The above questions were asked by members of EFFORTS on our EMail List. If you wish to join EFFORTS, please go to http://www.emphysema.net/ to learn more about us.

Pete's Posts...
 

Please select a question
 from the list above.

Peter Bliss is EFFORTS resident oxygen expert...

Mr. Bliss has eighteen years experience in the field of medical equipment design and manufacturing, most recently as President of a custom fluid control systems manufacturing company. He has been involved in respiratory research through his association with the Pulmonary Research department at the University of Minnesota and Regions Medical Center.

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EFFORTS wishes to thank Peter for devoting his time and EFFORTS in providing many, many answers, for our members, to some of our most important questions.


Disclaimer: The information provided herein, is not intended to be of a diagnostic nature or to question treatment by your own physician. It is meant strictly as information and education based on what is disclosed in the questions submitted by our membership. Any response by Mr. Bliss is based solely on his training and knowledge and of course might be subject to correction or difference of opinion. In the event you feel a mistake has been made, Mr. Bliss would be interested in hearing from you.

These pages provided by Gary Bain, EFFORTS

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Pulse Mode vs Continuous

Q. A question that I have long wanted  to ask fellow users - I have large concentrator at home which I use 24/7 at a  setting of 2 1/2 to 3 litres.  When I go out to grocery shop, dine out,  visit grandbabies, etc., I use my size D gas tank on wheels with regulator  that is PULSE up to setting of 5.  Rehab told me to use it on 5 for when  I am doing exercise or out running errands, etc.  This same regulator top  CAN be used on CONTINUOUS flow but only at a setting of 2.  I hardly ever  use that setting as the tank empties out VERY FAST of course. My issue is this:  I always feel like I am struggling just a bit to breathe in when on pulse mode.  I HATE THAT FEELING.  I am not  nearly as comfortable "out" as when I am at home with the continuous flow of  my concentrator in house.  Please don't any of you suggest, no matter how  gently, for me to switch to LIQUID OXYGEN.  Liquis scares hell out of me  & I will NOT go there. So,...am I alone in this  "struggling" to feel like I am getting enough oxygen when on pulse mode, or do  I have company in my feeling this way?? Thanks to all who care  enough to respond to my plea! Elizabeth

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A. There are 2 possibilities.  First, I assume that 2 1/2 - 3 liters per minute is good enough for you when you're using your concentrator at home.  If so, then 5 should work for you on most pulse devices, but........
1)every pulse device delivers differently.  5 on one might be the same as 3 on another.  What name is on yours?
2)pulse devices deliver different from each other and different from continuous flow.  So, for some patients, the settings on a particular device work just fine.  For another, they may not work well at all.  Breathing patterns of different patients affect the delivery differently.
3)your pulse device might not be operating properly.

So, I'd say trust your body and get someone (home care dealer therapist or clinic) to check out your oxygen saturation with an oximeter while you're walking with your conserving device.  Maybe a different conserving device would work better (doesn't have to be liquid to be good, liquid will generally just be lighter for a given amount of oxygen). Peter B

LOX Portables

Q. Hey folks, got a question perhaps someone can answer. I use LOX and prior to changing DME's some months ago I was using the Companion 1000's. Each would last me from 6 to 7 hours, sometimes more depending on flow rate, but when forced to change DME's the new company gave me brand new Companion 1000 T's - which supposedly is only different in the higher flow rate available. With the Companion T's I can get no more than 4 to 5 hours out of a tank and I was wondering if anyone else has had this experience when switching from the Companion to the Companion T units. (I was tested and cannot use the Helios units.) Dick, OH

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A. You're supplier is right, at least in theory.  The higher flow rates of the T are the only outward differences.  If the units are set to the same flow rate, then they should last the same amount of time.  You have to be a little careful because the settings on the dial are different. If you were getting 6-7 hours on a C1000, that should have been at setting 2.5 or so.  If it was set higher then maybe your old supplier had a unit that wasn't working properly.  The units hold approximately 1000 liters, so you use time (in minutes) should be 1000 divided by flow setting. Peter B

Easy Mate

Q. Is this [Easy Mate] available now or do you know?  And even though I  went through their site I couldn't find what it cost if your supplier doesn't  carry it. Thanks for any information you may have. Charlotte

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A. The EasyMate is a pulse only type system, ie -  no continuous flow capability.  It has settings of 1 to 4 (like any conserving system not 'equivalent' to liters/minute).  The settings are 'constant minute volume' settings, meaning the faster you breathe, the smaller the pulses get, so that the total per minute is constant.  This isn't necessarily bad, just something to understand.  At 4 setting, I believe that the minute volume is about 700 cc/minute, meaning at 20 breaths per minute, you'd get about 35 cc per breath, and at 30 breaths per minute you'd get 23 per breath.

So, as a comparison, the O2 delivery is roughly equivalent to Helios.  DeVilbiss/Sunrise conservers give this max dose at their settings of 1.5-2.5.  Chad conservers at 2.5-3.5. Peter B

Portable Oxygen Concentrators

Q. I am looking into obtaining one of the new portable concentrators. During my search I found that Air Sep has one called Free Style that is much smaller than than their Life Style unit and is also smaller that the Inogen One. It has a battery belt available that makes it possible to run for up to 8 hours. Does anyone have any experience with the Free Style unit that could comment
on it's performance? Regards, Tom

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A. Keep in mind that the "3" setting of the Freestyle and "5" setting of the Lifestyle, like any conserving system, do not equate to continuous flow, or to other conserving systems.  Every manufacturer and model has a different idea of what the numbers should stand for. If we assume that the Freestyle will be capable of delivering 3/5ths (60%) of what the Lifestyle does, it will generate a maximum of approximately 400 cc/minute of gas at 90% concentration.  This is quite a bit less than other systems on the market (about 1/2 of what the Helios 300 can provide, just as a reference).  I would anticipate that it will provide adequate ambulatory oxygen for a small portion of patients.

