Jordan Ellis
Oxygen is a critical resource in hospitals and disaster management, with hospitals maintaining large supplies of liquid oxygen and compressed gas cylinders for reserve. It is a basic human need and an essential medicine, as recognised by the WHO, that can be the difference between life and death for patients with respiratory issues, severe pneumonia, acute respiratory distress syndrome, sepsis, and other critical conditions.
| Characteristics | Values |
|---|---|
| People need oxygen in hospitals | To treat respiratory issues |
| Oxygen is administered when | A patient is experiencing shortness of breath or acute respiratory distress syndrome |
| Oxygen therapy | Recommended at 5 litres/min |
| High-flow nasal cannula oxygen therapy | Can be considered when standard oxygen therapy is ineffective |
| Pulse oximeters | Can be used at home to monitor oxygen levels |
| Access to oxygen | Is a necessity, especially in developing countries |
| Oxygen supplies in hospitals | Need to be strategically managed, especially during disasters |
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What You'll Learn
Oxygen therapy for acute respiratory distress
Oxygen therapy is the main treatment for acute respiratory distress syndrome (ARDS). The goal of oxygen therapy is to improve oxygen levels and treat the underlying cause of the patient's condition. It is administered to maintain SpO2 above 92% and below 98%. Patients can receive oxygen therapy in a hospital or at home, and it can be delivered through tubes in the nose, a face mask, or a tube placed in the trachea.
Oxygen therapy can be given for a short or long period, depending on the patient's needs and condition. It is important to monitor oxygen levels, especially in the case of respiratory illnesses such as COVID-19, where low oxygen levels can be a critical symptom. Silent hypoxia, where patients experience extremely low blood oxygen levels without showing signs of breathlessness, can be deadly in COVID-19 patients. Therefore, monitoring oxygen levels at home with pulse oximeters can be a helpful early warning system.
In cases of severe acute respiratory distress, a ventilator may be required to restore blood oxygen levels. However, being on a ventilator carries risks such as pneumonia and pneumothorax (collapsed lung). To reduce these risks and lower the body's oxygen needs, doctors may recommend muscle relaxants or sedatives.
For patients with ARDS, the National Heart, Lung, and Blood Institute ARDS Clinical Trials Network recommends a target partial pressure of arterial oxygen (PaO2) between 55 and 80 mm Hg. A conservative-oxygenation strategy was tested in a study of over 15,000 ICU patients, showing a reduction in the median PaO2 from 87 mm Hg to 76 mm Hg and was deemed safe with respect to ICU and hospital mortality.
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Pulse oximetry as an early warning system
Oxygen is often required to treat severe cases of Covid-19, which can cause acute respiratory distress syndrome (ARDS). Covid-19 patients with "silent hypoxia" can have extremely low blood oxygen levels without displaying signs of breathlessness.
Pulse oximetry can be used as an early warning system to detect silent hypoxia in Covid-19 patients. Pulse oximetry measures the change in absorbance over the course of a cardiac cycle, determining the absorbance due to arterial blood alone, excluding venous blood, skin, bone, muscle, fat, and nail polish. The two wavelengths used in pulse oximetry measure the quantities of bound (oxygenated) and unbound (non-oxygenated) haemoglobin, and the ratio is used to compute the percentage of bound haemoglobin. This bound haemoglobin percentage indicates blood oxygen levels.
Pulse oximetry is typically performed by attaching a clip-like device called a probe to the finger or earlobe, although it can also be placed on the toe, forehead, or tongue. Portable pulse oximeters are useful for pilots, mountain climbers, and athletes who experience decreased oxygen levels at high altitudes or during exercise. During the Covid-19 pandemic, public health experts recommended that individuals with Covid-19 symptoms monitor their blood oxygen levels at home using pulse oximeters. This allowed for earlier detection of silent hypoxia, enabling individuals to seek medical attention before their condition deteriorated.
However, it is important to note that pulse oximetry may be less accurate in individuals with dark skin due to the technology's underlying assumptions about skin pigmentation. This inaccuracy can lead to potentially missing people who require treatment. Therefore, individuals with darker skin should discuss the accuracy of their pulse oximetry results with their healthcare providers and consider other factors such as increased breathing or overall worsening of symptoms.
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Silent hypoxia in COVID-19 patients
Oxygen is a crucial element for human survival. During the COVID-19 pandemic, supplemental oxygen demand surged due to the respiratory nature of the virus. Typically, patients with coronavirus experience a respiratory tract infection, and in critical cases, symptoms can include acute respiratory distress syndrome (ARDS) and shortness of breath.
However, a unique phenomenon observed in COVID-19 patients is "silent hypoxia," where individuals have extremely low blood oxygen levels but exhibit no signs of breathlessness. This condition can be life-threatening, and patients may present to the hospital with no apparent breathing difficulties despite having alarmingly low oxygen saturation levels.
Silent hypoxia, also referred to as "silent" or "apathetic" hypoxemia, is a clinical presentation caused by SARS-CoV-2. It is characterised by inconsistencies between arterial oxygen saturation levels and respiratory symptoms. Patients with silent hypoxia may have oxygen saturation levels as low as 50%, yet they appear alert and comfortable, with only slight breathlessness that does not correspond to the severity of oxygen deprivation. This delay in medical assistance can result in advanced lung damage and, in some cases, organ failure and death.
