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Medical Oxygen Support

Oxygen therapy, also known as supplemental oxygen, is the use of oxygen as a medical treatment.This can include for low blood oxygen, carbon monoxide toxicity, cluster headaches, and to maintain enough oxygen while inhaled anesthetics are given.Long-term oxygen is often useful in people with chronically low oxygen such as from severe COPD or cystic fibrosis.Oxygen can be given in a number of ways including nasal cannula, face mask, and inside a hyperbaric chamber.Home and medical Oxygen Support in Bangladesh.

Oxygen is required for normal cell metabolism.Excessively high concentrations can cause oxygen toxicity such as lung damage or result in respiratory failure in those who are predisposed. Higher oxygen concentrations also increase the risk of fires, particularly while smoking, and without humidification can also dry out the nose.The target oxygen saturation recommended depends on the condition being treated. In most conditions a saturation of 94–96% is recommended, while in those at risk of carbon dioxide retention saturations of 88–92% are preferred, and in those with carbon monoxide toxicity or cardiac arrest they should be as high as possible. Air is typically 21% oxygen by volume while oxygen therapy increases this by some amount up to 100%.

The use of oxygen in medicine became common around 1917.It is on the World Health Organization’s List of Essential Medicines, the most effective and safe medicines needed in a health system.The cost of home oxygen is about US$150 a month in Brazil and US$400 a month in the United States. Home oxygen can be provided either by oxygen tanks or an oxygen concentrator. Oxygen is believed to be the most common treatment given in hospitals in the developed world.Home and medical Oxygen Support in Bangladesh.

Medical uses

Nasal cannula

Oxygen piping and regulator with flow meter, for oxygen therapy, mounted in an ambulance

Pin-indexed Oxygen Regulator for portable D-Cylinder, usually carried in an ambulance’s resuscitation kit

Pin index medical oxygen cylinder valve
Oxygen is used as a medical treatment in both chronic and acute cases, and can be used in hospital, pre-hospital or entirely out of hospital.

Chronic conditions
A common use of supplementary oxygen is in people with chronic obstructive pulmonary disease (COPD), the occurrence of chronic bronchitis or emphysema, a common long-term effect of smoking, who may require additional oxygen to breathe either during a temporary worsening of their condition, or throughout the day and night. It is indicated in people with COPD, with arterial oxygen partial pressure PaO
2 ≤ 55 mmHg (7.3 kPa) or arterial oxygen saturation SaO
2 ≤ 88% and has been shown to increase lifespan.Home and medical Oxygen Support in Bangladesh.

Oxygen is often prescribed for people with breathlessness, in the setting of end-stage cardiac or respiratory failure, advanced cancer or neurodegenerative disease, despite having relatively normal blood oxygen levels. A 2010 trial of 239 subjects found no significant difference in reducing breathlessness between oxygen and air delivered in the same way.

Acute conditions
Oxygen is widely used in emergency medicine, both in hospital and by emergency medical services or those giving advanced first aid.

In the pre-hospital environment, high-flow oxygen is indicated for use in resuscitation, major trauma, anaphylaxis, major bleeding, shock, active convulsions, and hypothermia.

It may also be indicated for any other people where their injury or illness has caused low oxygen levels, although in this case oxygen flow should be moderated to achieve oxygen saturation levels, based on pulse oximetry (with a target level of 94–96% in most, or 88–92% in people with COPD).Excessively use of oxygen in those who are acutely ill however increases the risk of death. In 2018 recommendations within the British Medical Journal were that oxygen should be stopped if saturations are greater than 96% and should not be started if above 90 to 93%. Exceptions were those with carbon monoxide poisoning, cluster headaches, attacks of sickle cell disease, and pneumothorax.Home and medical Oxygen Support in Bangladesh.

For personal use, high concentration oxygen is used as home therapy to abort cluster headache attacks, due to its vaso-constrictive effects.

People who are receiving oxygen therapy for low oxygen following an acute illness or hospitalization should not routinely have a prescription renewal for continued oxygen therapy without a physician’s re-assessment of the person’s condition.If the person has recovered from the illness, then the hypoxemia is expected to resolve and additional care would be unnecessary and a waste of resources.

Side effects

Many EMS protocols indicate that oxygen should not be withheld from anyone, while other protocols are more specific or circumspect. However, there are certain situations in which oxygen therapy is known to have a negative impact on a person’s condition.

Oxygen should never be given to a person who is suffering from paraquat poisoning unless they are suffering from severe respiratory distress or respiratory arrest, as this can increase the toxicity. (Paraquat poisoning is rare – for example 200 deaths globally from 1958 to 1978). Oxygen therapy is not recommended for people who have suffered pulmonary fibrosis or other lung damage resulting from bleomycin treatment.

High levels of oxygen given to infants causes blindness by promoting overgrowth of new blood vessels in the eye obstructing sight. This is retinopathy of prematurity (ROP).Home and medical Oxygen Support in Bangladesh.

Oxygen has vasoconstrictive effects on the circulatory system, reducing peripheral circulation and was once thought to potentially increase the effects of stroke. However, when additional oxygen is given to the person, additional oxygen is dissolved in the plasma according to Henry’s Law. This allows a compensating change to occur and the dissolved oxygen in plasma supports embarrassed (oxygen-starved) neurons, reduces inflammation and post-stroke cerebral edema. Since 1990, hyperbaric oxygen therapy has been used in the treatments of stroke on a worldwide basis. In rare instances, people receiving hyperbaric oxygen therapy have had seizures. However, because of the aforementioned Henry’s Law effect of extra available dissolved oxygen to neurons, there is usually no negative sequel to the event. Such seizures are generally a result of oxygen toxicity,[25][26] although hypoglycemia may be a contributing factor, but the latter risk can be eradicated or reduced by carefully monitoring the person’s nutritional intake prior to oxygen treatment.

Oxygen first aid has been used as an emergency treatment for diving injuries for years. Recompression in a hyperbaric chamber with the person breathing 100% oxygen is the standard hospital and military medical response to decompression illness. The success of recompression therapy as well as a decrease in the number of recompression treatments required has been shown if first aid oxygen is given within four hours after surfacing.[30] There are suggestions that oxygen administration may not be the most effective measure for the treatment of decompression illness and that heliox may be a better alternative.

Chronic obstructive pulmonary disease