patient, a cylinder may suffice in combination with a stationary oxygen concentrator [14].

Disadvantages

Due to their size and weight, cylinders are less convenient to comport without equipment. Patients can benefit from the provision of trolleys, wheeled carts or backpacks to enable them to carry home oxygen equipment [14]. When compared to liquid oxygen, cylinders were least favoured, while liquid oxygen was well-nigh favoured, with the everyman long-term costs [14, xv]. Despite the lack of improvement in the quality of life, patients using portable cylinders, in comparison with liquid oxygen, spent significantly shorter periods outside the house and used their oxygen less [18].

Case presentation

A 90-twelvemonth-old female person patient from a nursing home presented at the emergency department due to acute onset of shortness of breath, coughing and purulent sputum for the by few days. She denied fever and night sweats. She reported that she is a heavy smoker (80 pack-years of cigarettes) and has non been leaving the bed lately due to the deterioration of her COPD. So far, she had not been in need of supplementary oxygen. Initial arterial blood gas testing showed hypoxaemia (P
aO2

50 mmHg) without hypercapnia (P
aCOii

twoscore mmHg) and with normal pH (seven.40). Breast radiography was unremarkable except for signs of bilateral upmost emphysema.

She was admitted for an astute exacerbation of COPD. After treatment with bronchodilators, intravenous corticosteroids, antibiotics, and oxygen
via
nasal cannula, she recovered quickly, inside 5 days. Only the hypoxaemia did non improve dorsum to normal limits without nasal oxygen supply. Since ii Fifty·min−1
nasal oxygen fully resolved hypoxaemia (P
aO2

70 mmHg) without developing hypercapnia, she was prescribed nasal oxygen supply.

Afterwards exhaustive give-and-take with her about her present needs at the nursing home, we decided to prescribe her an oxygen concentrator in combination with a compressed oxygen cylinder. With the help of the oxygen concentrator she would be supplied with oxygen in her room. The compressed oxygen cylinder would supply her with mobile oxygen when she needed to leave her room (e.chiliad.
when her family unit members visit her or she has a medical appointment outside the premises).

Liquid oxygen

The introduction of liquid oxygen transformed the landscape of domiciliary oxygen therapy [12]. The showtime home-based liquid oxygen system was developed in 1965 with the view of providing a larger stationary oxygen arrangement within the home, with smaller liquid oxygen portables that tin can be refilled and used outside the home [19, 20].

How do liquid oxygen systems deliver oxygen?

Liquid oxygen is a cryogenic liquid, that is, a liquefied gas with a boiling point of −183°C [21–23]. Liquid oxygen allows a larger quantity of oxygen (gas) to be stored as a liquid in a small receptacle [24]. The 860:i expansion ratio for liquid oxygen means that when one L of liquid oxygen is evaporated, it expands to approximately 860 L of gaseous oxygen [25]. The medical liquid oxygen (minimum 99.five% purity) must first be vaporised to a compressed gas then warmed at ambience (room) temperature within the equipment before the patient can receive the oxygen through tubing into the nostrils
via
a nasal cannula [22]. How long a patient can utilize the ambulatory oxygen in the portable flask depends on the menstruum rate of oxygen the patient is using, as prescribed by the treating physician [21].

Both the stationary storage containers (“mother unit vessels”) and portables come in different sizes. These cryogenic containers go on the liquid cold [24]. Small stationary containers may provide a conveni­ent refill supply in a automobile or van during extended trips from home [25]. If the patient is on loftier-flow liquid oxygen (up to xv L·min−1
of continuous menstruation oxygen), information technology is important to note that ice may form on the portable’s estrus exchange coils due to freezing of ambience humidity [25]. These patients usually possess ii portable systems to facilitate continuous usage, allowing for de-icing of one of the units while using the convalescent oxygen in the other [25].

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Indications

Selecting the right oxygen delivery organisation for the right candidate tin can be challenging for the clinician. There are two major deciding factors when choosing between liquid oxygen and oxygen from a compressed gas cylinder, which are convenience and efficiency. For ambulatory patients who wish to exist mobile, limited French data from the ANTADIR registry support the use of portable liquid oxygen in this group [26]. According to the literature, liquid oxygen may be suitable for patients with chronic respiratory disabilities who could return to piece of work, require period rates >five 50·min−1, tin can walk, and cannot behave out their activities without an oxygen supply [12, xviii]. For ambulatory patients requiring loftier-flow oxygen, liquid oxygen is the about practical option [25].
Figure 3
shows a patient with a nasal cannula and liquid oxygen tank.


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Object name is EDU-0204-2019.03.jpg

Patient with a nasal cannula and liquid ­oxygen tank.

Correlation with clinical outcomes

Patients using liquid oxygen are more apt to venture exterior the habitation and apply daily oxygen for longer periods compared with their counterparts using oxygen concentrators [27]. In addition, liquid oxygen therapy improves both patient compliance and health-related quality of life [eighteen, 28]. Meaning differences, favouring liquid oxygen therapy
versus
oxygen concentrators, have been found in the following quality of life measures: physical function, body care, airing, social interaction and total Sickness Touch Profile score [28].