Airsep does not publish the maximum oxygen generation for either portable machine, but these numbers are based soley on my testing and assumptions, so could be misguided. Peter B

True Demand Conservers

Q. I have used 2 different conserver regulators. One is the Chad 511 and the other I don't know the name of. Both of these units release a pulse of O2 when one starts to inhale but cuts if off before I finish inhaling. (pulse dose) The Chad unit will sometimes give a double hit if the length of time during the inhale is long enough usually "over shooting" or cutting a little short. Is there a regulator that is a "true demand" type that is activated by ones breathing pattern that delivers O2 as long as ones inhale is detected and cuts off only when I start to exhale? Scuba regulators work this way. Rusty

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A. Units like the Puritan Bennett CR-50, Helios, Companion 550, Victor's O2N Demand, Salter, and generally any conserver that has a dual lumen (2 tube) cannula are described as 'demand'. They stay open as long as you keep inhaling. The good side is that it matches your breathing pattern as you suggest. The bad side is that you waste some O2 that is delivered late in inhalation, because it never makes it to your lungs. Pulse type devices that stop short intentionally do so to try to make the O2 delivery as efficient as possible.

In addition, continuous flow has the advantage of pooling some O2 in and around your nose during late exhalation. With a "true" demand valve, you miss that, and the therapy is less effective. Some devices that work this way actually don't save any O2 at all once you turn up the flow rate to compensate for what you lost in pooling. So the devices mentioned above have some bolus (pulse) at the beginning of delivery to make up for that.

The Chad 511 uses a scheme that has a fixed pulse time of roughly 1/2 second. The flow rate during that time is adjusted with the the setting to give the desired pulse volume. For this reason, at low settings, it's hard to tell if it's working, because it is very quiet. Contrast this to other pulse devices that keep a fixed flow rate, but adjust the on time, and they can always be heard, (also true of many demand systems because of the aforementioned bolus). This is good and bad. You can hear it, which you may or may not like. Peter B

Inogen and Flow Rates

Q. Use of the Inogen on airlines is sure a great step forward. BUT, notice in there specs that the flow rate is adjustable in 9 different settings up to 5. They are careful not to label it in lpm which most of us are familiar with. Marks explanation is detailed, BUT - what is the flow rate in lpm to compare it to what I use now with the Helios and Spirit? Jim

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A. The setting numbers really mean nothing relative to other devices or continuous flow. The Inogen One will make up to 750 cc/min of gas, at approximately 90% O2. This is roughly the same as 670 cc/min (2/3 lpm) of USP (99+%) O2. Assuming a breathing rate of 25 breaths per minute, Helios can put out approx. 780 cc/min and Spirit 1875 cc/min. Since the delivery type is not the same, this will be of varying benefit to different users.

Inogen - 670 cc/min
Helios - 780
Spirit - 1875

Problem with Spirit 600

Q. I have a problem with the Spirit 600 on the pulse. It is fine at first but then it will be puffing when it is not supposed to. In other words I get out of time with it, is putting out when I am breathing out. The 2 on continuous is not enough for me. I wish we could have a good portable. I still am hanging on to my Companion 550. The case is broke but I am very careful with it. Maxine NC

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A. It shouldn't be doing that, so the unit should probably be replaced. It is possible for this to happen if you are breathing very fast (over 35 breaths per minute or so), or if you use a cannula that's very restrictive (like a "micro cannula"). If these aren't the case, I'd ask for a different unit. Peter B

Oxygen Difficulties in England

Q. I am having severe difficulties over in England with two matters that deeply concern me and if members of Efforts could advise me I should be very grateful.

Firstly - I live in a small seaside town 30 miles from the nearest large hospital. However there are four 'cottage' hospitals within 15 miles. Last week I had a severe panic attack & sleeplessness which led to severe SOB (my FEV1 is 0.71 ie near end stage) - paramedics arrived and stated that because I was using my ancillary muscles for breathing I was in danger of respiratory collapse (well that happens in panic before I can employ stomach muscles etc). My PaO2 levels were adequate above 92%. But they insisted in taking me on a stretcher by ambulance for thirty miles for a blood gas test. In the A & E department I was given diazepam and discharged after 4 hours and dumped into a taxi costing $70 to get back home without any social support (wife was away). My point is this. I asked why they did not take me to one of the cottage hospitals (indeed I live 200 yards from one) - they said that any tests would have to be sent away to Exeter and take two weeks (same for other local hospitals). My doctor informed me that in any case there was no=one near here that could do an arterial stab! My question is - is there any relatively inexpensive equipment on the market to measure blood gases without involving technicians etc? I wish to be treated in my own town, preferably at home, and not have to die in a city. I am in touch with the medical authorities here but I know in America they have advanced machines that nobody here is aware of.

Secondly, the provision of ambulatory equipment here is woefull. I have a CD cylinder weighing 8 lbs! Useless. My doctor tells me that I cannot have liquid oxygen at home (even if I pay for it) because I might suffer severe burns to y face and arms during a refilling operation (if there is a blockage in the pipes). This is rubbish - isn't it? If I have to buy a machine myself that also delivers lightweight cylinders etc I have considered the Total O2 Delivery System, International by Chad. However, I am very concerned that there are no local arrangements for servicing this model. Does anyone use this system? and I should appreciate any thoughts on both reliability & frequency of servicing.

Any comments that or other members might make will be gladly received. Everybody has my introduction I think. Kind regards, John Kirtley

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A. Liquid oxygen has been used safely in the states for 40 years, but largely because of reluctance by BOC, has only recently been introduced on any large scale in the UK. So, the reluctance of your doctor is probably the result of ignorance or worse, propaganda from those that wanted to keep it out.

It's hard to find options, but hopefully you can get connected with a more enlightened MD and/or a home medical provider that can help educate them. Try calling around to anyone you might be able to find that supplies or uses liquid. I wish there were any easier way.

You might try contacting a liquid oxygen equipment manufacturer like Caire or Puritan Bennett, and ask who distributes their equipment in the UK, hopefully in your area. www.cairemedical.com  www.puritanbennett.com Cheers! Peter B.

High Flow Oxygen and Liquid

Q. For those of you who are high-flow users (over 4 lpm) are you able to use liquid 02? What do you do when you exercise? Are there concentrators that will manage these higher flows? It seems that most of them stop at 5 lpm. Joy

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A. There are several liquid portables like the PB Companion 1000 and Caire Stroller or Sprint that go up to 6 lpm continuous flow. If you need more, both companies also make a Hi Flow version that goes up to 15 lpm.

