Oxygen therapy


Oxygen may be classified as an element, a gas, and a drug. Oxygen therapy is the administration of oxygen at concentrations greater than that in room air to treat or prevent hypoxemia (not enough oxygen in the blood). Oxygen delivery systems are classified as stationary, portable, or ambulatory. Oxygen can be administered by nasal cannula, mask, and tent. Hyperbaric oxygen therapy involves placing the patient in an airtight chamber with oxygen under pressure.


The body is constantly taking in oxygen and releasing carbon dioxide. If this process is inadequate, oxygen levels in the blood decrease, and the patient may need supplemental oxygen. Oxygen therapy is a key treatment in respiratory care. The purpose is to increase oxygen saturation in tissues where the saturation levels are too low due to illness or injury. Breathing prescribed oxygen increases the amount of oxygen in the blood, reduces the extra work of the heart, and decreases shortness of breath. Oxygen therapy is frequently ordered in the home care setting, as well as in acute (urgent) care facilities.

Some of the conditions oxygen therapy is used to treat include:

Oxygen may also be used to treat chronic lung disease patients during exercise .

Hyperbaric oxygen therapy is used to treat the following conditions:

Helium-oxygen therapy is a treatment that may be used for patients with severe airway obstruction. The combination of helium and oxygen, known as heliox, reduces the density of the delivered gas, and has been shown to reduce the effort of breathing and improve ventilation when an airway obstruction is present. This type of treatment may be used in an emergency room for patients with acute, severe asthma.


Oxygen delivery (other than mechanical ventilators and hyperbaric chambers)

In the hospital, oxygen is supplied to each patient room via an outlet in the wall. Oxygen is delivered from a central source through a pipeline in the facility. A flow meter attached to the wall outlet accesses the oxygen. A valve regulates the oxygen flow, and attachments may be connected to provide moisture. In the home, the oxygen source is usually a canister or air compressor. Whether in home or hospital, plastic tubing connects the oxygen source to the patient.

Oxygen is most commonly delivered to the patient via a nasal cannula or mask attached to the tubing. The nasal cannula is usually the delivery device of choice since it is well tolerated and doesn't interfere with the patient's ability to communicate, eat, or drink. The concentration of oxygen inhaled depends upon the prescribed flow rate and the ventilatory minute volume (MV).

Another delivery option is transtracheal oxygen therapy, which involves a small flexible catheter inserted in the trachea or windpipe through a tracheostomy tube. In this method, the oxygen bypasses the mouth, nose, and throat, and a humidifier is required at flow rates of 1 liter (2.1 pt) per minute and above. Other oxygen delivery methods include tents and specialized infant oxygen delivery systems.

TYPES OF OXYGEN DELIVERY SYSTEMS. The types of oxygen delivery systems include:


A physician's order is required for oxygen therapy, except in emergency use. The need for supplemental oxygen is determined by inadequate oxygen saturation, indicated in blood gas measurements, pulse oximetry, or clinical observations. The physician will prescribe the specific amount of oxygen needed by the patient. Some patients require supplemental oxygen 24 hours a day, while others may only need treatments during exercise or sleep. No special patient preparation is required to administer oxygen therapy.

Patient education

SELECTING AN OXYGEN SYSTEM. A health care provider will meet with the patient to discuss the oxygen systems available. A system recommendation will be made, based on the patient's overall condition and personal needs, as well as the system's ease of use, reliability, cost, range of oxygen delivery, and features. The health care provider can give the patient a list of medical supply companies that stock home oxygen equipment and supplies. The patient can meet with home care representatives from these companies to evaluate the product lines that best fit his or her needs. Patients in the home setting are directed to notify the vendors when replacement oxygen supplies are needed.

OXYGEN SAFETY. Patients will receive instructions about the safe use of oxygen in the home. Patients must be advised not to change the flow rate of oxygen unless directed to do so by the physician.

Oxygen supports combustion, therefore no open flame or combustible products should be permitted when oxygen is in use. These include petroleum jelly, oils, and aerosol sprays. A spark from a cigarette, electric razor, or other electrical device could easily ignite oxygen-saturated hair or bedclothes around the patient. Explosion-proof plugs should be used for vaporizers and humidifier attachments. The patient should be sure to have a functioning smoke detector and fire extinguisher in the home at all times.