Advantages and disadvantages

Advantages

Liquid oxygen takes upwards less infinite than oxygen in its gas course, making it easier and lighter to deport around. Liquid oxygen tanks are safer compared to compressed gas cylinders considering they are under lower pressure. Of the three current modes of delivery for domicilic oxygen treatment, the nigh flexible and convenient source of home oxygen is the liquid oxygen system [29]. Low-cal portable containers are refilled with liquid oxygen from the large stationary reservoir at the patient’due south home whenever necessary, giving the patient control over the refilling frequency [25, 30]. The base equipment provides oxygen for >11 days, and convalescent oxygen in the portable canisters lasts 8–x h [28, 31]. At a catamenia rate of 2 L·min−1
of oxygen, this longer elapsing of oxygen supply in liquid grade benefits patients with chronic respiratory illness who would otherwise be restricted to a maximum of 2 h of oxygen, thus limiting their time spent outdoors [xviii]. Modern liquid oxygen canisters are less cumbersome for the patient to carry than previously reported [32]: iii.5 kg when full
versus
2.five kg when empty [18] for the larger portable canisters, and fifty-fifty lighter for the smaller ones. When compared to gaseous oxygen, patients adopt the liquid oxygen organisation considering the oxygen lasts longer, filling the canister is simpler, and the portable system is easier to carry due to a lighter weight [18]. However, portable oxygen concentrators are even lighter than liquid oxygen canisters because they do not require a storage reservoir of pressurised oxygen. Notwithstanding, oxygen concentrators are less convenient for patients than liquid oxygen considering they require internal batteries, automobile adaptors or standard electricity, and this demand for a continuous power source could hinder patient mobility and independence.

Disadvantages

Oxygen tanks and liquid oxygen canisters are limited past a finite chapters defined by their size, whereas portable oxygen concentrators have no compressed tanks to exchange or refill given that they draw in ambience air directly from the surroundings, filter it instantly and deliver the approximately 93% pure oxygen directly to the patient through the nasal cannula. It is necessary to keep the large liquid oxygen containers filled at home to replenish the smaller, portable tanks frequently. The recurring oxygen deliveries can get quite expensive. Another important bespeak to retrieve is that the liquid oxygen constantly evaporates and needs to be used and resupplied past a professional person service provider at least 2 to three times a month. Therefore, one of the chief drawbacks for liquid oxygen therapy is the cost. In addition, the number of patients with impaired lung role wishing to travel past aeroplane is increasing, but aviation regulations prohibit liquid oxygen on commercial aircraft [33].

Price

Compared with oxygen concentrator treatment, long-term liquid oxygen therapy is about four times more expensive [28, 30]. In their Swedish study in 1998, Andersson
et al. [28] found that the average full cost per patient over a 6-month catamenia was USD 1310 for the concentrator grouping
versus
USD 4950 for the liquid oxygen group. There is a high delivery/service cost associated with refilling the liquid oxygen stationary systems at a set frequency, contingent on the oxygen flow setting and the unit’south size [25]. In improver, other associated costs include electricity, conquering costs and metering gas to the patient [25].

Oxygen delivery systems

Oxygen delivery systems are categorised into low-menstruation and high-period systems. Depression-flow systems provide lower oxygen menstruation than the actual inspiratory flow (∼thirty Fifty·min−1). When the patient inspires, the oxygen is diluted with room air, and the degree of dilution depends on the inspiratory flows. Therefore, these oxygen delivery systems do non allow for accurate calculation of the inspiratory oxygen fraction (F
IO2
). High-flow oxygen delivery systems provide higher oxygen flows and the
F
IO2

is stable and is not affected by the patient’s type of breathing.

Low-flow oxygen delivery systems

Nasal cannula

A nasal cannula is the most common oxygen commitment arrangement, used for mild hypoxia (figure 4a). Information technology delivers oxygen into the nasopharyngeal space and tin can be gear up to deliver between ane and 6 L·min−1
(24–40%
F
IOii
) (tabular array 2).
F
IO2

increases past approximately 4% with each litre of oxygen per minute. Nasal cannulae are widely used in domiciliary oxygen devices. An oxygen menstruation >half-dozen L·min−1
should be avoided every bit it can dry the nasal mucosa and tin disturb sleeping patterns [34, 35]. A nasal cannula is user-friendly equally the patient can talk and swallow while receiving oxygen, and information technology is easy to utilize. However, it tin can be easily dislodged and is not as effective in patients with deviated septum or polyps.


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Object name is EDU-0204-2019.04.jpg

a) Nasal cannula. b) Not-rebreather mask. c) Venturi mask with different sized ports to alter the FIOii

delivered (24–fifty%). d) FIO2

and oxygen period are clearly stated on the bottom of each port.