There are a couple of 6 lpm concentrators, but they are less common and not all dealers carry them, or many of them.

Sequal and Invacare make 10 lpm concentrators they less commen yet, but available for the few patients that need higher flows. Peter B

Liquid Oxygen Portables and TTO

Q. I am just now getting set up with liquid Oxygen. The portable my supplier >brought out here could only be used with a cannula and I have the TTO oxygen. She said she did not know if there was one that would work for me but would check in to it because I really need the continuous flow. Is the Companion T High-Flow Portable Liquid Oxygen Unit no longer available? The article stated it could be set from 1/2 to 15 LPM. It weighs 8.7 lb when filled and is 14.5 inches high. Thank You, Vera

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A. Any continuous flow liquid or cylinder system will work with TTO. This includes the Companion T, but do you really need the high flow (over 6 liters per minute)? There is the Companion 1000, also by Puritan Bennett, and Caire Medical makes the Stroller (1.2 liter, 9 lbs) and Sprint (0.6 liter, 6 lbs). These are all continuous flow up to 6 liters per minute.

In addition to these continuous flow products, conservers that use a single lumen cannula may also work with your TTO. This includes the Caire Medical Spirit, Penox Escort and quite a few gas (cylinder) conservers. The usefulness varies from one TTO patient to another.

The only things that won't work for sure are dual lumen conservers like the Helios and Marathon, and cylinder conservers like the CR-50 and similar.

www.cairemedical.com  http://www.penox.com/  http://www.puritanbennett.com/prod/List.aspx?S1=OXY  Peter B

Oxymatic vs DeVilbiss

Q. My conserver is a Oxymatic OM 400 series, it can be used as pulse or continuous. Is this equal to the ' DeVilbiss ' you mentioned ? We use it on small tanks for daily use. Larry H

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A. The OM400 delivers O2 in a manner very similar to the DeVilbiss units, but the settings themselves are not exactly equivalent. The OM400 gives 10 mL of O2 per breath for every setting number (eg 30 mL at '3'). Most DeVibiss (Sunrise Medical, PulseDose) conservers give 16 mL for each setting (eg 48 mL at '3'). One exception is the newer PD4000 which gives only 14 mL per setting (eg 42 mL at '3'). So, the therapy may be similar and the cylinder use time may be similar, but NOT at the same numerical setting. It's important with any O2 delivery to find the settings that give you the proper therapy, and not to pay attention to the numbers themselves. 3 on the Chad may give you the same results as 2 on the DeVilbiss. Peter B

Oxygen Delivery Question

Q. I have a question that I hope someone can answer? Are there people with COPD that cannot use the demand type delivery system for 02? People who must have constant flow in order to keep their sats high enough. Thanks Janet in MO

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A. Janet, Yes, but not many. These would be people that either need very high flows of O2 (over 5-6 lpm continuous flow) or very fast breathers that also breath mostly through their mouth. BUT - - there are many different conservers available, and many give a small dose of O2 even if the number setting is high. Because of this, there is a perception that demand/pulse delivery gives less than continuous flow.

Actually, some units for some patients give more with the pulse delivery than continuous flow. Moral - never assume the performance of a single conserving device represents all of them. Ask questions. Try different ones to find one that works best for you. Peter B

O2 Tank Leakage

Q. The O2 tank has a "main valve" to cut the flow on and off to the regulator. The regulator also has an off position on the LPM dial.If the tank valve was left on all the time would the off position on the regulator dial keep  the O2 from leaking out?  ...Rusty.......

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A. There's a reasonable probability that there would be a very small leak in the downstream side.  It might take days or
weeks, but you're tank may wind up empty.  This will vary a great deal from one regulator to the next, or even one cylinder to the next.  I've had several where the seal on the cylinder had a very tiny leak.

The part about having premature failure may be a wive's tale.  I've not experienced or heard of that, but there are many regulator designs out there, and it wouldn't surprise me if one from the past was sensitive to this. Peter B

Inogene Use

Q. Anyone Know if the Inogen One is compatible with a BiPap since it is a pulsing Oxygen delivery system? Sounds like just what I need because my husband and I love to travel and the Inogen would be so much easier for him than lifting a regular concentrator into our vehicle and out each night for a motel room then reload each day. We carry a lox tank to refill my portable for eating or visiting. would appreciate any input about information on the Inogen one. Thanks--Razorback Alice

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A. Typically, any pulse type system will not work with CPAP or Bi-Pap. This is for two reasons. First, the pulsing devices often look for a negative pressure caused by inhalation to trigger a dose of O2. With CPAP or BiPap, you won't ever see a negative pressure. Second, with CPAP or BiPap, there is a high flow of air out of the mask, which you never get to inhale. So it takes a higher continuous flow of O2 to keep up with this 'intentional leak'. Pulse systems like the Inogen One don't have the capacity to generate the higher (or any) continuous flow. But.... I never like to say never, it's alway's possible that they have come up with some slick work around. Never hurts to ask. Peter B

Invacare Homefill Compressor Question
 

Q. Hi Peter! I am Yury from St. Petersburg, Russia. Thank you for keeping your page. Now I have a possibility to purchase an american oxygen concentrator. I have a German one but I need something portable. Invacare Homefill Oxygen Compressor Package looks not bad (http://www.phc-online.com/oxygenconcentrator.htm ). It includes a concentrator, a compressor, and two tanks (M6 and M9). These are tanks that allow to leave the house with an oxygen supply. Is it really a reliable system? If yes, my question is whether this unit needs any supplementary things to function (special liquid or smth.) or not. Ordering liquid or any other component several times yearly from U.S. may be a trouble for me. This is why, for instance, I cannot use Helios in Russia. Another problem is that I do not understand a distinction between variations of Invacare compressors (IOH200 and IOH200A or C). This difference, meanwhile, costs 1000 $!

Peter, one more question. You wrote about AirSep - LifeStyle. But I did not find any information on its site about how long it can function with AC Power. 6, 12, 24 hours?

