Demand valve oxygen therapy

Last updated
Demand valve oxygen therapy
Specialty pulmonology

Demand Valve Oxygen Therapy (DVOT) is a way of delivering high flow oxygen therapy using a device that only delivers oxygen when the patient breathes in and shuts off when they breathe out. DVOT is commonly used to treat conditions such as cluster headache, which affects up to four in 1000 people (0.4%), [1] [2] [3] and is a recommended first aid procedure for several diving disorders. [4] [5] It is also a recommended prophylactic for decompression sickness in the event of minor omitted decompression without symptoms. [5]

Contents

Medical uses

Cluster headache

High flow oxygen therapy, delivered at a rate of between 7 and 15 litres per minute, has been recognized as an effective treatment for cluster headache since 1981. [6] Since then, several double-blind, randomized, placebo-controlled, crossover trials have provided further clinical evidence for its efficacy. [7] [8]

When inhaled at 100% at the outset of a cluster headache attack, high flow oxygen therapy has been proven to abort episodes in up to 78% of patients. [7] Inhaling 100% oxygen is recommended by the European Federation of Neurological Societies as the first choice for the treatment of cluster headache attacks. [9] [8] The British Thoracic Society and National Institute of Health and Care Excellence, among other organisations, endorse the therapy. [10] [11]

Diving disorders

Equipment

A portable administration set will comprise a portable high-pressure oxygen cylinder containing sufficient gas for the expected treatment, with an oxygen service cylinder valve, an oxygen compatible first stage regulator with pressure gauge, intermediate pressure hose, and demand valve with mouthpiece.

Equipment for cluster headache treatment

Demand valves have been proven to be particularly effective at delivering high flow oxygen therapy. [13] Unlike conventional breathing systems, oxygen demand valves only deliver gas when the patient inhales and shut off the flow when they exhale. Exhaled gas is directed to the atmosphere through side vents. This means that almost 100 percent of the oxygen is inhaled, while the amount of exhaled carbon dioxide that the patient rebreathes is minimized.

Demand valve function
Demand valve exhalation Demand valve exhalation.jpg
Demand valve exhalation
Demand valve inhalation Demand valve inhalation.jpg
Demand valve inhalation

Compared to other mask types, demand valves have been better at achieving pain relief at 15 minutes in the first cluster headache attack. [14]

Equipment for diving first aid

For diving first aid an oxygen compatible diving regulator may be used if a special purpose oxygen treatment demand valve is not available. Technical divers routinely use such equipment for in-water decompression.

When used in diving recompression chambers and multi-place medical hyperbaric chambers, a built-in breathing system venting to the exterior is generally used to avoid buildup of oxygen partial pressure in the chamber to dangerous levels which would otherwise require more frequent venting.

Procedure

Contraindications

Hazards and precautions

High oxygen concentrations in the surroundings constitute a fire hazard. Oxygen therapy should be accompanied by good ventilation and avoidance of ignition sources, and where reasonably practicable, removal of combustible materials. Oxygen firebreaks are a requirement in some countries for patients using oxygen therapy.

See also

Related Research Articles

<span class="mw-page-title-main">Migraine</span> Disorder resulting in recurrent moderate-severe headaches

Migraine is a common neurological disorder characterized by recurrent headaches. Typically, the associated headache affects one side of the head, is pulsating in nature, may be moderate to severe in intensity, and could last from a few hours to three days. Non-headache symptoms may include nausea, vomiting, and sensitivity to light, sound, or smell. The pain is generally made worse by physical activity during an attack, although regular physical exercise may prevent future attacks. Up to one-third of people affected have aura: typically, it is a short period of visual disturbance that signals that the headache will soon occur. Occasionally, aura can occur with little or no headache following, but not everyone has this symptom.

<span class="mw-page-title-main">Decompression sickness</span> Disorder caused by dissolved gases emerging from solution

Decompression sickness is a medical condition caused by dissolved gases emerging from solution as bubbles inside the body tissues during decompression. DCS most commonly occurs during or soon after a decompression ascent from underwater diving, but can also result from other causes of depressurisation, such as emerging from a caisson, decompression from saturation, flying in an unpressurised aircraft at high altitude, and extravehicular activity from spacecraft. DCS and arterial gas embolism are collectively referred to as decompression illness.

