Oxygen is flammable so the patient must have stopped smoking.
- Once a patient is felt to be for LTOT then a Home oxygen order form must be filled in before discharge (HOOF).
- NICE states that the following are indications for considering long term oxygen therapy (LTOT):
Evidence level A
- Patients PaO2 < 7.3kPa when stable usually at 6 weeks or
- PaO2 of 7.3 to 8.0kPa when stable at 6 weeks + secondary polycythaemia, nocturnal hypoxaemia, peripheral oedema or pulmonary hypertension.
- The patient has stopped smoking by the time LTOT is arranged
- LTOT > 15 hours/day. No benefit for shorter durations.
- Target PaO2 > 8Kpa (60 mmHg) without an unacceptable rise in PCO2
NICE suggests assessment of the need for oxygen therapy in patients with the following
- Severe airflow obstruction> FEV1 < 30% of predicted.
- Cyanosis, Polycythaemia, Peripheral oedema.
- Elevated jugular venous pressure.
- Oxygen saturation less than 92% when breathing air.
Department of Health guidelines for use of long term oxygen in COPD
- Assessment when clinically stable. Not during an acute episode
- Smoking cessation and bronchodilator therapy established
- FEV1 < 1.5 L VC < 2.0 L PO2 < 7.3 KPa PCO2 > 6 KPa
- Aim for Oxygen usage for 15 hours per day
- Mostly delivered through oxygen concentrators.
- An oxygen concentrator is a device that concentrates the oxygen from a gas supply (typically ambient air) to supply an oxygen-enriched gas stream.
- Many are small and portable.