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A. Peter, I am sorry for my English, but I am not sure that you would understand my Russian. All the best! Thanks! YuryThe difference between the different models I believe has nothing to do with the compressor itself. Invacare offers various packages that include other items, such as the O2 cylinders. I believe that the IOH200 alone is only the compressor ($2270). The 'A' package includes 2 cylinders and the older Invacare conserving device($3225). The PC package includes the newer Precision Medical pneumatic conserving device built into the cylinders($3347). None of these packages includes the concentrator($969).

The Homefill II is relatively new to the marketplace (about 2 years), and is just starting to be used in significant numbers. This is the second product design of this type for Invacare, so it has been refined some. It takes about 200 watts of power when it's running, but only takes a few hours to fill a cylinder. Somewhat noisy, but again only when filling. Especially for a location where liquid or easy access to cylinders is not available, I think it might be a good product. The AirSep LifeStyle operates for 50 minutes on 1 battery. You can carry spare batteries, which cost about $200 each. Peter B

Getting Oxygen in Europe

Q. I am going to England in a couple of weeks. I am renting an AirSep Lifestyle (plus a spare battery) before I leave and taking that with me. Hopefully that will do the trick for me. I am on O2 at night and when active. Sitting and light movement does not put me below 90% but I need 3.5 l/min when on the treadmill. I do have a backup plan, and could setup a supply in a day or so through my sister's doctor in London, and I am carrying a prescription from my pulmo. I really wish the Inogen was out, and I also really wish I could use a POC when flying. AhWell! I always seem to do things before the world is ready for me!!! Chris W

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A. If you haven't already, try out the Lifestyle before you go. It's a neat little machine, but for most people only makes the equivalent of about 2 lpm (even though the knob says it goes up to a hypothetical '5'). Also, since it delivers only in a pulse fashion, it may or may not work for you while sleeping. This because many people breath more shallowly or through their mouth at night, which may not trigger the pulse device. Finally, check out the power setup. Lifestyle works from AC or a car adapter. Don't know if they have the same cigarette lighters over there. And while the AC adapter is universal voltage, you'll need an adapter or special cord to plug it in. Hope you have a fab trip! Peter B

Can I Fill a Portable from this Unit?

Q. I have a Respritronics Millennium M600. Pretty much the "run of the mill" concentrator.Is there a "unit" made that would connect to the discharge nipple on the concentrator and go through a compressor that would fill a portable tank? I realize that the out put pressure of the concentrator is around 5.5 psi and with a max LPM of about 5 LPM so this "unit" would have to compress O2 from the concentrator at a flow less than 5 LPM and boost the pressure in the tank to 2000 psi or what ever the Max tank pressure is........Thanks Rusty

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A. No, The only units that fill cylinders are the Invacare Venture Homefill II, and the Chad Therapeutics Total O2. The latter is an all in one device that is both concentrator and filling station. Invacare is a separate unit, but can only be used with an Invacare concentrator. Originally, they wanted it to be universal, but the FDA wouldn't allow it, so it has a special connector that only lets it work with their unit. Peter B

Concentrator Oxygen Output

Q. What should the percentage of oxygen output of my concentrator be? In the past, when checked by a technician, it has always been at the 95% level, or sometimes just a shade higher. Today when it was checked, it was 93% and the tech said that was just fine. What say ye all?? Should I accept that, or ask for another machine? I sometime think that switching to LOX might be a good idea ... just thinking, though. No decision yet. Les

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A. The absolute maximum that a concentrator can put out is about 95. This is because the rest is Argon, that the concentrator can't get out of the air. Most concentrators will produce 92-95% when operating below the max output. If your setting is towards the max, it may dip down to 90% or below. As Craig said, correctly, the 'allowable' limit is 85%, but most suppliers will change out the unit if it gets down around 87-89%. The way the math works out, you can get by just fine with 85% O2, but you would need 23% more flow (2.5 lpm vs 2) to make up for the lower purity. At 93%, it would be 10% more. That's only in theory. Nobody go running to turn up your machines now.... Peter B.

Don't Understand FEV1

Q. I really do not understand what it means to be FEV1 at 102% and FEV1 at 108%.  Would someone please explain all this to me - guess I came in a little late to know what it is. Dot/AZ

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A. FEV stands for Forced Expiratory Volume, or the amount of air you can forcibly exhale.  The number after it indicates the time (seconds) that they measure it in.  So FEV1 is the Volume you can exhale in 1 second.  FEV 3 is not used much.  FEV 6 is a substitute for FVC (forced vital capacity) which is the total amount you can exhale without any time limit.

When these numbers are expressed in %, its related to your predicted value, based on measurements of thousands of people, divided by age, gender, race, etc.  Tom is correct, in that if FEV1 is over 100%, it indicates no obvious obstructive disease, because you're getting plenty of air out in that first second. Some more information- http://www.nlhep.org/spirom1.html Peter B

Cost of LOX

Q. I thought liquid 02 was the more expensive! Have I been misinformed? Thanks. Carrie

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A. Gas is not necessarily 'cheaper' than liquid oxygen.  It depends on how mobile the patient is, or the supplier lets them be.  If a patient is very active, out several times a week, then gas gets very expensive.  This is because they have to pay to fill each cylinder.  With liquid, they just deliver once.  But if they constrain your activity by delivering just a couple of tanks, then gas is 'cheaper', but at the cost of the patient's freedom. Peter B

Use of Oxygen

Q. I was diagnosed in '93 and have used inhalers since. A nebulizer was added over a year ago. Saw dr last week and was told would have to go on oxygen-which was delivered yesterday.I do not understand all that goes with using oxygen. I have a concentrater(?) for the house and was given several  of two different sizes canasters. Was told the smallest will last approx two hrs, the bigger about three. Talked to a lady in a store today. She told me if I do not use the oxygen as dr prescribed it could cause me to have heart attack or stroke. Now if dr said 24/7 & I don't do i all the time-can it cause heart attack/stroke? Sorry this was so long. Thanks to everyone for welcome/advice. Ruby

