The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

VALIDATION OF RECOMMENDED PATIENT ASSESSMENT AND TITRATION OF OXYGEN CONSERVING DEVICES

Louis M. Kaufman1



Background: Although numerous bench studies have documented the variability in flow and volume of oxygen delivered by oxygen conserving devices (OCD), respiratory therapists, physicians, and other health professionals continue to assume that at a given numerical setting on an OCD the amount of oxygen provided is equivalent to continuous flow oxygen (CFO). The AARC Clinical Practice Guideline on Oxygen Therapy in the Home or Alternate Site Health Care Facility--2007 Revision and Update references the Recommendations of the 6th Long Term Oxygen Consensus Conference for patient evaluation and titration of the specific OCD during rest and routine activities of daily living (ADL). The purpose of this study was to evaluate the impact on the OCD setting due to the variability of OCD flow and volume when compared to CFO delivery in the home care patient population.

Methods: I conducted a retrospective record review of a systematic random sample of 100 of 291 patients who from September 2007 to March 2008 underwent evaluation and titration for an OCD. Routine titration included assessment of SPO2 at the prescribed CFO at rest and with exertion (ADL to patient limitation or 6 minute walk, whichever came first); and at the OCD setting required to maintain equivalent SPO2 at rest and at the same level of exertion. Each patient was assessed for one specific OCD: either the DeVilbiss PD1000; Precision Medical EasyPulse5; Puritan-Bennett CR50; or SeQual Eclipse.

Results: Four (4) patients were sedentary and tested at rest only; three (3) patients had exertion only oxygen prescriptions and were not tested at rest; five (5) patients were excluded due to a resting SPO2 on the prescribed CFO of <90%. Of the ninety-five patients titrated, one (1) required a flared-tip nasal cannula to allow the OCD to trigger; and twenty-three (23) required a higher or lower OCD setting at rest and/or with exertion to maintain SPO2 equivalent to CFO.

Conclusion: The OCD assessment and titration of 23 of the 95 patients (24%) evaluated resulted in a different OCD setting when compared to CFO than if an assessment and titration had not been performed. Assessment and titration of the OCD as recommended in current published literature is validated in this home care patient population.