<span class="mw-page-title-main">Cluster headache</span> Neurological disorder

Cluster headache (CH) is a neurological disorder characterized by recurrent severe headaches on one side of the head, typically around the eye(s). There is often accompanying eye watering, nasal congestion, or swelling around the eye on the affected side. These symptoms typically last 15 minutes to 3 hours. Attacks often occur in clusters which typically last for weeks or months and occasionally more than a year.

A medication overuse headache (MOH), also known as a rebound headache, usually occurs when painkillers are taken frequently to relieve headaches. These cases are often referred to as painkiller headaches. Rebound headaches frequently occur daily, can be very painful and are a common cause of chronic daily headache. They typically occur in patients with an underlying headache disorder such as migraine or tension-type headache that "transforms" over time from an episodic condition to chronic daily headache due to excessive intake of acute headache relief medications. MOH is a serious, disabling and well-characterized disorder, which represents a worldwide problem and is now considered the third-most prevalent type of headache. Population-based studies report the prevalence rate of MOH to be 1% to 2% in the general population, but its relative frequency is much higher in secondary and tertiary care.

<span class="mw-page-title-main">Hyperbaric medicine</span> Medical treatment at raised ambient pressure

Hyperbaric medicine is medical treatment in which an ambient pressure greater than sea level atmospheric pressure is a necessary component. The treatment comprises hyperbaric oxygen therapy (HBOT), the medical use of oxygen at an ambient pressure higher than atmospheric pressure, and therapeutic recompression for decompression illness, intended to reduce the injurious effects of systemic gas bubbles by physically reducing their size and providing improved conditions for elimination of bubbles and excess dissolved gas.

<span class="mw-page-title-main">Air embolism</span> Vascular blockage by air bubbles

An air embolism, also known as a gas embolism, is a blood vessel blockage caused by one or more bubbles of air or other gas in the circulatory system. Air can be introduced into the circulation during surgical procedures, lung over-expansion injury, decompression, and a few other causes. Air embolisms may also occur in the xylem of vascular plants, especially when suffering from water stress.

<span class="mw-page-title-main">Barotrauma</span> Injury caused by pressure

Barotrauma is physical damage to body tissues caused by a difference in pressure between a gas space inside, or contact with, the body and the surrounding gas or liquid. The initial damage is usually due to over-stretching the tissues in tension or shear, either directly by an expansion of the gas in the closed space or by pressure difference hydrostatically transmitted through the tissue. Tissue rupture may be complicated by the introduction of gas into the local tissue or circulation through the initial trauma site, which can cause blockage of circulation at distant sites or interfere with the normal function of an organ by its presence.

Salt water aspiration syndrome is a rare diving disorder suffered by scuba divers who inhale a mist of seawater from a faulty demand valve causing irritation of the lungs. It is not the same thing as aspiration of salt water as a bulk liquid, i.e. drowning. It can usually be treated by rest for several hours. If severe, medical assessment is required. First described by Carl Edmonds.

<span class="mw-page-title-main">Oxygen therapy</span> Use of oxygen as a medical treatment

Oxygen therapy, also known as supplemental oxygen, is the use of oxygen as medical treatment. Acute indications for therapy include hypoxemia, carbon monoxide toxicity and cluster headache. It may also be prophylactically given to maintain blood oxygen levels during the induction of anesthesia. Oxygen therapy is often useful in chronic hypoxemia caused by conditions such as severe COPD or cystic fibrosis. Oxygen can be delivered via nasal cannula or face mask, or via high pressure conditions such as in endotracheal intubation or hyperbaric chamber. It can also be given through bypassing the airway, such as in ECMO therapy.

<span class="mw-page-title-main">Visual snow syndrome</span> Visual impairment

Visual snow syndrome (VSS) is an uncommon neurological condition in which the primary symptom is that affected individuals see persistent flickering white, black, transparent, or coloured dots across the whole visual field. Other common symptoms are palinopsia, enhanced entoptic phenomena, photophobia, and headaches. The condition is typically always present and has no known cure, as viable treatments are still under research. Migraine and tinnitus are common comorbidities and are both associated with a more severe presentation of the syndrome.

