supplemental o2 and titration

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supplemental o2 and titration

Postby stars » Wed Mar 03, 2010 7:07 am

We probably some time ago talk about this topic.But i to ask where you usually add o2 to cpap or directly with mask
may be some yuo have good data about this. Two major rep as Resmed and respironics recomended differently
thank you
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Re: supplemental o2 and titration

Postby Pleistos_Hypnos » Wed Mar 03, 2010 7:15 am

stars wrote:We probably some time ago talk about this topic.But i to ask where you usually add o2 to cpap or directly with mask
may be some yuo have good data about this. Two major rep as Resmed and respironics recomended differently
thank you


Use the splitter @ the humidifier....not the mask.
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Re: supplemental o2 and titration

Postby Bevelman » Wed Mar 03, 2010 5:33 pm

stars wrote:We probably some time ago talk about this topic.But i to ask where you usually add o2 to cpap or directly with mask
may be some yuo have good data about this. Two major rep as Resmed and respironics recomended differently
thank you


We have ours through an elbow on the humidifier. It's a straight in line piece with a nipple sticking off it for the o2 line. :)

Two labs running two differnet systems **respironics** **resmed** both done the same way.

Hope that helps some.
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Postby respbarb » Wed Mar 03, 2010 5:56 pm

You are right, Stars. There is very little data on this. One study I know about states where you place it inline can affect FIO2.
In our lab we do not have a strict policy. Most of our DME's like to place it at the CPAP machine their reasoning is the patient is less likely to pull it out of line. Sounds plausible enough. and works for most patients, however all bets are off with some COPD patients. We have had to place it at the mask as close to the patient as possible to get the best pulse ox reading. Leaks effect this as well
It is something that is left to best-practices by your doctor in your lab. Most pulmonolgists have had a lot of experience with this.


Inspired Oxygen Concentrations during Positive Pressure Therapy
Sleep and Breathing
Volume 8, Number 1 / January, 2004
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Postby Rattlehead » Thu Mar 04, 2010 4:14 am

Barring conflicting data in the CPAP unit manuals, I like to bleed-in at the humidifier outlet for a better air/O2/humidity mix. Mask leakage is critical and must be tightly controlled.

I would love to see a universal standard set between the manufacturers, home-care providers, respiratory associations, and physicians. A sleep-related issue the AARC can tackle that needs addressed.
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Postby ttangles » Thu Mar 04, 2010 9:27 pm

We do it at the humidifier also.
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Postby Neil » Fri Mar 05, 2010 2:23 am

Rattlehead wrote:Barring conflicting data in the CPAP unit manuals, I like to bleed-in at the humidifier outlet for a better air/O2/humidity mix. Mask leakage is critical and must be tightly controlled.

I would love to see a universal standard set between the manufacturers, home-care providers, respiratory associations, and physicians. A sleep-related issue the AARC can tackle that needs addressed.

I'm not sure I understand why the leak needs to be tightly controlled. Remember an O2 mask is generally VERY leaky, as in essence is an O2 cannula.

Also FWIW we used to bleed supplemental O2 in at the mask, but I'll happily concede that the consensus here seems to be to bleed earlier in the circuit.

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Postby somnonaut » Fri Mar 05, 2010 9:44 pm

ONe thing that would help bleed the O2 back in at the mask is a better "O2/CPAP tubing" connection paradigm. The tubing for getting the O2 to the mask is terrible. There is a market for a better, standard, pre-packaged, stand-alone, O2 CPAP tube clip on, packaged product.

Another thing for "Friday delivery," OK Neil? :wink:
This sounds doable, though.
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Postby Rattlehead » Sat Mar 06, 2010 5:24 am

Neil wrote:
Rattlehead wrote:Barring conflicting data in the CPAP unit manuals, I like to bleed-in at the humidifier outlet for a better air/O2/humidity mix. Mask leakage is critical and must be tightly controlled.

I would love to see a universal standard set between the manufacturers, home-care providers, respiratory associations, and physicians. A sleep-related issue the AARC can tackle that needs addressed.

I'm not sure I understand why the leak needs to be tightly controlled. Remember an O2 mask is generally VERY leaky, as in essence is an O2 cannula.

Also FWIW we used to bleed supplemental O2 in at the mask, but I'll happily concede that the consensus here seems to be to bleed earlier in the circuit.

Neil


With my reasoning, I'm assuming CPAP airflow coming into the mask will take the path of least resistance, possibly flowing the enriched CPAP flow out the leak. I'm also remembering the Synchrony units with the electric oxygen valve located on the side of the unit. The manual stated leak had to be controlled tightly due to the valve operating in relation to airflow.

I can see where a minor mask leak could possibly help flush CO2 out of a known CO2-retaining patient.

The best option I have seen for routing oxygen tubing to a mask is to use the sensing-tube clips that ResMed included with their first-generation VPAP Adapt SV unit; I'm not sure if the newer versions still use this or not. These clips also apparently came on AutoSet CS 2 units; ResMed part #'s are:

ACS2 P/N 26911

VPAP Adapt SV equivalent P/N 26925
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Postby stars » Sat Mar 06, 2010 6:27 am

My preference FP dual connector one port for flow and second port as need for supplemental o2.Very easy to use
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Postby Patience » Sat Mar 06, 2010 7:07 pm

Our lab prefers the adapter at the humidifier due to less patient disturbance when adding the 02.
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Postby somnonaut » Sat Mar 06, 2010 8:14 pm

Rattle, I agree. I love that inline injector (Y port, not T).
Patience, if every CPAP titration had the ability to have the oxygen turned on or not because oxygen tubing was automatically installed with each CPAP usage, then it would not be a "disturbance."
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Re: supplemental o2 and titration

Postby dcbajack@comcast.net » Thu Jul 03, 2014 3:13 pm

I know it's been awhile since anybody has posted to this question, but I believe the reason it best to place the O2 at the machine is simply so it has less of a chance to come disconnected by the patient when they move at night. Also, remember that oxygen supports combustion so it's best to turn on the cpap, then the 02 and vice versa in the morning so the oxygen does not enter the device (does anybody still teach patients this???).
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Re: supplemental o2 and titration

Postby bduce » Fri Jul 04, 2014 12:44 am

It is more than just less risk of a patient disconnecting. When you connect closer to the device/humidifier and further away form the mask port you will get better admixture of the oxygen with the flow of air. Now this is usually not an issue at low pressure but at higher pressure (with consequent higher unilateral flows) this can be very important. I have posted an example of this.

Here is a ten minute snapshot of a 42 yr old female. She was diagnosed with severe OSA and sleep hypoventilation. The patient has a background history of COPD (moderate airflow limitation with very little hyperinflation), hypertension, type 2 dm, morbid obesity, and GERD. She was in for a NIV study. Staff called me overnight as they had already added oxygen into the system via the mask port. The titrating staff member had already reached our 4L/min oxygen flow limit (if they need to go any further than 4L/min O2 they need to get the approval of the oncall sleep physician). The first thing I asked is what pressures they are on, is that controlling obstruction and hypoventilation, is there a kink in the oxygen line and where are they injecting the oxygen into the circuit? They stated that obstructive events are reasonably controlled, TcCO2 is good, no kinks in the O2 line and they are injecting at the mask port. I then stated to move the oxygen injection site back to distal end of the NIV tubing (via a ResMed Y connector). Nothing else changes....

With a small increase in EPAP later on we had her at 88-90%.
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Re: supplemental o2 and titration

Postby Vix » Fri Jul 04, 2014 1:01 am

That is an excellent example, thank you for sharing!
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