Care must be taken with oxygen equipment used in the home or hospital. The oxygen system should be kept clean and dust-free. Cylinders should be kept in carts, or have collars for safe storage. If not stored in a cart, smaller canisters may be lain on the floor. Knocking cylinders together can cause sparks, so bumping them should be avoided. In the home, the oxygen source must be placed at least 6 ft (1.8 m) away from flames or other sources of ignition, such as a lit cigarette. Oxygen tanks should be kept in a well–ventilated area. Oxygen tanks should not be kept in the trunk of a car. "No Smoking—Oxygen in Use" signs should be used to warn visitors not to smoke near the patient.

Special care must be given when administering oxygen to premature infants because of the danger of high oxygen levels causing retinopathy of prematurity, or contributing to the construction of ductus arteriosis. PaO 2 (partial pressure of oxygen) levels greater than 80 mm Hg should be avoided.

Patients who are undergoing a laser bronchoscopy should receive concurrent administration of supplemental oxygen to avoid burns to the trachea.

Insurance clearance

The patient should check with his or her insurance provider to determine if the treatment is covered and what out-of-pocket expenses may be incurred. Oxygen therapy is usually fully or partially covered by most insurance plans, including Medicare , when prescribed according to specific guidelines. Usually test results indicating the medical necessity of the supplemental oxygen are needed before insurance clearance is granted.

Travel guidelines

Traveling with oxygen requires advanced planning. The patient needs to obtain a letter from his or her health care provider that verifies all medications, including oxygen. In addition, a copy of the patient's oxygen prescription must be shown to travel personnel. Home health care companies can help the patient make travel plans, and can arrange for oxygen when the patient arrives at his or her destination. Patients cannot bring or use their own oxygen tanks on an airplane; therefore the patient must leave his or her portable oxygen tank at the airport before boarding. Oxygen suppliers can pick up the oxygen unit from the airport if necessary, or a family member can take it home.


Once oxygen therapy is initiated, periodic assessment and documentation of oxygen saturation levels is required. Follow-up monitoring includes blood gas measurements and pulse oximetry tests. If the patient is using a mask or a cannula, gauze can be tucked under the tubing to prevent irritation of the cheeks or the skin behind the ears. Water-based lubricants can be used to relieve dryness of the lips and nostrils.


Oxygen is not addictive and causes no side effects when used as prescribed. Complications from oxygen therapy used in appropriate situations are infrequent. Respiratory depression, oxygen toxicity, and absorption atelectasis are the most serious complications of oxygen overuse.

A physician should be notified and emergency services may be required if the following symptoms develop:

Oxygen delivery equipment may present other problems. Perforation of the nasal septum as a result of using a nasal cannula and non–humidified oxygen has been reported. In addition, bacterial contamination of nebulizer and humidification systems can occur, possibly leading to the spread of pneumonia. High-flow systems that employ heated humidifiers and aerosol generators, especially when used by patients with artificial airways, also pose a risk of infection.

Normal results

A normal result is a patient that demonstrates adequate oxygenation through pulse oximetry, blood gas tests, and clinical observation. Signs and symptoms of inadequate oxygenation include cyanosis, drowsiness, confusion, restlessness, anxiety, or slow, shallow, difficult, or irregular breathing. Patients with obstructive airway disease may exhibit "aerophagia" (air hunger) as they work to pull air into the lungs. In cases of carbon monoxide inhalation, the oxygen saturation can be falsely elevated.



Branson, Richard, et al. Respiratory Care Equipment 2nd. ed. Philadelphia: Lippincott Williams and Wilkins Publishers, 1999.

Hyatt, Robert E., Paul D. Scanlon, Masao Nakamura,. Interpretation of Pulmonary Function Tests: A Practical Guide, 2nd ed. Philadelphia: Lippincott Williams and Wilkins Publishers, 2003.

Wilkins, Robert, et al. Clinical Assessment in Respiratory Care, 2nd ed. St. Louis: Mosby, 2000.

Wilkins, Robert, et al. Egan's Fundamentals of Respiratory Care, 8th ed. St. Louis: Mosby, 2003.