<span class="mw-page-title-main">Oxygen mask</span> Interface between the oxygen delivery system and the human user

An oxygen mask provides a method to transfer breathing oxygen gas from a storage tank to the lungs. Oxygen masks may cover only the nose and mouth or the entire face. They may be made of plastic, silicone, or rubber. In certain circumstances, oxygen may be delivered via a nasal cannula instead of a mask.

<span class="mw-page-title-main">Non-rebreather mask</span> Device used for emergency oxygen therapy

A non-rebreather mask is a device used in medicine to assist in the delivery of oxygen therapy. A NRB requires that the patient can breathe unassisted, but unlike a low-flow nasal cannula, the NRB allows for the delivery of higher concentrations of oxygen. An ideal non-rebreather mask does not permit air from the surrounding environment to be inhaled, hence an event of a source gas failure is life-threatening.

Hypnic headaches are benign primary headaches that affect the elderly, with an average age of onset at 63 ± 11 years. They are moderate, throbbing, bilateral or unilateral headaches that wake the sufferer from sleep once or multiple times a night. They typically begin a few hours after sleep begins and can last from 15–180 min. There is normally no nausea, photophobia, phonophobia or autonomic symptoms associated with the headache. They commonly occur at the same time every night possibly linking the headaches with circadian rhythm, but polysomnography has recently revealed that the onset of hypnic headaches may be associated with REM sleep.

Preventive treatment of migraine can be an important component of migraine management. Such treatments can take many forms, including everything from surgery, taking certain drugs or nutritional supplements, to lifestyle alterations such as increased exercise and avoidance of migraine triggers.

Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing is a rare headache disorder that belongs to the group of headaches called trigeminal autonomic cephalalgia (TACs). Symptoms include excruciating burning, stabbing, or electrical headaches mainly near the eye and typically these sensations are only on one side of the body. The headache attacks are typically accompanied by cranial autonomic signs that are unique to SUNCT. Each attack can last from five seconds to six minutes and may occur up to 200 times daily.

<span class="mw-page-title-main">Heated humidified high-flow therapy</span> Respiratory support method

Heated humidified high-flow (HHHF) therapy, often also high flow nasal cannula(e) (HFNC) or high flow nasal oxygen (HFNO), is a type of respiratory support method that delivers a high flow of medical gas to a patient through an interface intended to create a wash-out of the upper airway. The applied gas is heated to best match human body temperature (37 °C) and humidified targeting ideal body saturation vapor pressure. It is used in acute and chronic breathing problems, and is a suitable choice for treatment of patients with severe or critical COVID-19.

Migraine treatment may be either prophylactic (preventive) or abortive (rescue). Prevention is better than cure, so the ideal treatment goal is to prevent migraine attacks. Because migraine is an exceedingly complex condition, there are various preventive treatments which have their effect by disrupting different links in the chain of events that occur during a migraine attack. As rescue treatments also target and disrupt different processes occurring during migraine, these are summarized, with their relative merits and demerits.

<span class="mw-page-title-main">Hyperbaric treatment schedules</span> Diving decompression treatment

Hyperbaric treatment schedules or hyperbaric treatment tables, are planned sequences of events in chronological order for hyperbaric pressure exposures specifying the pressure profile over time and the breathing gas to be used during specified periods, for medical treatment. Hyperbaric therapy is based on exposure to pressures greater than normal atmospheric pressure, and in many cases the use of breathing gases with oxygen content greater than that of air.

<span class="mw-page-title-main">Built-in breathing system</span> System for supply of breathing gas on demand within a confined space

A built-in breathing system is a source of breathing gas installed in a confined space where an alternative to the ambient gas may be required for medical treatment, emergency use, or to minimise a hazard. They are found in diving chambers, hyperbaric treatment chambers, and submarines.