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A. Not having enough O2 is hard on all of your organs including heart, kidneys etc.  Not to mention your brain :>)  Two studies done in the late 1970s showed that using supplemental O2 only at night significantly increased survival over not at all, and that using it 24 hours was a big improvement over only at night.  These were called the British MRC study and the US Nocturnal Oxygen Therapy Trial (NOTT).  Basically, they found that you had about a 50% chance of survival 2 years into the study with no O2, and 80% chance with O2 all the time.  The O2 systems they had to work with were much heavier and bulkier than what we have today, so the possibilities are better that you can actually use it. Peter B

Oxygen and Medicare

Q. My oxygen co said insurance [Medicare] wouldn't cover both types [of oxygen]. What do other people do? Love Sandy

[Comment] When your oxygen supplier says Medicare won't pay for more than one type of oxygen what they are really saying is that their company will not provide more than one type of oxygen for what Medicare is paying. Medicare pays a
flat fee for oxygen with an additional amount if you prescription is for higher flow rates (I think it is above 4 l/m but I'm not sure) and a separate payment if you have an order for portable oxygen. Medicare does not restrict what type or how much oxygen the provider gives you, Medicare's only real concerns are that: 1. you are getting what the supplier says you are getting 2. that you are happy with the supplier. It might seem funny to see me say that Medicare actually cares if you are happy with your supplier
but it is true. If you doubt it, the next time you have a problem with your supplier tell them you are thinking of complaining to Medicare and watch them jump. When I worked in home care, the owner and president of the company was (and is) a man of great compassion and kindness and we often provided customers with special needs with equipment and supplies which cost
the company more than we were paid for providing the service. I feel confident that we were not the only ones in the country doing that. I won't say the company's name as that would seem like advertising, but the man's name is Manny Likou RRT (US & Canada) and I always like to see him recognized as the great patient advocate that he is. He always puts the patient's needs first. We would have a much better health care system in this country if everyone did that. John A. Richter RRT

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A. John has identified the type of HME that we wish exemplified all.  While this one company is certainly a standout, there are many (the majority, I believe) that will give the patient what they need, if they ask for it. Unfortunately, there are a few companies that don't have that compassion, and set a perception of all being greedy.  Even the national companies will generally help you maintain your lifestyle as best they can, but not always automatically, it may take a few phone calls. Peter B.

Liquid vs Gas for Portable Oxygen

Q. Thanks, Barbara. Do you like the liquid better than the M6? What kind of portable are you using? My suppliers haven't had any luck finding a 550 and the 1000's are so heavy. How long did the M6 last you? Pat/MO

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A. Pat, In theory, any single lumen cannula OCD should work with TTO, but theory is only that.  Unfortunately, there is no published data on this.  The people at Transtracheal have experience, and I would ask them.

Possibilities working with cylinders include:
Chad Oxymatic series
DeVilbiss PD1000, PD4000
AirSep Impulse Elite

With liquid, the Escort and Spirit should work well.  I know the Spirit is in use by TTO patients with good results.  Don't know about Escort for sure.

Experience shows that TTO is itself a good conserver of oxygen.  Most patients seem to need about half the continuous flow rate, because your airway acts as a nice reservoir, storing up oxygen late in exhalation.  But, a good conserver such as those listed above should do a bit better.  For instance (completely hypothetical here), an M6 tank on 3 lpm continuous flow will last about 1 hour.  With TTO, you may be able to use 1.5 lpm, and it would last you 2 hours.  With an OCD, you may need about 40 mL/breath, and at 20 breaths per minute, the cylinder would last 3 hours.

If you can't find a 550, you might ask for a Caire Sprint.  Same size, (continuous flow only) about 4 hours at 2 lpm continuous, 6 lbs.  Works nicely for TTO patients on lower flows. Peter B

Instructions on Oxygen Use

Q. I wonder why this information isn't routinely provided to new users. I saw several things I've been doing or not doing that I need to change. "Life is not measured by the breaths we take but by the moments that take our breath away." Karen Beeson, Seattle, WA

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A. I found this instruction book for PB products on the internet. http://www.wright-filippis.com/pdfs/liquid_oxy.pdf pb

Oxygen Use While Golfing

Q. I am getting my first delivery of liquid O2 this AM. I currently don't need it expect for exercising, I also want to carry the Companion 550 with me when I go golfing. Do any of the EFFORTS members use O2 on the golf course? I would really appreciate any info you could share, especially about special "backpack" type holders or sacks or whatever that have been found to be helpful. Thanks, Otto Becker - NC

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A. I would recommend a backpack from Airlift. They are designed for O2 systems, so they are well vented. Especially liquid O2 needs some airflow to work properly. Cylinder systems aren't as critical. www.airlift.com Peter B

Comparing HELiOS, Escort and Spirit

Q. Can anyone tell me what is the difference between the Helios, Spirit and Escort? Is there a place on the internet that you can get info on each?.....Esther/Wi Chapter Leader

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A. All are about the same size, holding 300 liters of gas. Set at the same level of oxygenation (not same number setting) they  will > last about the same time.  Helios is a bit lighter than the other two, 4 lbs with belt pack vs  about  4.5. Helios uses dual lumen cannula and no batteries, Spirit and Escort use batteries, and single lumen cannula. Spirit batteries will last much longer than Escort.  Spirit and Escort will give you much more O2 (twice as much at the highest setting) if you need it. Spirit and Escort have 2 lpm continuous flow backup setting.  http://www.heliosoxygen.comhttp://www.cairemedical.com  http://www.respiratorygroup.com/products/liquid_o2/port_units.htm  Peter B

Pulse Portable with TTO?

Q. Another question...with TTO, a pulse portable won't work so what do you >use? Sure wouldn't want to go back to those big, ole tanks. Pat/MO

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A. Pat, There are several smaller portable options with TTO. First, with TTO, your O2 flow needs are usually quite a bit lower, so it is like a conserving device.  Caire makes the Sprint, which is about 6 lbs full, and holds about 500 liters (4 hrs at 2 lpm, 8hrs at 1).  Any of the smaller (M6, M9) cylinders might work ok also.

