A. Indications

1. Dyspnea from advanced lung disease
2. Dyspnea from cardiac or cardiovascular disease
3. Sleep apnea with evidence of nocturnal desaturation
4. Carbon monoxide poisoning
5. Other Toxic gas inhalation
6. Nitrogen narcosis (scuba / deep-sea diving)
7. Other causes of dyspnea
8. HCFA groups indications into Group I and II

B. Group I

1. PaO2 <56 mm Hg or SaO2 <89% taken at rest, breathing room air, while awake
2. During Sleep (nocturnal O2 use only):
   1. PaO2 <56 mm Hg or SaO2 <89% taken during sleep in room air
   2. Decrease in PaO2 >10 mm Hg or decrease in SaO2 >5% with symptoms or signs of hypoxia
3. During Exercise (use of O2 only for exercise):
   1. PaO2 <56 mm Hg or SaO2 <89% taken during exercise in room air
   2. Evidence that use of supplemental O2 during exercise improves hypoxemia

C. Group II

1. PaO2 =55-59 mm Hg or SaO2 =89% with evidence of any of the following:
2. Depedent edema suggesting congestive heart failure (CHF)
3. Pulmonary hypertension (HTN) or Cor Pulmonale determined by:
   1. Measurement of pulmonary artery pressure OR
   2. Gated blood pool scan OR
   3. Echocardiogram OR
   4. P pulmonale on electrocardiogram
4. Hematocrit >56% (secondary polycythemia)

D. Efficacy in COPD

1. Usually for patients with pO2 at rest of <56mm Hg or COPD with <60mm Hg [3]
2. Clear benefits in exercise tolerance when given over long term
3. Improvement in cardiac function (including right heart pressures)
4. Reduction in mortality in most studies
5. Some patients do not respond at all, and there are currently no predictors of response
6. Strongly recommend a trial of supplemental oxygen for patients with pO2 <55mm

References

1. Luce JM and Luce JA. 2001. JAMA. 285(10):1331
2. Tarpy SP and Celli BR. 1995. NEJM. 333(11):710
3. Sin DD, McAlister FA, Man SFP, Anthonisen NR. 2003. JAMA. 290(17):2301
4. Man SFP. McAlister FA, Anthonisen NR, Sin DD. 2003. JAMA. 290(17):2313