Yutsis, Pavel I. Oxygen to the Rescue: Oxygen Therapies and How They Help Overcome Disease, Promote Repair, and Improve Overall Function. Basic Health Publications, Inc., 2003.


Crockett, A. J., J.M. Cranston, et al. "A Review of Long-term Oxygen Therapy for Chronic Obstructive Pulmonary Disease." Respiratory Medicine 95 (June 2001): 437-43.

Eaton, T.E., et al. "An Evaluation of Short-term Oxygen Therapy: The Prescription of Oxygen to Patients with Chronic Lung Disease Hypoxic at Discharge." Respiratory Medicine 95 (July 2001): 582-7.

Kelly, Martin G., et al. "Nasal Septal Perforation and Oxygen Cannulae." Hospital Medicine 62, no.4 (April 2001): 248.

Ruiz-Bailen M, M.C. Serrano-Corcoles, J.A. Ramos-Cuadra "Tracheal Injury Caused by Ingested Paraquat." Chest 119, no.6 (June 2001): 1956-7.


American Association for Cardiovascular and Pulmonary Rehabilitation (AACVPR). 7600 Terrace Avenue, Suite 203, Middleton, Wisconsin 53562. (608) 831-6989. E-mail: aacvpr@tmahq.com. http://www.aacvpr.org .

American Association for Respiratory Care. 11030 Ables Lane, Dallas, Texas 75229. (972) 243-2272. E-mail: info@aarc.org. http://www.aarc.org .

American College of Chest Physicians. 3300 Dundee Road, Northbrook, Illinois 60062-2348. (847) 498-1400. http://www.chestnet.org .

American Lung Association and American Thoracic Society. 1740 Broadway, New York, NY 10019-4374. (800) LUNG-USA or (800) 586-4872. http://www.lungusa.org .

National Heart, Lung and Blood Institute. Information Center. P.O. Box 30105, Bethesda, Maryland 20824. (301) 251-2222. http://www.nhlbi.nih.gov/nhlbi/ .

National Jewish Medical and Research Center. Lung-Line. 14090 Jackson Street, Denver, Colorado 80206. http://www.nationaljewish.org .


Daily Lung. http://www.dailylung.com . A full-feature magazine covering lung disease and related health topics.

National Lung Health Education Program. http://www.nlhep.org .

The Pulmonary Paper. P.O. Box 877, Ormond Beach, Florida 32175. (800) 950-3698. http://www.pulmonarypaper.org . Not-for-profit newsletter supporting people with chronic lung problems.