Pulse type (single lumen) conservers should also work.  The only one I've tested with TTO is Spirit, but others (Escort, DeVilbiss, Chad) may work. Dual lumen (Helios, CR-50 etc) won't work. Peter B

Airsep Portable Concentrator

Q. Mom has a converter that changes the air into pure oxygen so she doesn't have to use the oxygen tanks at home (which she is terrified of falling over and exploding -- one of those fears she has).  She saw an ad somewhere about a portable conserver that uses batteries  and can be worn on the back or attached to the wheelchair. She is driving me crazy to find out about it and I thought what better place  than right here on EFFORTS. So, if anyone knows anything about this please email me as soon as possible. Thanks Shawn

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A. Shawn, I think you might be looking for the portable concentrator?? There is one offered by AirSep. It's called LifeStyle. It costs about $2750 (from one website I saw, list price is $4995). The battery lasts 50 minutes, but you can plug it in to a car, or anywhere you can find AC power. The settings go up to '5', but this isn't 5 liters per minute. Figure it's good for 2-2.5, because the dose is quite small. Weighs about 10 lbs. https://www.airsep.net/Products_Online/Concentrators/MK172_1_Brochure.pdf http://www.noahsarkhomecare.com/poroxcon.html http://www.shopmash.com/mash_featured_1.htm Hope this helps. pb

Chad 401

Q. Peter, Do you have any idea how much O2 the Chad 401 puts out at a setting of 5 or 6? Al, Ft.Lauderdale

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A. 50 mL per breath on 5 and 60 mL on 6.

Are You Limited to Continuous Flow with TTO?

Q. Peter, happen to read your post and was surprised that you say a person isn't limited to continuous oxygen flow with the Transtracheal. Am I missing something? I talked to my oxygen supplier and pulm doctor and they say as far as they know nothing new has came out and I must stay on continuous. Do you have the TTO? If so are you using pulse flow? Interesting. Louise, Idaho

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A. There is nothing that precludes using TTO with a pulsed conserver. Each model may respond a bit differently, because the breathing 'signal' it gets is much stronger than from a cannula. Several clinical studies have been done over the years with TTO and different pulse type systems. As Tom mentioned, TTO itself is a conserving system, the continuous flows you need are usually lower (about half). This means that the relative gain you get with a pulse conserving device is less than with a cannula. Say your needs with a cannula and continuous flow are 3 lpm when you're walking. You want to use M6 (B) cylinders which are light (maybe 5-6 lbs with everything) Continuous flow +Cannula@ 3 lpm = <1 hour If you use a conserving device, you will extend that to approx 3 hours. If you use TTO, your flow rate might drop to 1.5, so the cylinder would last around 2 hours. If you use TTO AND the conserving device, you still get about 3 hours. As for the comfort or lack thereof from having the burst of O2 hit your trachea, that's going to be a very personal thing. Might bother some and not others. Should be easy to try, as most O2 suppliers have some conserving devices in service. Ask to try one out. Make sure your sats are monitored to get the best settings during different activity levels. Peter B. PS - Louise, no, I'm not on TTO. I'm an engineer that works with O2 systems.

PiKos

Q. I can not understand how this unit can be accurate. Strick guide lines are adhered to that control the parameters effecting normal PFT's. These controls won't exist in the general population. I think the results may lead some individual down a Primrose path, or just the opposite. Just my opinion, Frank J. - NY

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A. Frank, You've struck on a big debate in the clinical community. Regardless of how accurate the equipment is, many feel that PFT done outside a lab is dangerous. Even in a physician's office. On the other hand, many studies have shown that peak flow only is not a good indicator for COPD, and FEV1 is much better. Therefore, replacing the old peak flowmeters with a home FEV1 indicator would be beneficial. There's no end in sight to this debate, but just remember that the numbers you get may not be absolutely correct. They probably provide a good trend though, as whatever technique used in the home is likely to be consistent. But for 'real' diagnostic value, a PFT lab is still the best bet. Peter B

Does Medicare Pay for LOX?

Q. I'm not sure that Medicare pays for liquid. Does anyone know that? Darcy

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A. Medicare pays for oxygen the same, regardless of the type. That is to say, YES they pay for liquid. Some suppliers will tell you they "don't pay for liquid", meaning, they don't pay any extra for liquid (like they did in the good old days before 1986). Many suppliers judge who gets liquid based on the amount you use your portable oxygen. If you only go out once a week, then cylinders are economical. If you're going every day, then they will provide liquid, because the cost of cylinders would be too high. Peter B

"Weaning" from Oxygen?

Q. Until last June my wife was on o2 only at nite. She ended up in hospital after an exacerbation, pneumonia, etc.,for about 8 days. Drs. ordered 24/7 o2. Now ,with help of oximeter, we are trying to wean her off of daytime oxygen. Her nos. seem good to me. Low 90's-up to 95 most times. Is this practice okay, or harmful?? As usual Pul. Dr. is no help, he doesn't even think we need oximeter of our own. Thanks for responses.... Larry FL

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A. Larry, My opinion is that if you can keep her saturation over 90%, it's ok but... If she's restricting her activity to do so, it's not. Oxygen should enable her to feel good AND do the things she wants to do. Peter Bliss

Affect of Altitude on Oxygen in the Air

Q. At an increase in Altitude above sea level, air becomes less dense, at increase in temperature, air becomes less dense. this equals Density Altitude.. Does the Oxygen content vary in proportion to the Density Altitude? We have pretty much, very unscientifically, proven to ourselves that it does increase with a surface altitude nearer sea level. We live at an altitude of 6500 ASEL (above sea level). Wife is on O2 when >exercising ie, moving and at nite sleeping @ 2L,3 when doing exercise. On a trip to Phoenix..Altitude 1122 ft ASEL. She found she could walk and not de saturate below 90%.(using Nonin oximeter). Then we went to an Altitude of 4800ft ASEL and when she walked it would go to 88% indicating the need for supplemental O2. Now somewhere, I thought I was told that if we moved to a lower altitude like PHX at around 1000ft ASEL.That she would soon become acclimated to the lower altitude and have to use the O2 the same as here. That doesn't seem right.Is this how it works? Some of the above statements I have stated as facts. They are only as I believe them to be.And I may be entirely wrong. Engines develop more HP at Lower elevations due to the increase in air density. Would our bodies not also? Thanks for any info helping me better understand the questions. Fuzz

