Pulse Dose Oxygen Delivery
Long-Term Oxygen Therapy
Portable oxygen concentrators (POCs) are devices developed in response to demand for a lightweight, portable source of supplemental oxygen.[1] Pulse dose delivery allows concentrators to deliver medical grade oxygen all day, every day while remaining convenient to carry.
Is Pulse Dose a More Efficient Form of Oxygen Delivery?
To understand the mechanics of pulse dose therapy, knowing the meaning of a few key terms is helpful.
- An oxygen bolus is a single puff of air. The cycling phase is the moment between inhaling and exhaling.
- Pulse dose flow oxygen therapy provides earlier delivery of the oxygen bolus into the inspiratory cycle, for more efficient oxygen delivery.[2]
- An oxygen bolus delivered late in inspiration may be less effective in improving blood oxygen levels, as portions of the bolus may fall into the anatomical dead space.[3]
Pulse Dose Oxygen Delivery
Pulse dose mechanisms utilize an oxygen conserver and other technology to deliver oxygen to the patient based on breathing rate and other factors. The sensor determines when the patient begins inhaling and delivers the oxygen pulse/bolus at that moment, which is most productive[2], meaning the patient gets the oxygen they need, when they need it.
Pulse dosing is more akin to drinking water from a glass with a straw instead of a fountain. The intake will be based purely on the amount and intensity of sips. The bolus of pulse dose oxygen is measured in milliliters per breath, rather than liters per minute.[3]
Continuous Oxygen Flow Delivery
The traditional home oxygen therapy is low-flow oxygen, comprising a continuous oxygen flow delivered from a stationary oxygen tank via nasal cannula.[4] Continuous flow (CF) delivers oxygen at a constant adjustable rate, regardless of the user’s breathing, measured in liters per minute.[5]
This method of delivery is simple but inherently inefficient. The oxygen delivered throughout expiration is wasted, with the exception of any oxygen which may ‘pool’ for subsequent inhalation, and may still be potentially wasted. Also wasted is the oxygen flow during late inhalation, which reaches only the conduit airways rather than gas-exchanging lung units.[4]
Think of it like a water fountain: If an individual stands in front of a water fountain flowing at 1 liter per minute, they don’t actually drink one full liter of water in a minute. The amount of water a person drinks is determined by the number of sips and the size of the sip. The rest of the water is not consumed. The same applies to continuous flow oxygen; the net amount of oxygen inhaled is a combination of the flow rate, the number of breaths and the size of the breaths.
If instead, the oxygen is delivered only intermittently, at those times productive for gas exchange, oxygen is conserved[4], and patients get the oxygen they need, when they need it.
The sensor determines when the patient begins inhaling and delivers the oxygen pulse/bolus at that moment, which is most productive[2], meaning the patient gets the oxygen they need, when they need it.
Pulse dose flow oxygen therapy provides earlier delivery of the oxygen bolus into the inspiratory cycle, providing more efficient oxygen delivery.
Inogen’s Intelligent
Delivery Technology
Inogen® POCs feature proprietary Intelligent Delivery Technology, a reliable pulse-dose based algorithm designed to minimize missed breaths. Inogen’s Intelligent Delivery Technology is designed to deliver oxygen effectively and efficiently whether you are sleeping, at rest, or exerting yourself. With patented conserver technology, an Inogen® portable oxygen concentrator ensures oxygen is delivered within the first 250 milliseconds of inspiration, where oxygen has the most effect on lung gas exchange.
Portability of Pulse Dose Oxygen
Pulse dose oxygen can be delivered using a lightweight, battery powered oxygen concentrator which delivers an oxygen pulse only when an inhalation is detected. These portable devices provide a mobile oxygen source resulting in up to 12 hours of continuous use, depending on the model.[5]
Conclusion
Oxygen use has extended from inpatient to outpatient settings for patients with chronic pulmonary diseases and complications of hypoxemia. Pulse delivery of oxygen, such as that delivered by POCs, can provide prescribed oxygen needs in lightweight systems. Additionally, Inogen® oxygen concentrators may offer the patient one single solution[6] for long term oxygen therapy.
References
- McCoy R. Oxygen-conserving techniques and devices. Respir Care. 2000 Jan:45(1):95-103; discussion 104, PMID: 10771785.
- Tiep BL, Lewis MI. Oxygen conservation and oxygen-conserving devices in chronic lung disease. A review. Chest. 1987 Aug;92(2):263-72. doi: 10.1378/chest.92.2.263. PMID:3608597.
