Long term Oxygen therapy (LTOT)

Oxygen is flammable so the patient must have stopped smoking.

About

• 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.

Note

• 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

Oxygen Delivery

• 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.