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0544 Pulsed Oxygen Delivery Inadequate with CPAP

Introduction Obstructive sleep apnea (OSA) affects approximately 17% of women and 34% of men in the United States and many require oxygen with CPAP. Pulsed oxygen devices are ideal for travel due to oxygen conservation, but there have been no studies looking at the efficacy of oxygen deliverability...

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Published in:	Sleep (New York, N.Y.) N.Y.), 2019-04, Vol.42 (Supplement_1), p.A217-A218
Main Authors:	Wolfe, Kathy M, Kern, Joseph, Cutrufello, Nicholas
Format:	Article
Language:	English
Subjects:	Continuous positive airway pressure Respiratory therapy Sleep apnea
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creator	Wolfe, Kathy M Kern, Joseph Cutrufello, Nicholas
description	Introduction Obstructive sleep apnea (OSA) affects approximately 17% of women and 34% of men in the United States and many require oxygen with CPAP. Pulsed oxygen devices are ideal for travel due to oxygen conservation, but there have been no studies looking at the efficacy of oxygen deliverability in the setting of CPAP use.Majority of the studies focus on oxygen device efficacy in COPD populations.One study in 1999 showed that the demand oxygen system was inferior in walking distance, oxygenation, and recovery time compared to continuous. Recent studies have shown that in pairs of nominally equivalent flow settings, pulsed flow FiO2 was consistently lower than steady flow FiO2. Methods Using a healthy control subject with no lung or cardiac disease or sleep apnea, tested pulsed oxygen via portable compressed oxygen cylinder in conjunction with varying PAP therapies, mask types, and distances of oxygen port from the oxygen cylinder and from the mask.A respiratory therapist monitored the pulsed O2 regulator for sensing and delivery of oxygen to the circuit (system/subject). Oxygen was delivered at rates of 2-5LPM, the maximum allowed via the cylinder. Results There was no measurable ability of the pulsed flow system to sense and deliver oxygen with attempted trigger via normal breathing despite increasing oxygen flow rate and despite mask type. Variations in rise time, Ti, pressure support, trigger and cycling time did not alter the ability to sense and deliver oxygen.The only modality that triggered oxygen delivery via the cylinder was the nasal mask with oxygen port closest to the mask, only in the setting of low CPAP pressure (4-6cwp) and only with intentional supranormal tidal volumes (&gt1L).Only hyperpnea or tachypnea was sufficient to trigger oxygen cylinder to deliver oxygen and despite triggering it, there was no measurable change in SpO2 in the subject. Conclusion Typical breaths with physiologic tidal volumes are inadequate to trigger oxygen delivery from the pulsed oxygen system while wearing PAP, regardless of modality and at various pressures.This is concerning for patients who require supplemental oxygen and rely on pulsed oxygen systems while traveling. Support (If Any)
doi_str_mv	10.1093/sleep/zsz067.542
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Pulsed oxygen devices are ideal for travel due to oxygen conservation, but there have been no studies looking at the efficacy of oxygen deliverability in the setting of CPAP use.Majority of the studies focus on oxygen device efficacy in COPD populations.One study in 1999 showed that the demand oxygen system was inferior in walking distance, oxygenation, and recovery time compared to continuous. Recent studies have shown that in pairs of nominally equivalent flow settings, pulsed flow FiO2 was consistently lower than steady flow FiO2. Methods Using a healthy control subject with no lung or cardiac disease or sleep apnea, tested pulsed oxygen via portable compressed oxygen cylinder in conjunction with varying PAP therapies, mask types, and distances of oxygen port from the oxygen cylinder and from the mask.A respiratory therapist monitored the pulsed O2 regulator for sensing and delivery of oxygen to the circuit (system/subject). Oxygen was delivered at rates of 2-5LPM, the maximum allowed via the cylinder. Results There was no measurable ability of the pulsed flow system to sense and deliver oxygen with attempted trigger via normal breathing despite increasing oxygen flow rate and despite mask type. Variations in rise time, Ti, pressure support, trigger and cycling time did not alter the ability to sense and deliver oxygen.The only modality that triggered oxygen delivery via the cylinder was the nasal mask with oxygen port closest to the mask, only in the setting of low CPAP pressure (4-6cwp) and only with intentional supranormal tidal volumes (&gt1L).Only hyperpnea or tachypnea was sufficient to trigger oxygen cylinder to deliver oxygen and despite triggering it, there was no measurable change in SpO2 in the subject. Conclusion Typical breaths with physiologic tidal volumes are inadequate to trigger oxygen delivery from the pulsed oxygen system while wearing PAP, regardless of modality and at various pressures.This is concerning for patients who require supplemental oxygen and rely on pulsed oxygen systems while traveling. Support (If Any)</description><identifier>ISSN: 0161-8105</identifier><identifier>EISSN: 1550-9109</identifier><identifier>DOI: 10.1093/sleep/zsz067.542</identifier><language>eng</language><publisher>Westchester: Oxford University Press</publisher><subject>Continuous positive airway pressure ; Respiratory therapy ; Sleep apnea</subject><ispartof>Sleep (New York, N.Y.), 2019-04, Vol.42 (Supplement_1), p.A217-A218</ispartof><rights>Sleep Research Society 2019. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids></links><search><creatorcontrib>Wolfe, Kathy M</creatorcontrib><creatorcontrib>Kern, Joseph</creatorcontrib><creatorcontrib>Cutrufello, Nicholas</creatorcontrib><title>0544 Pulsed Oxygen Delivery Inadequate with CPAP</title><title>Sleep (New York, N.Y.)</title><description>Introduction Obstructive sleep apnea (OSA) affects approximately 17% of women and 34% of men in the United States and many require oxygen with CPAP. Pulsed oxygen devices are ideal for travel due to oxygen conservation, but there have been no studies looking at the efficacy of oxygen deliverability in the setting of CPAP use.Majority of the studies focus on oxygen device efficacy in COPD populations.One study in 1999 showed that the demand oxygen system was inferior in walking distance, oxygenation, and recovery time compared to continuous. Recent studies have shown that in pairs of nominally equivalent flow settings, pulsed flow FiO2 was consistently lower than steady flow FiO2. Methods Using a healthy control subject with no lung or cardiac disease or sleep apnea, tested pulsed oxygen via portable compressed oxygen cylinder in conjunction with varying PAP therapies, mask types, and distances of oxygen port from the oxygen cylinder and from the mask.A respiratory therapist monitored the pulsed O2 regulator for sensing and delivery of oxygen to the circuit (system/subject). Oxygen was delivered at rates of 2-5LPM, the maximum allowed via the cylinder. Results There was no measurable ability of the pulsed flow system to sense and deliver oxygen with attempted trigger via normal breathing despite increasing oxygen flow rate and despite mask type. Variations in rise time, Ti, pressure support, trigger and cycling time did not alter the ability to sense and deliver oxygen.The only modality that triggered oxygen delivery via the cylinder was the nasal mask with oxygen port closest to the mask, only in the setting of low CPAP pressure (4-6cwp) and only with intentional supranormal tidal volumes (&gt1L).Only hyperpnea or tachypnea was sufficient to trigger oxygen cylinder to deliver oxygen and despite triggering it, there was no measurable change in SpO2 in the subject. Conclusion Typical breaths with physiologic tidal volumes are inadequate to trigger oxygen delivery from the pulsed oxygen system while wearing PAP, regardless of modality and at various pressures.This is concerning for patients who require supplemental oxygen and rely on pulsed oxygen systems while traveling. 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Pulsed oxygen devices are ideal for travel due to oxygen conservation, but there have been no studies looking at the efficacy of oxygen deliverability in the setting of CPAP use.Majority of the studies focus on oxygen device efficacy in COPD populations.One study in 1999 showed that the demand oxygen system was inferior in walking distance, oxygenation, and recovery time compared to continuous. Recent studies have shown that in pairs of nominally equivalent flow settings, pulsed flow FiO2 was consistently lower than steady flow FiO2. Methods Using a healthy control subject with no lung or cardiac disease or sleep apnea, tested pulsed oxygen via portable compressed oxygen cylinder in conjunction with varying PAP therapies, mask types, and distances of oxygen port from the oxygen cylinder and from the mask.A respiratory therapist monitored the pulsed O2 regulator for sensing and delivery of oxygen to the circuit (system/subject). Oxygen was delivered at rates of 2-5LPM, the maximum allowed via the cylinder. Results There was no measurable ability of the pulsed flow system to sense and deliver oxygen with attempted trigger via normal breathing despite increasing oxygen flow rate and despite mask type. Variations in rise time, Ti, pressure support, trigger and cycling time did not alter the ability to sense and deliver oxygen.The only modality that triggered oxygen delivery via the cylinder was the nasal mask with oxygen port closest to the mask, only in the setting of low CPAP pressure (4-6cwp) and only with intentional supranormal tidal volumes (&gt1L).Only hyperpnea or tachypnea was sufficient to trigger oxygen cylinder to deliver oxygen and despite triggering it, there was no measurable change in SpO2 in the subject. Conclusion Typical breaths with physiologic tidal volumes are inadequate to trigger oxygen delivery from the pulsed oxygen system while wearing PAP, regardless of modality and at various pressures.This is concerning for patients who require supplemental oxygen and rely on pulsed oxygen systems while traveling. Support (If Any)</abstract><cop>Westchester</cop><pub>Oxford University Press</pub><doi>10.1093/sleep/zsz067.542</doi><oa>free_for_read</oa></addata></record>
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subjects	Continuous positive airway pressure Respiratory therapy Sleep apnea
title	0544 Pulsed Oxygen Delivery Inadequate with CPAP
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