The demand for portable oxygen is on the rise, at least according to researchers at Frost & Sullivan. Over the next 7 years, they expect portable oxygen use to increase by 15%, and as portable oxygen demand goes up, so does the demand for oxygen-conserving devices. Frost & Sullivan researchers expect that in the same time period there will be a 20% increase in devices using oxygen-conserving equipment.

Given these figures, it is unsurprising that oxygen-conserving device manufacturers are introducing an ever-increasing number of new product features designed to attract sales by making their conservers safer, easier to use, and more comfortable for oxygen patients. As a result, oxygen and respiratory equipment providers and their customers can now choose from a dizzying array of conserving devices.

However, while innovation is usually good, the number of products and product features can make selecting which oxygen-conserving devices to carry more complicated. Few respiratory equipment providers find carrying every oxygen conserver on the market practical, and most prefer modalities from only a few manufacturers since it is easier to build strong relationships with just a handful of suppliers. Consequently, the oxygen- conserver product selection process is very important.

“Over the years, we’ve used five different types of cylinder oxygen-conserving devices from five different manufacturers, but one is used a lot more than the others,” says Jim Frederick, RRT, corporate compliance officer of Young Medical in Toledo, Ohio. “Performance, reliability, and ease of use are what we look for in purchasing these devices.”

Luis Velasquez, clinical manager of DependiCare Home Health in Broadview, Ill, stresses that despite all the different oxygen-conserving devices on the marketplace, the best ones are those that customers feel comfortable operating. “My challenge is to match patients with the right systems so they can easily exchange the cylinders or refill the portable units without any trouble,” he says.

Since senior citizens are the predominant users of oxygen conservers, suppliers like Velasquez look for conservers that do not have too many features, which can be overwhelming to elderly customers.

The Selection Problem
Comparing one conserving device to another is easier said than done, says Bob McCoy, managing director of Valley Inspired Products, a respiratory device consulting firm in Apple Valley, Minn, and author of a 2003 comparative guide to oxygen-conserving devices. The problem, McCoy says, is that manufacturers often differ in how they measure important values, like the volume of oxygen delivered at a particular setting. While two different devices both may have a volume setting of 2, that does not mean that they both deliver the same amount of oxygen at the 2 setting, he says.

In addition, individual patients may respond differently on the same oxygen-conserving device. They should therefore have their blood-oxygen level tested on their oxygen system at different activity levels reflecting real-life conditions, McCoy adds.

How the conserver delivers the oxygen is another important consideration. There are three basic varieties of conserving devices: pulse, demand, and a hybrid of pulse and demand. Pulse devices deliver fixed volumes for each flow setting each time the patient’s inhalation triggers a pulse. They do not deliver any more or less volume as the length of the patient’s inspiration time varies. All electronic conservers are of the pulse variety. Demand devices, in contrast, vary the amount of oxygen delivered on each breath consistent with the length of time the patient inhales. The combination-type devices feature characteristics of both pulse and demand flow.

“These combination devices seem to be used more frequently, mainly because of their affordability and the fact that they can be utilized by most patients fairly easily,” Frederick says.

In addition, oxygen-conserving devices can be either pneumatic (gas powered) or electronic (battery powered). On the pneumatic conserving device, the only setting that needs to be adjusted is the flow rate knob. There is no battery to replace and no power indicators. Electronic conservers operate on a battery and use electronic circuitry to measure a dose of oxygen pulsed to the patient at the beginning of inhalation.

Outcomes Matter Most
Regardless of which conserving device is selected, Frederick points out that the most important consideration is the modality’s ability to meet the patient’s appropriate oxygen saturation level, which is measured using a pulse oximeter. In most cases, the physician leaves it up to the respiratory supplier to determine which device the patient should use.

“Even if the physician writes down a specific product on the prescription, he or she rarely cares how the intermittent oxygen works as long as saturation stays at the right level,” Frederick says. Since Young Medical frequently works with the same group of referring physicians, Frederick has set up a standing order for physicians prescribing oxygen-conserving devices.

According to Kurt Kaufman, RRT, clinical manager of Oakwood Village, Ohio-based Medical Service Corporation, to determine if a patient can even use an oxygen-conserving device, the therapist making the initial in-home visit looks for an oxygen saturation level of 90% during ambulation. If the individual can maintain that level, an oxygen-conserving device is then considered suitable.

“Few physicians dictate that they want the oxygen saturation at a certain level, even though we give them an option on the form to make this indication,” Kaufman says. “The form states that if they don’t say what the saturation should be, we will keep it at a minimum of 90%.”

Matching Patient and Device
Velasquez notes that since there are so many types of conserving devices, one of the biggest challenges is finding the perfect match for an individual patient. “When our therapists visit the patient, they not only look at saturation levels, they also look at the patient’s ambulatory needs and the patient’s ability to trigger the conserving device,” Velasquez says. “The key is finding a device that the customer feels is easy to use.”

Although DependiCare uses predominantly two different cylinder models and one liquid oxygen model, should a patient require a different device, the therapists always have different models with them when they make the home visit.

Now that conserving devices have been on the market for several years, many manufacturers have added electronic bells and whistles to enhance the products. The problem, according to Kaufman, is that additional electronic gadgetry does not always ensure a better product. “I actually prefer those devices that have fewer electronic features,” he says. “Not only do they tend to confuse patients, they also have a greater likelihood of malfunction.”

Frederick also tends to prefer less complex devices, such as pneumatic conservers without alarms and internal batteries that can run out of power.

Because oxygen-conserving devices can be confusing, patient education and follow-up is important. And some patients need more support than others. After Young Medical makes a home visit, its therapist assigns a numeric risk value to the patient, based on their health, whether they smoke, cleanliness of their house, and other safety factors. “Since a low score increases the risk to the patient’s health and affects our liability, we establish higher degrees of follow-up with them than with a person with a higher score,” Frederick says.

Carol Daus is a contributing writer for Dealer/Provider.