The mechanism behind silent hypoxia in COVID-19 patients is not yet fully understood. However, it is believed that the virus's impact on the blood vessels and alveoli may play a role. The blood vessels fail to constrict and redirect blood to the least damaged areas of the lungs, resulting in ineffective oxygen capture by damaged alveoli. This leads to a disparity between the hypoxia observed and the condition of the lungs, suggesting an issue with the blood vessels.
The early detection of silent hypoxia is crucial to prevent clinical deterioration. Pulse oximeters have emerged as a useful, inexpensive, and easy-to-use tool for monitoring oxygen saturation levels at home. They can detect silent hypoxemia, enabling early diagnosis and treatment, potentially saving lives.
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Oxygen supply in disaster management
Oxygen is essential for human life. A significant reduction in tissue oxygen levels can cause rapid and severe injury to multiple organs, with the brain being the most susceptible to hypoxia. Hence, oxygen is a critical resource in disaster management.
Hospitals typically have large tanks of liquid oxygen (LOX) on site, which is the most efficient system for oxygen storage and transportation. One liter of LOX provides approximately 860 liters of gaseous oxygen. However, in the event that this system is destroyed, oxygen must be supplied by other means, such as compressed gas cylinders. These cylinders are cumbersome and dangerous if mishandled, and are often in limited supply.
The management of oxygen supplies in disaster scenarios is a priority. Mass casualty events and disasters, both natural and human-generated, occur frequently and can generate numerous injured or ill victims in need of oxygen. In the United States, the Federal Emergency Management Agency (FEMA) is responsible for coordinating disaster preparedness and recovery, but it does not have a plan for the management of oxygen supplies. Similarly, the Strategic National Stockpile (SNS) supplies medications, medical supplies, and equipment to disaster areas, but it does not include oxygen.
Some states, counties, and cities offer disaster preparedness programs and have downloadable ACF application forms for patients to outline their medical needs, including the need for oxygen. In Florida, for example, patients who are receiving oxygen at home and exhaust their supply or lose electricity to power their concentrator can obtain oxygen, electricity, and medications at a facility.
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Global oxygen availability gap
Oxygen is a vital, lifesaving medicine with no substitute. It is a One Health, equity, and human rights issue. However, access to medical oxygen is plagued by challenges such as availability, quality, affordability, management, supply, human resources capacity, and safety. The COVID-19 pandemic exposed vulnerabilities in oxygen infrastructure, particularly in low- and middle-income countries (LMICs). Emergency measures were implemented, but long-term solutions are still needed.
According to the Lancet Global Health Commission on Medical Oxygen Safety, South Asia, East Asia, and the Pacific have the largest gaps in demand for medical oxygen, with coverage gaps of 78%, 74%, and 74%, respectively. The World Health Organization (WHO) report "Promising practices and lessons learned in the South-East Asia Region in accessing medical oxygen during the COVID-19 pandemic" highlights the need for sustained investments and policy commitments to ensure oxygen availability. The financial burden of increasing oxygen access is a significant obstacle, with $6.8 billion needed to bridge the global oxygen gap, $2.6 billion of which is required in South Asia alone.
Several systemic barriers hinder the availability of medical oxygen, including equipment shortages, financial constraints, and a lack of trained biomedical engineers and technicians. Only 54% of hospitals in LMICs have pulse oximeters, and 58% have access to medical oxygen, leading to delayed diagnoses, inadequate treatment, and preventable fatalities. The COVID-19 pandemic further emphasized the need for early detection of low oxygen levels, as sudden deaths were reported due to "silent hypoxia," where patients exhibited extremely low blood oxygen levels without showing signs of breathlessness.
To address the global oxygen availability gap, a multi-stakeholder approach, innovation, and sustained investment are required. Academic institutions can play a role by developing low-cost oxygen solutions tailored for LMICs, utilizing digital technologies for improved efficiency. Sustainable financing mechanisms are crucial to ensuring long-term improvements in oxygen access. Additionally, cross-border collaboration, solar-powered oxygen systems, portable oxygen concentrators, and community-based hubs can be explored to enhance oxygen availability.
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Frequently asked questions
People need oxygen in hospitals to treat respiratory issues and other medical conditions. Oxygen is a vital medicine that supports patients with lung conditions, pneumonia, sepsis, and Acute Respiratory Distress Syndrome (ARDS).
Hospitals typically have large supplies of liquid oxygen and compressed gas oxygen cylinders, providing several days of reserve. However, during emergencies with a large influx of patients, these resources can be strained. Hospitals must have comprehensive plans to address potential issues, including damaged systems, delayed deliveries, and an insufficient number of outlets for patients.
Pulse oximeters are devices that can be used at home to monitor oxygen levels. They are typically placed on the finger and provide a reading within seconds. While they can be a helpful tool, individuals should exercise caution as proper interpretation of the readings is crucial. It is important to consult with a doctor if you have concerns about your oxygen levels.
