Critical Comparisons of the Clinical Performance of Oxygen-conserving Devices

• Published in: American journal of respiratory and critical care medicine 2010-05, Vol.181 (10), p.1061-1071
• Main Authors: PALWAI, Aishwarya, SKOWRONSKI, Mary, CORENO, Albert, DRUMMOND, Colin, MCFADDEN, E. R
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; B. Chronic Obstructive Pulmonary Disease; Biological and medical sciences; Diseases of the respiratory system; Double-Blind Method; Equipment Design; Exercise Test; Female; Forced Expiratory Volume; Humans; Intensive care medicine; Male; Medical sciences; Middle Aged; Oximetry; Oxygen - administration & dosage; Oxygen Inhalation Therapy - instrumentation; Partial Pressure; Pulmonary Disease, Chronic Obstructive - metabolism; Pulmonary Disease, Chronic Obstructive - physiopathology; Pulmonary Disease, Chronic Obstructive - therapy; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Sickness Impact Profile
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.200910-1638oc

Clinical testing of oxygen-conserving devices is not mandated before marketing. Consequently, little is known about individual or comparative therapeutic effectiveness. To relate oxygen delivery from prototypical instruments to physiological performance. Thirteen subjects with obstructive lung disease performed progressive treadmill exercise while inhaling either room air, 2 L O(2)/min, or bolus oxygen from four commercially available conserving devices at regulator settings of 2, 5, and continuous. The devices were studied blindly in random order after first being tested to determine performance characteristics. Pulse oximetry, oxygen delivery, and nasal and oral ventilations were monitored at rest and with exertion. At a setting of 2 at rest, all conservers maintained saturation greater than 90%, but there were significant differences in oxygenation between systems. Only one equaled 2 L O(2)/min. With exertion, saturation decreased with all conservers but not with 2 L O(2)/min. One device did not perform any better than room air. Two systems provided less oxygen than predicted, one more, and in one the expected and actual amounts were equal only at rest. Breath-by-breath performance was highly variable, with irregular activation and inconsistent oxygen bolus size delivery. Increasing oxygen pulse volume to the point of eradicating conservation with the continuous setting did not eliminate all disparities. The mechanical and clinical performances of current oxygen conservers are highly variable and in some instances actually contribute to limitations in exercise ability. Seemingly equivalent technical features do not guarantee equivalent therapeutic functionality.