NLHEP
National Lung Health Education Program www.nlhep.org
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Guide to Prescribing Home Oxygen
by Thomas L. Petty, M.D.
Contents
The Key to Prescibing Home Oxygen
Patient Considerations in Selecting Equipment
Patient Considerations In Selecting Equipment
Diagnosis
No physician would prescribe insulin or dialysis therapy without a thorough evaluation, and the same is true for the home oxygen prescription. Most hospital Respiratory Therapy departments are able to evaluate home oxygen patients for correct liter flow at rest and during exercise. The exercise evaluation should be done up to the patient's usual level of exercise (10-30 minutes). Oxygen should be prescribed in a specific liter flow that corrects the hypoxemia and results in an oxygen saturation of greater than 90% at all conditions of rest, exercise and sleep. In COPD, the required liter flow to achieve this goal is usually one to three liters by nasal cannula. Higher flows are required in advanced cases and for many patients with interstitial lung diseases. When transtracheal oxygen is the route of delivery, the liter flow can usually be reduced by approximately 50%. The advantages and disadvantages of transtracheal oxygen delivery go beyond the scope of this brochure. The reader is referred to citations 7-8 in the literature.
Rehabilitation Potential
Most patients, if diagnosed early, will benefit from a pulmonary rehab program if one is available. Rehab not only helps patients rebuild their stamina but exposure to patients with similar problems seems to have a profound impact on their self-esteem and it improves their ability to adjust to their new lifestyle. These groups often meet socially and provide much-needed emotional support that might otherwise be lacking. Equipment providing maximum ambulation is recommended for individuals participating in these groups to facilitate patient participation. Conservers should be chosen that maintain high SpO2 levels commensurate with the higher activity levels typical of rehab groups.
Lifestyle is Important
Patient lifestyles are critical. Fitting individual patients' needs is incumbent on what they do or would like to be doing. Getting to know your patients is to be aware of their interests. What kinds of activities do they participate in? Do they go out a lot? For how long? Or do they stay at home? Do they perhaps work part-time? What are their hobbies? How can you best enhance their quality of life with the proper and appropriate oxygen modality?
CONCLUSION
When selecting the proper modality for LTOT patients, one must consider their lifestyle and rehab potential. If quality of life goals are set to be as normal as possible, oxygen devices should be chosen that will allow the patient to achieve this goal. Each patient's quality of life goals are different, however. There is one oxygen system or combination that is suitable for every patient. This brochure has been prepared to increase the knowledge and awareness of the importance in selecting the proper oxygen delivery device.