- Questions about Portable Oxygen Concentrators COPD Foundation
This article was reviewed by Senior Director of Community Engagement and COPD360social Community Manager, Bill Clark, as well as certified staff Respiratory Therapists on January 23, 2020. Page accessed Jan 31,
2024. https://www.copdfoundation.org/COPD360social/Community/COPD-Digest/Article/232/Questions-about-Portable-Oxygen-Concentrators.aspx. - Martin DC. Contemporary portable oxygen concentrators and diverse breathing behaviours — a bench comparison. BMC Pulm Med. 2019 Nov
19;19(1):217. doi: 10.1186/s12890-019-0980-x. PMID: 31744499; PMCID: PMC6862795. - Hardavella G, Karampinis I, Frille A, Sreter K, Rousalova I. Oxygen devices and delivery systems. Breathe (Sheff). 2019 Sep;15(3):e108-e116. doi:
10.1183/20734735.0204-2019. PMID: 31777573; PMCID: PMC6876135. - Single solution encompasses both portable and stationary oxygen concentrators provided together
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Inogen® Portable Oxygen Concentrators
USES: Inogen® Portable Oxygen Concentrators provide a high concentration of supplemental oxygen to patients requiring respiratory therapy on a prescriptive basis. It may be used in home, institution, vehicle and various mobile environments.
DO NOT USE IF: This device is not intended to be used in any way other than described in the indications for use. Do not use in parallel or series with other oxygen concentrators or oxygen therapy devices. This device is to be used as an oxygen supplement and is not intended to be life sustaining or life supporting. ONLY use this product if the patient is capable of spontaneous breath, able to inhale and exhale without the use of a machine. The conserving, or pulse dose, oxygen delivery technique used by this device is contraindicated in persons whose breathing during normal resting would be unable to trigger the device. Proper device triggering, set up and operation must be confirmed by an experienced clinician or other respiratory professional. Not for use by tracheotomized patients. Use of this device has not been studied in pediatric populations. Consult your physician before using the product for pediatric patients.
WARNINGS: The device produces enriched oxygen gas, which accelerates combustion. Do not allow smoking or open flames within 2m (6.56ft) of this device while in use. If you feel ill or uncomfortable, or if the concentrator does not signal an oxygen pulse and you are unable to hear and/or feel the oxygen pulse, consult your equipment provider and/or your physician immediately. If you are unable to communicate discomfort, you may require additional monitoring and or a distributed alarm system to convey the information about the discomfort and or the medical urgency to your responsible caregiver to avoid harm. Use only spare parts recommended by the manufacturer to ensure proper function and to avoid the risk of fire and burns. To avoid danger of choking or strangulation hazard, keep cords away from children and pets.
TALK TO YOUR HEALTH CARE PROVIDER: The oxygen flow setting must be determined and recorded for each patient individually by the prescriber, including the configuration of the device, its parts and the accessories. It is the responsibility of the patient to periodically reassess the setting(s) of the therapy for effectiveness. The proper placement and positioning of the prongs of the nasal cannula in the nose is critical for oxygen to be delivered.
Inogen At Home® Stationary Oxygen Concentrator
USES: The Inogen At Home® Oxygen Concentrator is used on a prescriptive basis by patients requiring supplemental oxygen. It supplies a high concentration of oxygen and is used with a nasal cannula to channel oxygen from the concentrator to the patient. The Inogen At Home® Oxygen Concentrator may be used in a home or institution.
DO NOT USE IF: This device is not intended to be used in any way other than described in the indications for use. This device is to be used as an oxygen supplement and is not intended to be life sustaining or life supporting. ONLY use this product if the patient is capable of spontaneous breath, able to inhale and exhale without the use of a machine. Not for pediatric use. Not for use by tracheotomized patients.
WARNINGS: The device produces enriched oxygen gas, which accelerates combustion. Do not use the device when smoking or near open flame, matches, petroleum, oil, grease, solvents, radiant heaters, aerosols, etc. If you feel ill or uncomfortable, consult your equipment provider and/or your physician immediately. If you are unable to communicate discomfort, you may require additional monitoring and or a distributed alarm system to convey the information about the discomfort and or the medical urgency to your responsible caregiver to avoid harm. Use only spare parts recommended by the manufacturer to ensure proper function and to avoid the risk of fire and burns. To avoid danger of choking or strangulation hazard, keep cords away from children and pets.
TALK TO YOUR HEALTH CARE PROVIDER: The oxygen flow setting must be determined and recorded for each patient individually by the prescriber, including the configuration of the device, its parts and the accessories. It is the responsibility of the patient to periodically reassess the setting(s) of the therapy for effectiveness. The proper placement and positioning of the prongs of the nasal cannula in the nose is critical for oxygen to be delivered.
Rove 4, Rove 6, G3, G4, G5, Inogen, Inogen At Home, and Inogen One are trademarks of Inogen, Inc. The usage of any Inogen, Inc. trademarks is strictly forbidden without the prior consent of Inogen, Inc. All other trademarks are trademarks of their respective owners or holders.
The Inogen® portable oxygen concentrators are available by prescription only. For safe and proper use of the Inogen® devices, please refer to https://www.inogen.com/support/inogen-manuals/
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