Info
A. Indications
- Dyspnea from advanced lung disease
- Dyspnea from cardiac or cardiovascular disease
- Sleep apnea with evidence of nocturnal desaturation
- Carbon monoxide poisoning
- Other Toxic gas inhalation
- Nitrogen narcosis (scuba / deep-sea diving)
- Other causes of dyspnea
- HCFA groups indications into Group I and II
B. Group I
- PaO2 <56 mm Hg or SaO2 <89% taken at rest, breathing room air, while awake
- During Sleep (nocturnal O2 use only):
- PaO2 <56 mm Hg or SaO2 <89% taken during sleep in room air
- Decrease in PaO2 >10 mm Hg or decrease in SaO2 >5% with symptoms or signs of hypoxia
- During Exercise (use of O2 only for exercise):
- PaO2 <56 mm Hg or SaO2 <89% taken during exercise in room air
- Evidence that use of supplemental O2 during exercise improves hypoxemia
C. Group II
- PaO2 =55-59 mm Hg or SaO2 =89% with evidence of any of the following:
- Depedent edema suggesting congestive heart failure (CHF)
- Pulmonary hypertension (HTN) or Cor Pulmonale determined by:
- Measurement of pulmonary artery pressure OR
- Gated blood pool scan OR
- Echocardiogram OR
- P pulmonale on electrocardiogram
- Hematocrit >56% (secondary polycythemia)
D. Efficacy in COPD
- Usually for patients with pO2 at rest of <56mm Hg or COPD with <60mm Hg [3]
- Clear benefits in exercise tolerance when given over long term
- Improvement in cardiac function (including right heart pressures)
- Reduction in mortality in most studies
- Some patients do not respond at all, and there are currently no predictors of response
- Strongly recommend a trial of supplemental oxygen for patients with pO2 <55mm
References
- Luce JM and Luce JA. 2001. JAMA. 285(10):1331

- Tarpy SP and Celli BR. 1995. NEJM. 333(11):710

- Sin DD, McAlister FA, Man SFP, Anthonisen NR. 2003. JAMA. 290(17):2301

- Man SFP. McAlister FA, Anthonisen NR, Sin DD. 2003. JAMA. 290(17):2313
