The Science Journal of the American Association for Respiratory Care

2007 OPEN FORUM Abstracts

THE DIFFICULTY IN OXYGENATING AN AMBULATORY SEVERE CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENT

V. Subramaniam1, B. Carlin1, V. Benton2, D. Germeyer2, R. McCoy3


Introduction:
Ambulatory oxygen therapy has been shown to improve the quality of life and exercise capacity in some patients with chronic obstructive pulmonary disease (COPD.) Studies have shown that every oxygen delivery device has its own performance limitations.

Case Summary:
A 63 year old man with oxygen dependent severe COPD presented for oxygen titration as part of pulmonary rehabilitation. His presenting oxygen prescription was 3 liters at rest and 5 liters on activity. At time of presentation he was using a portable oxygen concentrator at a “3” setting at rest and “5” setting on activity. On repeat oxygen titration using his concentrator, he was unable to maintain a saturation > 89% during ambulation at his normal walking pace. He was then placed on a prototype oxygen doser (Smart Dose) capable of monitoring and recording pulse oximetry, heart rate, breath rate, I:E ratio and volume of oxygen delivered per breath and per minute. The device was setup to emulate flow from a PD1000 (DeVilbiss), continuous flow, and Smart Dose algorithm (COPD Partners.) We could not achieve ambulatory saturations > 89% using the PD1000 mode. When placed into the Smart Dose mode the patient was able to maintain saturations > 89%. His maximal vital signs showed a breath rate of 27 BPM, pulse of 97 and best activity saturation of 93%. To achieve his saturation goal, the Smart Dose algorithm had to intermittently provide up to 106 ml O2 per breath (11.69 Liters per minute.)

Discussion:
The Smart Dose algorithm increases the delivered oxygen based upon an increase in breath rate. As our patient’s activity level increased his breath rate and amount of delivered oxygen increased in an effort to meet his physiological demand. When his breath rate returned to his baseline, the Smart Dose decreased the oxygen delivery to allow for greater oxygen conservation. Our case illustrates a success in oxygenating a difficult severe COPD patient while still allowing for a functional ambulatory status.


Smart Dose Real Time Display Screen
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