Ventilator-Assisted Living©

Winter 2001, Vol. 15, No. 4

(continued)

More on Oxygen Use

E.A. (Tony) Oppenheimer, MD, FACP, FCCP, Pulmonary Medicine (retired), Los Angeles, California

Are there circumstances when using oxygen might be appropriate for a person with respiratory muscle weakness due to neuromuscular or musculoskeletal disease? Yes, there are several situations in which using supple-mental oxygen is warranted.

For people who are not using any type of ventilator

Oxygen might be used if the individual does not want to use any type of assisted ventilation but wishes to have symptomatic relief without improving survival; this is often called palliative care.

Supplemental oxygen is justified if the arterial carbon dioxide (CO2) is repeatedly not elevated, indicating that there is no hypoventilation, but the oxygen saturation (SaO2) is 88% or lower and the arterial oxygen (PaO2) is 55 mm Hg or less. Adjusting the added oxygen to achieve oxygen saturation of 90-95% should be on the advice of one’s physician. He or she may prescribe it only at night or whenever the oxygen saturation is 88% or lower. Sometimes the cause for this is difficult to identify, but can occur more often at higher altitudes, such as Denver or Mexico City, than at sea level because at altitude, atmospheric pressure is reduced and this decreases the availability of oxygen.

For people who are using a ventilator (noninvasively or via tracheostomy) to successfully treat hypoventilation caused by respiratory muscle weakness resulting in normal arterial CO2

Oxygen might be needed if there is also a chronic lung or heart problem such as COPD, pulmonary fibrosis, cor pulmonale, or heart failure.

Oxygen might be needed if there is an acute lung problem, such as pneumonia, until this resolves.

Oxygen might be needed if one is living (or visiting) at altitude in cities such as Denver or Mexico City. If the ventilator is adjusted properly so the arterial CO2 is normal, but the high altitude causes the oxygen saturation to drop to 88% or lower and the arterial PaO2 is 55 mm Hg or less, then supplemental oxygen is justified – again adjusting the added oxygen to achieve an oxygen saturation of 90-95% following the advice of one’s physician. A variation of this, often at altitude, might be that the night-time adjustment of the ventilator, despite all attempts, is not optimal (perhaps due to leaks), so the physician may suggest adding supplemental oxygen rather than considering tracheostomy.

In air travel, the airplane often flies at about 30,000 feet, with the cabin pressure adjusted to between 5,000 to 8,000 feet. This is equivalent to being at high altitude. The arterial oxygen would drop by at least 16 mm Hg, compared to the sea level value. A person who usually only uses night-time ventilation may need supplemental oxygen during air travel. A physician would need to advise, arrange this, and deter-mine the oxygen flow (usually available either with 2 or 4 liters per minute). Some people need to be sure a small portable oxygen tank will be available in order to leave one’s seat and use the toilet.

The general guideline is true – oxygen is not the right treatment for hypoventilation due to respiratory muscle weakness. In fact, using oxygen rather than assisted ventilation can result in serious complications. However, in the situations described above, using oxygen can be quite reasonable and important. The individual needs to discuss this with their physician to get the best advice.


Aging With a Ventilator: Independence or Security?

Several ventilator users in the United States who are at retirement age or who no longer want to deal with owning and maintaining a home face a dilemma about where to move. Many retirement communities offer progressive levels of care ranging from an individual apartment to assisted living to a nursing home.

Jerry Grady, who has used a ventilator during the night for several years, wanted to sign up for an apartment in a such a retirement community, but he was told by the administrator that if and when he needed to use the ventilator fulltime (perhaps mistakenly assuming he would at that point need to live in the nursing home wing and require extra care), he would not be allowed to stay.

Finding a nursing home to care for a ventilator user is another problem. Previously, IVUN tried to locate nursing homes that would admit ventilator users, but found that they do not abound in great numbers.

The relative lack may be understandable but not excusable when one considers that nursing homes receive inadequate reimbursement for respiratory therapy, they perceive increased nursing time and cost for patients who use ventilators, and there is fear among the staff of equipment that is “life support.”

A great deal of education is necessary to correct misperceptions and overcome fear, as well as lobbying for increased reimbursement for respiratory therapy.

Dick Wieler writes, “As I drift even farther away from my working days, I begin to question the quality of my living conditions. Even with the assistance of a home health care agency, the quality of the help is spotty and the constant turnover frustrating. I’m beginning to feel the need for security more than the need for independence. As I explore the avenues of assisted or skilled care facilities, I find even more questions rather than answers, and I am curious about the findings of others in my predicament.”

IVUN welcomes additional stories, advice, solutions, etc. Send them to IVUN,
4207 Lindell Blvd., #110, Saint Louis, MO (Missouri) 63108 (info@ventusers.org).

Back to Contents of this issue of Ventilator-Assisted Living

Back to top