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A. Fuzz, You pretty much have it right. Although there is still 21% oxygen in the air up there or down here, the total air (say, pounds per cubic foot) is less up there, hence less total oxygen. Much of the early research in respiratory disease came out of Denver, simply because the effects show up sooner. Moving to lower elevation has the same effect of always having a bit of supplemental O2 on. The disease state may still progress, but the advantage of the higher density will remain. Peter Bliss

Escorts and Spirits Flow Rate

Q. I would be interested in any info on the Spirit or the Escort. I've been trying to get a Companion 550 and have been having some problems. If for some reason, I can't get one, I wonder about those others. Pat

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A. Both Escort and Spirit allow for a 2 lpm fixed continuous flow. Really meant as a backup for dead batteries. Units will last about 2.5 hours at 2  lpm.  If continuous flow is required, the (out of production) Purtian Bennett 550 or Pulsair 0.5 liter units are good alternatives, if you can find them.  Each allows for conserving or continuous flow. Peter Bliss

Escort Question

Q. My Escort has a switch for either pulse or continuous. Weighs 4.6 lbs filled. Has never frozen. The Penox base tank is refilled once a month. 1) On 2l pulse, with 2/3 ten-minute switches to 3l, it lasts 10/11 hrs. 2) When I start with pulse, go to a meeting & switch to continuous for an hour before going >back to pulse, the fill lasts about 7-1/2 hrs. 3) Escort can also be fed directly from base but I prefer new Invacare concentrator for home. 25% as noisy as old concentrator. Caution -- Have discovered I sometimes don't inhale hard enough to activate the pulse mechanism while quietly working in my office, which may make my O2 last longer. -- so check out my times against your own levels of activity. I definitely am not jogging around Manhattan all day!

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A. Andi, Either you breath really slow, or somethings wrong with that Escort. At 20 breaths/min, it shouldn't last longer than 8 hours. And at 2 lpm continuous, it should only go 2.5, so if you switch to that for an hour, that burns up 40% of it... Of course, as long as your saturation stays up, it doesn't matter. Do you use and oximeter? Peter Bliss

Chad System

Q. Would appreciate info on chad system. I use the helios along with a concentrator. I will be going on a10 day cruise, I feel that the Chad system would be better on the cruise. Most cruise cabins are on the small size. With Chad I would only need the concentrator. The reservoir for the Helios is quite large. Thanks

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A. I assume you refer to the Total O2 system? This is a concentrator that also fills cylinders. It fills an M6 (5-6 lb system) in about 6 hours. Uses any of Chad's oxygen conserving devices, both pneumatic or electronic. Company web info : http://www.chadtherapeutics.com/totalo2.htm Peter Bliss

Do You Use a Humidifier With LOX?

Q. Well, I finally got switched over to a different O2 supplier today. Now I have a question for you guys. I was using a concentrator while at home and my Helios when going out. Now with this company, I am on LOX full time. I am using the big reservoir at home and the Helios when going out. The guy that brought it out said that most people that use LOX do not use humidifiers. Do any of you that are on liquid full time use a humidifier. Is there one even available? Thanks, Pat/MO

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A. Pat, The oxygen coming out is just as dry either way. Many people on lower flows don't use a humidifier, because it doesn't significantly increase the overall humidity going into your nose. Depends on how dry your house is and how sensitive your nose is. Peter Bliss

Trans Tracheal Oxygen

Q. I have seen a couple of you refer to using the TTO and would like to hear of any disadvantages you've experienced. I am seriously considering it for a number of reasons: mouth breathing at night, constant (it seems) nasal congestion, and trouble keeping my sats up if doing anything other than sitting or reclining (even at 4-5). In addition, I'm still working and it's difficult to attend meetings with the irritating puff-puff-puff of my on-demand portable or to give training classes with tubing hanging off my > face. My pulmo says I may be close to requiring the TTO instead of conventional delivery anyway. So if you have any encouragement or discouragement, please let me know what > your experience has been like. Also, I can't seem to get an answer to the > question of whether or not it works with the on-demand or impluse systems versus continuous flow. Thanks! Barbara CO

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A. Joyce, Two things. 1. You are not limited to continuous flow oxygen. Many single lumen cannula conservers will work fine with TTO. Dual lumen models like Helios and CR-50 will not, however. 2. TTO is in itself an oxygen conserving device, because much of the gas that would otherwise be wasted when you exhale is pooled in your trachea, so you get it back when you inhale. This means that a lower continuous flow often works (maybe half what you used with a cannula). Peter Bliss

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How Long Will a LOX Reservoir Last

Q. It was my understanding that liquid oxygen is made to be used continuously. If not, it simply evaporates. I know the Helios system says to use it 24/7, hooking the portable up to the tank at night. At 2 liters, they say the supplier may only have to come every 8 weeks. Is that possible? Ethel

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A. Ethyl, 8 weeks is possible, but not very realistic. It depends on how the oxygen is used. They way Helios was originally intended to be used was for you to use the portable 24/7, hooking it up with the 'umbilical cord' when you were home. Then none of the evaporation gets away, because you breath it. Even at that, 6 weeks is more realistic. In reality, most people need continuous flow at night, so they use more O2. Doing this, maybe 3-4 weeks is realistic. Also, many patients get a concentrator to use when they're home, and only use the liquid for going out. Then the tank can last quite a bit longer, but you have the noise and electricity of the concentrator. Nice for the supplier though$$. Peter Bliss

Using the HELiOS with a BI-PAP

Q. I was just told by my supplier that I can't use the Helios with a Bi-Pap. Also, they only supply one portable with the Helios so I couldn't go very far away from the central supply. In other words, I would have less time than on an Oxylite. I'm more confused than ever. Ethel

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A. Ethel, Tell your supplier YOU CAN USE HELIOS WITH THE BIPAP. Sort of. Can't use the portable with conserving feature, but it can be connected to the base tank. Don't let them snow you. Same applies to all liquid systems. Also, I don't think you would get less time on a liquid portable than on the Oxylite, unless with the Oxylite you were carrying multiple cylinders. The Helios/Spirit/Escorts hold about the same O2 as a M9 or C cylinder. But you're right. You have to get back to the base unit within that 5-8 hours. Peter Bliss

Portable Concentrator

Q. Will anyone with knowledge of the new Airsep oxygen concentrator ( Lifestyle) please contact me directly. I believe that someone on the list wrote in that he had ordered one. Thank you! Joan (NJ)

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A. Just a note on this product... Although it is labeled up to '5 lpm', it is only in the pulse mode, and the largest pulse is 44 mL. Also, it will not be at 100% oxygen, probably 88-92%. That's not bad, but it will probably have a top end similar to or a little better than Helios, or 2-3 lpm continuous flow, or '3' on a DeVilbiss type conserver. Peter B.

