Demand valve oxygen therapy

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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">Decompression sickness</span> Disorder caused by dissolved gases forming bubbles in tissues

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 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. The proportion of patients in the population with Chronic Daily Headache (CDH) who overuse acute medications ranges from 18% to 33%. The prevalence of medication overuse headache (MOH) varies depending on the population studied and diagnostic criteria used. However, it is estimated that MOH affects approximately 1-2% of 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 a medical treatment in which an increase in barometric pressure over ambient pressure is employed increasing the partial pressures of all gases present in the compressed air. The immediate effects include reducing the size of gas embolisms and raising the partial pressures of all gases present according to Henry's law. Currently, there are two types of hyperbaric medicine depending on the gases compressed, hyperbaric air and hyperbaric oxygen.

<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. In flora, 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 in 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. The term is usually applied when the gas volume involved already exists prior to decompression. Barotrauma can occur during both compression and decompression events.

Salt water aspiration syndrome is a rare diving disorder suffered by scuba divers who inhale a mist of seawater, usually 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 referred to as supplemental oxygen, is the use of oxygen as medical treatment. Supplemental oxygen can also refer to the use of oxygen enriched air at altitude. 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, face mask, or endotracheal intubation at normal atmospheric pressure, or in a hyperbaric chamber. It can also be given through bypassing the airway, such as in ECMO therapy.

<span class="mw-page-title-main">Breathing apparatus</span> Equipment allowing or assisting the user to breath in a hostile environment

A breathing apparatus or breathing set is equipment which allows a person to breathe in a hostile environment where breathing would otherwise be impossible, difficult, harmful, or hazardous, or assists a person to breathe. A respirator, medical ventilator, or resuscitator may also be considered to be breathing apparatus. Equipment that supplies or recycles breathing gas other than ambient air in a space used by several people is usually referred to as being part of a life-support system, and a life-support system for one person may include breathing apparatus, when the breathing gas is specifically supplied to the user rather than to the enclosure in which the user is the occupant.

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

An oxygen mask is a mask that 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.

Migraine surgery is a surgical operation undertaken with the goal of reducing or preventing migraines. Migraine surgery most often refers to surgical nerve decompression of one or several nerves in the head and neck which have been shown to trigger migraine symptoms in many migraine sufferers. Following the development of nerve decompression techniques for the relief of migraine pain in the year 2000, these procedures have been extensively studied and shown to be effective in appropriate candidates. The nerves that are most often addressed in migraine surgery are found outside of the skull, in the face and neck, and include the supra-orbital and supra-trochlear nerves in the forehead, the zygomaticotemporal nerve and auriculotemporal nerves in the temple region, and the greater occipital, lesser occipital, and third occipital nerves in the back of the neck. Nerve impingement in the nasal cavity has additionally been shown to be a trigger of migraine symptoms.

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. The goals of preventive therapy are to reduce the frequency, painfulness, and/or duration of migraine attacks, and to increase the effectiveness of abortive therapy. Another reason to pursue prevention is to avoid medication overuse headache (MOH), otherwise known as rebound headache, which can arise from overuse of pain medications, and can result in chronic daily headache. Preventive treatments of migraine include medications, nutritional supplements, lifestyle alterations, and surgery. Prevention is recommended in those who have headaches more than two days a week, cannot tolerate the medications used to treat acute attacks, or those with severe attacks that are not easily controlled.

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">Hyperbaric treatment schedules</span> Planned hyperbaric exposure using a specified breathing gas as medical 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">Ditan</span> Drug class

Ditans are a class of abortive medication for the treatment of migraines. The first ditan, Eli Lilly's lasmiditan, was approved by the FDA in 2019.

<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.

Inner ear decompression sickness, (IEDCS) or audiovestibular decompression sickness is a medical condition of the inner ear caused by the formation of gas bubbles in the tissues or blood vessels of the inner ear. Generally referred to as a form of decompression sickness, it can also occur at constant pressure due to inert gas counterdiffusion effects.

<span class="mw-page-title-main">Glossary of breathing apparatus terminology</span> Definitions of technical terms used in connection with breathing apparatus

A breathing apparatus or breathing set is equipment which allows a person to breathe in a hostile environment where breathing would otherwise be impossible, difficult, harmful, or hazardous, or assists a person to breathe. A respirator, medical ventilator, or resuscitator may also be considered to be breathing apparatus. Equipment that supplies or recycles breathing gas other than ambient air in a space used by several people is usually referred to as being part of a life-support system, and a life-support system for one person may include breathing apparatus, when the breathing gas is specifically supplied to the user rather than to the enclosure in which the user is the occupant.

References

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  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.
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  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.