Table 2

FIO2

and oxygen flow delivered
via
nasal cannulae


F
IO2

%
Menses L·min−one
24–28 ane–2
30–35 3–four
38–44 5–6

Elementary face mask

A simple face mask tin be ready to evangelize between v and ten L·min−1
(35–55%
F
IO2
) and is indicated when a moderate amount of oxygen is needed. It fits over the patient’s mouth and nose, and has side exhalation ports through which the patient exhales carbon dioxide. Humidified air may be added if the oxygen concentrations are causing nasal mucosa dryness. The mask’s efficiency relies on how well it fits. Eating and drinking tin be difficult with the mask on and it tin be confining for some patients, who may feel claustrophobic with the mask on [34, 35].

Non-rebreather mask

A not-rebreather mask is a depression-period device with loftier
F
IO2
. It uses a reservoir bag (∼grand mL) to deliver a higher concentration of oxygen (figure 4b). A 1-way valve betwixt the mask and the reservoir bag prevents the patient from inhaling expired air. It can be set to deliver between ten and 15 Fifty·min−1
(lxxx–95% oxygen). Oxygen menses <10 L·min−1
can cause the purse to completely collapse during inspiration.
F
IOii

depends on the patient’s pattern of breathing. This mask is useful in severely hypoxic patients who are ventilating well, just it carries the chance of carbon dioxide retention and aspiration in instance of airsickness [34, 35].

Transtracheal oxygen catheter

Transtracheal oxygen catheters (TTOCs) can be constructive in palliating breathlessness and hypoxaemia. The TTOC delivers oxygen directly into the trachea and it is inserted percutaneously into the trachea using Seldinger technique. Withal, TTOC placement has not gained widespread popularity as only a few physicians are trained to insert the TTOC or manage patients with it, and there is also a widespread reservation towards performing this invasive process on hypoxaemic, elderly, frail patients [36].

Oxygen flow through a TTOC ranges between 0.v and 4 Fifty·min−i. Oxygen commitment by TTOC bypasses the anatomical “dead space” in the upper airways and oral cavity, allowing oxygen to pass directly into the trachea. This reduces the overall oxygen needed during rest and with practise.

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High-flow oxygen delivery systems

Rebreather mask

Unlike the non-rebreather mask, there is no one-manner valve betwixt the rebreather mask and the reservoir bag and the inspired oxygen and expired air are collected in the reservoir bag.

Venturi mask

A Venturi mask is a loftier-flow device that allows precise measurement of
F
IOii

delivered. It consists of a bottle of sterile h2o, corrugated tubing, air/oxygen ratio nebuliser organization, a drainage bag, and a mask (e.one thousand.
aerosol face mask, tracheostomy mask, T-piece, a face tent). The oxygen menses exceeds the patient’southward superlative expiratory flow. Therefore, information technology is unlikely for the patient to breathe in air from the room. A Venturi mask utilises different sized ports to alter the
F
IO2

delivered (24–50%) (figure 4c). The
F
IOii

and oxygen flow are clearly stated on the bottom of each port (figure 4d). It does not dry mucous membranes, simply it is confining for some patients, and it interferes with talking and eating. It is particularly useful in COPD patients, where precise oxygen delivery is crucial [34, 35].

Loftier-flow nasal cannula

A high-flow nasal cannula consists of a menses generator, an air-oxygen blender, a humidifier and a nasal cannula. The menstruum generator can provide gas flow upward to 60 Fifty·min−1, and the blender escalates
F
IOii

upwards to 100% while the humidifier saturates the gas mixture (at 31–37°C). The heated humidified oxygen is delivered to a wide-bore nasal prong. The menses charge per unit and
F
IO2

tin can be independently titrated based on the patient’south flow and
F
IO2

requirements. Overall, high flows and humidification better functional balance chapters and mucociliary clearance of secretions, and thereby they reduce the work of breathing [34, 35].

Conclusions

Advisable selection of oxygen devices and commitment systems depends on the degree of hypoxaemia, the existing testify for the patient’s underlying diagnosis and patient preference. Respiratory physicians should take a consolidated knowledge of all devices and systems to devise proper and individualised patient-based plans for oxygen therapy.

Acknowledgements

For this contribution, A. Frille was supported by the Federal Ministry building of Educational activity and Enquiry (BMBF), Germany, FKZ 01EO1501 (IFB Adiposity Diseases, MetaRot program). The authors would like to thank BETABET visitor for kindly agreeing for photos to be taken of their trade.

Footnotes

Conflict of interest: G. Hardavella has nothing to disclose.

Conflict of interest: I. Karampinis has nil to disembalm.

Conflict of interest: A. Frille has nothing to disclose.

Disharmonize of interest: Grand. Sreter has nothing to disclose.

Disharmonize of interest: I. Rousalova has zip to disclose.

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Oxygen Administration Through a Two-pronged Tube is Called a

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6876135/