Normal Saturation Level???

Q. My oximeter arrived this week and I've been having fun playing around with it. (Yes, I'm easily entertained!) Unfortunately the numbers are not good. The only way I can (sometimes) maintain 96 without oxygen is by sitting quietly or walking in the kind of sedate manner to which I am totally unaccustomed. I'm too ashamed to reveal the readings I get while shoveling manure or raking leaves but am hoping the chilly weather accounted for some of the low numbers. Clearly I need some kind of wearable oxygen if I am to maintain any semblance of my active life. That would seem to eliminate compressed oxygen since it is bulky and requires toting, pushing, or pulling if you need something to last longer than a quick trip down to the mailbox or out to the field and back. I understand they are working on a mini-concentrator you could backpack, but that's not on the market yet. To date, the Helios and Penox Escort have been recommended on this site. At the moment I'm leaning towards the Helios since it is designed to be wearable whereas the Escort would require me to rig my own backpack or fannypack system. Whatever I get has to allow me to move freely. I'd like to hear from > members who are active and have figured out some way of securing a system to their body so they have complete freedom of movement. What oxygen system do you use, why do you like it and what are the drawbacks?

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A. Elaine, I'm not a clinician, but for most patients, 96 is higher than is reasonable to expect. The general rule of thumb is 'over 90 is OK'. To qualify for O2, you have to go below 88. The cylinder options you mentioned don't have to be real heavy and bulky. There are 'M6' or 'B' cylinders that weigh around 5 lbs and will last you 2-4 hours depending on your usage. Also, the Caire Spirit is small and light like Helios, there is a belt option available and the O2 delivery goes much higher than Helios. The Escort has the higher delivery capability, but I don't know of any options for carrying it. Some good backpacks are available at www.airlift.com that are designed just for O2 products. Peter Bliss

Using Conservers

Q. I always have on hand 8 to12 M6 cylinders which I use when I'm waking a distance the rest of the time use C's. What I wanted say is that the length of time a person will get out of a M6 depends on the conservers savings ratio. The conserver I use is a DeVilbiss EX2005 and has a 3:1 savings ratio at 2L I get 3-1/2 hrs out of an M6, when I'm walking a distance I run it at 2-1/5L to 3L and get 2-1/5 to 2-3/4 hrs out of the M6 cylinders. There are other conservers out there that will give 4:1 & 5:1 savings ratios. Right now my supplier has me trying out a DeVilbiss PD4000 conserver with a 4:1 not much difference I just run the liters 1/2L to1L higher and get the required amount of O2. Hoping this finds you getting your strength back and feeling better. Syd - Ont

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A. Syd, You've found the magic spell for using conservers. Turn the knob till you get enough oxygen. The PD4000 is exactly the same as the EX2005, except it gives a bit less O2. That way, they can advertise 4:1 savings instead of 3:1. It's all BS. Your turn up of 1/2 is a close approximation in the middle of the range to correct for their 'specsmanship'. Good job.

Using Oxygen While Sleeping

Q. Of those of you that are using O2, do you keep your O2 at the same rate or lower or higher when going to bed. Of course, my doctor says what most doctors say.......2 lpm, 3 for exercise. Pat

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A. In our survey of patients that many of you particpated in, the vast majority used the same flow rate for 'rest' and sleeping. 80% had a higher value at least some of the time for exercise. During the Nocturnal Oxygen Therapy Trial, which is the foundation for why we prescribe O2, they arbitrarily used 1 lpm higher flow during sleep and exercise. When sleeping, some desaturate because of shallow breathing. Peter Bliss

Having Trouble with Portable

Q. I'm not even sure why I'm writing but am shaking, pulse is racing, just need to vent I guess. I've used the Victor portable for about 2 years and like it fine. The last few times I've gone out I noticed I was using more O2 than usual. Last night, I realized that even though the unit was set for "conserve", I was getting "continuous" O2. Called the supplier today. Told them what the problem was and they sent a driver out. The man didn't seem to know anything about the unit and didn't understand what I was telling him. He ended up turning the O2 to the Off direction so hard that (I believe) he stripped the O2 tank so you couldn't turn it off at all. It turned off fine when he got here, it was the conserve/continuous function that was the problem. His answer to this was to loosen the unit so that O2 was whooshing up all over the place (almost a full bottle) and I finally told him to tighten it back up or it was gonna take off. He finally called the company and they told him to give me a new bottle and unit and take the whole thing back with him. He told them that the >problem with the unit was that you couldn't turn off the O2 (not true until he "fixed" it). He brought me a new unit and insisted on putting it on the bottle for me. The new unit doesn't make the crisp sound I'm used to, can hardly hear it, and I'm not sure it's OK but, at that point, I just wanted him out of the house. I'm going out tomorrow and will try the new unit out then. I have an E tank back-up in the car. Maybe it's the E anxiety thing but I feel like I'm gonna pop. Jackie - CA

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A. Jackie, One possibility. The Victor device sometimes reverts to continuous flow if you are 'pursed lip breathing'. This is because it really needs your exhalation pressure in the cannula to shut it off. If you practice PLB, a PB CR-50 is a better alternative. If you have an oximeter, that is the true way to know if you're getting enough oxygen. If you don't, and are concerned that the new unit isn't giving as much O2 as the old one, perhaps your supplier will check you with their oximeter.

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