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CDHB

Long Term Oxygen Therapy, Domiciliary Oxygen

Long Term Oxygen Therapy (LTOT) (16-24 hours daily)

The aims of LTOT are to:

• Correct hypoxaemia without introducing dangerous hypercapnia.
• Improve survival.
• Reduce polycythaemia.
• Improve neuropsychological status.
• Improve sleep quality and prevent nocturnal hypoxaemia.
• Prevent right heart failure.
• Improve quality of life.
• Reduce health cost.

Note: LTOT is not a treatment for breathlessness, as such.

Indications for LTOT:

• COPD PaO₂ <55 mm Hg in the stable state (usually defined as approximately 6 weeks after admission/exacerbation).
• COPD PaO₂ 55-60 mm Hg with evidence of polycythaemia, clinical cor pulmonale, or pulmonary hypertension (in the stable state).
• Restrictive lung disease with PaO₂ <55 mm Hg in the stable state.

Notes:

• Periods of hypoxaemia may be tolerated quite well by patients during a stable phase of their illness.
• Patients should receive appropriate education about this treatment in order to avoid unnecessary anxiety.
• LTOT is not offered to current smokers, or those who are unable to clearly demonstrate abstinence from smoking (cessation advice must be provided).
• To initiate LTOT, fax a referral to the Respiratory Physician (fax 80914) and to Respiratory Outreach, fax 80849. Please complete the form fully in order to allow rapid determination of patient suitability.
• The flow rate for LTOT should be titrated to achieve a target sat.O₂ of around 90-92%. The flow rate may need to be increased at night time or during exercise. Specify the indication, the oxygen requirements, and the urgency of the referral. Domiciliary oxygen must be sanctioned by a Respiratory Physician. LTOT generally will be provided by using an oxygen concentrator – the highest possible flow rate is 5 L/min.

Short Term Oxygen Therapy (STOT)

Short term oxygen therapy is required for patients with COPD, restrictive lung disease, and other respiratory disorders in which there is significant hypoxaemia (PaO₂ <50 mm Hg), who need supplemental oxygen while recovering from acute illness. The primary purpose is to enable hospital discharge. Patients must be followed up within six weeks and reassessed. Patients will need to be informed that this is for short term only. Referral to a Respiratory Physician is required before STOT or LTOT is given.

STOT is not a treatment for breathlessness. If disabling breathlessness is the reason for delay in hospital discharge, consider referral to Respiratory Services for advice.

Portable Oxygen

Portable O₂ must be approved by a Respiratory Consultant. There is a limited availability.

Topic Code: 3645