Maggie Boleyn, R.N., B.S.N.
Angela M. Costello

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What happens if your small Grandson cranks the dial above the #2 setting???
can low red cell count affect your oxygen level and what should your oxygen level be
My wife uses the Oxygen Concentrator so some part of the day. She has been using the oxygen for about a month now. Lately, she has told me she has sores in her mouth. Is this caused be the oxygen? and what can be done? The flow rate is set on 3.
My sister's long plastic tubing stays twisted and looped. Is there anything to be sprayed or wiped on the tubing to prevent this? She has tried wax and soap. Neither worked. Thank you.
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My mother was recently diagnosed with COPD, in April,2011 she was hospitilized with what I thought was a stroke but it turned out to be she was a co2 retainer, no one explained this to her or how to deal with it, it just so happens a nurse told me when I visited her in the hosp. For the next few months she has her family dr. and pulmunoligist having her come into the office at least once a week, it was getting stressful and hard,, she was having a very hard time breathing even with the oxy. she couldn't go 3 steps without taking a rest but these dr. had her going in changing her meds adding stuff. Last month Aug. 2 she saw her dr and he ordered x-rays of her chest 2 days later she saw the pulm. who ordered a scan for the 8th. at that visit with him he used the oximeter to check her oxyg. it was 72 so he ordered her oxy. level to be turned up to 3 without even doing bloodwork to see how much oxy. was in her blood he never mentioned to her about being a co2 retainer. She was dark, more purple in color he sent her home and the next day the oxy. rep came and adjusted her tanks and moved them up to 3. That was on a Fri. by saturday she wasn't able to hold onto anything she kept dropping everything, she was very tired but couldn't sleep she was becoming a little confused and sometime during that night she had a massive seizure something she's never had before we called an ambulance and took her to a hosp. not where her drs are. The EMT"S performed cpr it took 3 trys and when she arrived at the hospital she had no pulse they finally got her on life support and put her in a hyperbarric chamber to stop any brain damage The drs. there wanted to wait till she came out of the paralitic meds and brought her temp up to assess her it took another 3 days at which time I was told she has extensive brain damage that she was no longer her self another dr. told me that her enzymes showed no damage to the heart still not truly understanding what the hell happened I would like to know if some one can help me ask the right questions from her pulminologist on why a 67 yr. old woman dies on something that should be treatable. Was I right in stopping life support? She had a hard death. Thanks any advice or help in steering me in the right direction would be greatly appreciated.
i am taking my sister on a cruise, i will be stopping at a motel for 3 days. will the oxygen be o.k. to stay in the car?
@14/Beverly- Having just read this exc. article and comments,I just have to respond; my heart so goes out to you- I was in tears after reading it. I can't even imagine the pain you've been in & gone through; no one should ever have endure such a difficult,painful situation and death, as your mother did. Almost worse, I'm sure, was your suffering in having to witness and be a part of such a heartbreaking loss; it is just unimaginable. That is just too young-my mother is only 2 yrs. older,so my heart aches for you. You will be in my earnest prayers,that He will give you strength, comfort, and freedom from any guilt you may have placed upon yourself. From your story, it sounds as though you really did not have a decision to make; it appears more that they simply needed your *permission* to proceed, with the only available option. If I were in your place, and if I was in the same condition as your mom was, I would've-without a second thought- wanted her to do for me what you did for her. You know she would've never allowed you to linger,if you had no medical hope for recovery, and if it was just needlessly prolonging your suffering; with totally unselfish love and sacrifice, you simply did the same for her. I hope you don't continue to question your final action, but I totally understand & empathize with your anger and frustration toward the circumstances preceding her passing. From what you wrote, it surely doesn't sound as though her care was handled appropriately (just my opinion), so I would be upset too. I hope someone can give you the answers you need, so you can find peace. Please know that others care about you, and your sorrow. May the Lord ease your grief, and instead I truly hope you can find a place of rejoicing her life and the ending of her pain. Blessings to you
my dad who is suffering with esophagus cancer is asking for artificial oxygen five times a day each time for ten minutes, is it dangerous
To Beverly, No. 14:
Please google: "John Perrini Danger in the Air Darcy Spears" and forward to anyone you know on
an oxygen concentrator. At the end of this investigative report are some entries of what I
discovered. Western Home Health Care in Las Vegas, NV take the oxygen from one patient's home
to the next. I made a complaint to the Nevada State Board of Pharmacy (governs licensing
of home health care companies)and thanks to the caring, professional State investigator. it
was uncovered that the concentrator that was delivered to my husband was used by eight
other people over a period of three years. The filter (which should be new) was bad when they
brought it in and we knew nothing. My husband had sleep apnea and was to use the oxygen at night
only, which he did, faithfully for almost six months. Then our lives turned upside down for
two years. In and out of the hospital, ICU, on life support, last rites were given to him.
Of course, these deadly bacterias vegitated to his heart and valve replacement was performed.
No one knows about this hidden side filter in INVACARE OXYGEN CONCENTRATORS. This contains the
HEPA filter that needs to be replaced before each patient.
When we are all strong enough, we will go to lobby for regulartory agencies to oversee the
Home Health Care companies who have no compassion for a human being that trusts the technician who calls on them and more than likely is not even certified.
People are dying from this and it goes undetected. When a person dies and they are on oxygen, The coroner speaks to the family and is told "oh, she had breast cancer five years ago." The coroner writes on the death certificate "breast cancer." No one ever checks the filter on the oxygen concentrator she was on with the dirty HEPA filter. I had the filter tested at Silver State Labs in Las Vegas. Results: PSEUDOMONAS, RUSTS,SMUTS AND MOLD. At the present time my husband has 12 antibodies of bacteria and fungus which, per a UNLV microbiologist are recurring biofilm bacteria. IF I CAN HELP ANY ONE, PLEASE EMAIL ME: ritaperrini@gmail.com
mairwen smith

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