Domiciliary oxygen therapy in persistent respiratory failure

Leszek Andrzej Szyszka

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Abstract

For a quarter of century Polish persistent respiratory failure patients are treated under
home conditions with the oxygen obtained from oxygen concentrators. Respiratory failure
is a condition where the par tial pressure of oxygen in the ar terial blood is below 60 mm
Hg or where the partial pressure of carbon dioxide is above 45 mm Hg. Hypoxemia causes
the damage of organs and their malfunction which results as sig nificant deterioration of
the patients’ prognostication. COPD and severe respirator y failure patients who breathe
oxygen for over 15 hours a day feel lesser dysponoea and their survival rate is higher. Their
previously
elevated haematocrit lowers, haemodynamics improves, pu lmonary hypertension
is inhibited, their physical competence improves, the number of hospitalisations
lowers, CNS activity enhances as well as their quality of life and psychical condition. It is
believed that domiciliary oxygen therapy for other hypoxemia-causing pulmonary diseases
improve life quality and also is recommended. Beneficial predictors of COPD patients under
domiciliary oxygen therapy are: younger age, higher spirometric merits, h igher BMI. On
the other hand, adverse predictors are: concomitant diseases, hypercapnea and elevated
red cells’ mass. Hypoxemia lower than 55 mm Hg, between 55 and 60 mm Hg and (at least
one of three symptoms): radiological features of pulmonary hypertension, electrocardiographical
features of right ventricular hypertrophy or haematocrit no lower than 55%, all
qualify to domiciliary oxygen treatment. Smoking disqualifies the patient from domiciliary
oxygen therapy. The patient should breathe oxygen of the flow between 0.5 and 3 liters for
over 15 hours daily. Increased flow of oxygen by 1 liter is recommended during sleep and
physical exertion. The patient treated with oxygen at home is under complex medical care.

Keywords

domiciliary oxygen therapy, respiratory failure, hypoxemia, chronic obstructive pulmonary disease (COPD)

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