Since the second wave of the COVID-19 pandemic has continued to cause havoc across the country, one issue that has become common is oxygen deficiency and lung infections faced by COVID patients. This has led to the increase in oxygen therapy – or the recommended use of medical devices like oxygen concentrators and cylinders at home. 

Here we will look at oxygen concentrators, what they are used for, when to use them, and the risks and dangers associated with them as well.

An oxygen concentrator is a medical device that helps people who have low blood oxygen levels or those facing respiratory issues. It absorbs air from the surroundings (atmospheric air consists of 21% oxygen, 78% nitrogen, and other gases) and filters out nitrogen and other gases. Then, the absorbed oxygen is stored in a cylinder and inhaled by the patient through a mask or a tube.

The oxygen concentrator is considered the best solution for supplemental oxygen supply at home. However, it is important to remember that this kind of oxygen therapy needs to be prescribed and must be an advised treatment or therapy by a registered doctor.

As we have mentioned, oxygen concentrators are designed to deliver supplemental oxygen to patients who are not able to get the desired amount of oxygen on their own (these oxygen levels can be checked using a pulse oximeter).

In an oxygen concentrator, the ambient air is passed through something called a “molecular sieve”. This separates the oxygen from the air at about 95% purity and then passes it to the patient. As a result, the device is able to provide oxygen, which can flow at a rate of up to 10 litres per minute.

Types of oxygen concentrators

There are two types of oxygen concentrators:

• Continuous flow – they provide a continuous flow of oxygen until it is turned off. So, the oxygen flow is the same every minute.
• Pulse dose – this type detects the breathing pattern of the patient and only dispenses oxygen when it is able to detect inhalation. This means that the oxygen used per minute will vary.

The use of an oxygen concentrator should be recommended by a doctor. However, this is usually only done when someone needs supplemental oxygen due to low oxygen levels in their blood.

This can be diagnosed (again by a qualified medical professional) by monitoring blood oxygen levels, which is done using devices like the pulse oximeter. Such devices measure SpO2, or oxygen saturation, which needs to be above 92-95% in a healthy individual. If it falls below this, supplemental oxygen might be recommended. 

Once it is recommended, the doctor will also decide how frequently or for how long oxygen therapy (or treatment with supplemental oxygen) is needed.

People suffering from COVID-19 face a series of respiratory and lung problems. Since oxygen concentrators were designed to help people who are having trouble breathing on their own, this kind of external oxygen support is helpful for COVID-19 patients.

However, since the machines are meant for patients with chronic respiratory illness and not short-term acute situations (like COVID-19), they can be used as a temporary measure. In such cases, they need to be used along with a pulse oximeter to monitor low levels of oxygen in the blood. 

This is because the concentrator is generally helpful to moderately ill patients, with an oxygen saturation level between 85-94%. If the oxygen saturation drops lower than this, they will need to get hospitalized and switch to an oxygen cylinder with a higher oxygen flow. 

To improve both breathing and the delivery of oxygen to the lungs, patients can use prone positioning. This involves having the patient lie down flat on their back and then using specific motions to turn them onto their abdomen. 

While it is important to remember that no form of oxygen therapy can instantly restore oxygen levels to normal, people with COVID-19 can aim to achieve a saturation of up to 92%.

No one should use an oxygen concentrator at home unless it has been prescribed by a doctor, as giving yourself oxygen when it is not recommended may do more harm than good. Here are some of the risks to keep in mind:

• Receiving too much oxygen can lead to oxygen toxicity.
• Too little oxygen can lead to hypoxia, which could damage the heart, brain, and other organs.
• If the concentration of oxygen is too high, it may damage your lungs. 
• Cleaning the tubing regularly to prevent the build-up of bacteria and fungi, which can lead to serious infections.
• Oxygen is highly combustible, so you need to be cautious with the oxygen around open flames and heaters and be sure to store them safely.

While you can store an oxygen concentrator anywhere inside the house while not in use, there are some steps you need to follow when operating the device.

Step 1: Set up the oxygen concentrator in an open area, at least 1-2 feet away from any walls or furniture so that the air vents are not blocked, and reduce the chances of overheating. 

Step 2: If prescribed, connect the humidification bottle to the outlet on your oxygen concentrator and securely attach it to the machine. (Remember to always use distilled or filtered water in the humidification bottle.)

Step 3: Next, you will need to attach the oxygen tubing to either a port on the humidification bottle or to a special adapter.

Step 4: Check if you need to remove or change the machine’s air inlet filter for cleaning. If you remove it, make sure it is in place before you turn on your machine. (Note: the air inlet filter removes particles and allergens from the air and needs to be cleaned and thoroughly dried once a week.)

Step 5: Make sure the oxygen concentrator is the only item plugged in the socket (that means you shouldn’t use an extension cord) as it can draw a lot of power and become a fire risk.

Step 6: Start the oxygen concentrator at least 15-20 minutes before you plan to start using it so that it can start producing the correct concentration of air.

Step 7: Once the machine is on, check the light indicators to see if it’s working properly. You should also be able to hear the air being processed quite loudly.

Step 8: Set the litre control knob or switch on your oxygen concentrator to the prescribed litres per minute (LPM). Your doctor should be able to tell you how much oxygen you need, such as 1, 2, 3, or more LPM. If you feel like you’re not getting enough oxygen, consult your doctor. DO NOT adjust the setting on your own. 

Step 9: Check the tubing for any bends or kinks, as these can cause interruptions or insufficient supply.

Step 10: Ensure your mask or tube is in working order, and put them on as follows:

• If you are using a mask: Make sure there are no gaps around the edges, then place it over your mouth and nose, securing the band behind your head or around your ears.
• If you are using nasal tubes: Adjust the nasal tubes upward into your nostrils and loop the tubes over your ears. You can use the tube adjuster to adjust the tubes under your chin.

While an oxygen concentrator might be considered one of the best solutions for supplemental oxygen therapy at home, there are some things you need to keep in mind before getting the device:

• Oxygen concentrators can supply between 0.1 litres per minute (LPM) to 5 to 10 LPM. Be sure about how many litres per minute of oxygen is required for you, as prescribed by your doctor.
• If constant oxygen support is required (for example, even while sleeping or resting), remember that the oxygen concentrator needs to be plugged in at all times. This means it will need a power backup in case of outages.
• Make sure the machine has sufficient capacity for your needs. Common models available in India offer an output of 5 LPM, 8 LPM, and 10 LPM.
• Also, check that you are getting the correct concentration of oxygen. The machine should give you at least 92-95% purity of oxygen at 5 LPM.
• Remember to check the noise level of the machine, as it can cause issues. The WHO recommends that oxygen concentrators should not produce more than 50 decibels while operating.