A migrainous infarction is a rare type of ischaemic stroke which occurs in correspondence with migraine aura symptoms. Symptoms include headaches, visual disturbances, strange sensations and dysphasia, all of which gradually worsen causing neurological changes which ultimately increase the risk of an ischaemic stroke. Typically, women under the age of 45 who experience migraine with aura (MA) are at the greatest risk for developing migrainous infarction, especially when combined with smoking and use of oral contraceptives.

References

  1. Rozen, T.D.; Fishman, R.S. (April 2013). "Demand valve oxygen: a promising new oxygen delivery system for the acute treatment of cluster headache". Pain Medicine. 14 (4): 455–459. doi: 10.1111/pme.12055 . PMID   23369112.
  2. Rossi, Paolo (28 September 2016). "What is cluster headache? Fact sheet for patients and their families. A publication to mark Cluster Headache Day 2016". Functional Neurology. 31 (3): 181–183. doi:10.11138/FNeur/2016.31.3.181. PMC   5115234 . PMID   27678213.
  3. Petersen, Anja S; Barloese, Mads CJ; Lund, Nunu LT; Jensen, Rigmor H (23 March 2016). "Oxygen therapy for cluster headache. A mask comparison trial. A single-blinded, placebo-controlled, crossover study". Cephalalgia. 37 (3): 214–224. doi:10.1177/0333102416637817. PMID   27013239. S2CID   7686710.
  4. Taylor, Larry "Harris". "A Diver's Guide To Oxygen Therapy Apparatus" . Retrieved 17 January 2019.
  5. 1 2 Sorrell, Lana; Bird, Nick (Fall 2012). "Tips for Better Oxygen Administration". Alert Diver. Retrieved 17 January 2019.
  6. Kudrow M.D., Lee (January 1981). "Response of Cluster Headache Attacks to Oxygen Inhalation". Headache. 21 (1): 1–4. doi:10.1111/j.1526-4610.1981.hed2101001.x. PMID   7007285. S2CID   5316549.
  7. 1 2 Cohen, Anna S; Burns, Brian; Goadsby, Peter J (13 December 2009). "High-Flow Oxygen for Treatment of Cluster Headache: A Randomized Trial (2009)". JAMA. 302 (22): 2451–7. doi: 10.1001/jama.2009.1855 . PMID   19996400.
  8. 1 2 Rozen, Todd D (10 August 2004). "High oxygen flow rates for cluster headache". Neurology. 63 (3): 593. doi:10.1212/01.WNL.0000133405.80679.4B. PMID   15304611. S2CID   33556485.
  9. May, A; Leone, M; Afra, J; Linde, M; Sandor, PS; Evers, S; Goadsby, PJ (October 2006). "EFNS guidelines on the treatment of cluster headache and other trigeminalautonomic cephalalgias". European Journal of Neurology. 13 (10): 1066–1007. doi: 10.1111/j.1468-1331.2006.01566.x . PMID   16987158. S2CID   9432289.
  10. British Thoracic Society Emergency Oxygen Guideline Development Group (June 2017). "BTS guideline for oxygen use in adults in healthcare and emergency settings". Thorax. 72 (1). Retrieved 17 January 2019.
  11. "Headache - cluster". NICE. National Institute for Health and Care Excellence. Retrieved 17 January 2019.
  12. 1 2 Denoble, Petar (Fall 2010). "Oxygen as Definitive Treatment". Alert Diver. Divers Alert Network. Retrieved 17 January 2019.
  13. Peterson, Anja S; Barloese, Mads CJ; Lund, Nunu LT; Jensen, Rigmor H (6 February 2016). "Oxygen therapy for cluster headache. A mask comparison trial. A single-blinded, placebo-controlled, crossover study" (PDF). Cephalalgia. 37 (3): 214–224. doi:10.1177/0333102416637817. PMID   27013239. S2CID   7686710 . Retrieved 18 January 2019.
  14. Peterson, Anja S; Barloese, Mads CJ; Lund, Nunu LT; Jensen, Rigmor H (6 February 2016). "Oxygen therapy for cluster headache. A mask comparison trial. A single-blinded, placebo-controlled, crossover study" (PDF). Cephalalgia. 37 (3): 214–224. doi:10.1177/0333102416637817. PMID   27013239. S2CID   7686710 . Retrieved 18 January 2019.