This study shows that, compared with continuous flow TTO, pulsed transtracheal oxygen improves the efficiency of oxygen delivery by a factor of 3:1 while achieving an equivalent Sa02. Previous studies have shown that continuous flow TTO therapy improves the efficiency of oxygen delivery by between 2:1 and 3:1 over continuous flow nasal oxygen therapy. If the efficiency resulting from combining pulse with transtracheal technologies were multiplicative, one might expect pulsed TTO delivery to result in a 6:1 to 7:1 savings compared with continuous flow nasal oxygen. In fact, these estimates are within the range encountered in previous nasal oxygen studies with the Oxymatic and the transtracheal study of the Oxymatic and the Pulsair.
It appears that a plateau has been reached in our ability to increase the efficiency of oxygen delivery with these two technologies. If the oxygen pulse is delivered to the patient during early, pre-dead space inspiration and there is no significant loss of oxygen to the surrounding atmosphere, oxygen therapy will be provided at nearly maximum efficiency either transtracheal or nasally. In support of this concept, the maximum efficiency that we have been able to achieve nasally and transtracheally using the Oxymatic is about the same.
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The foregoing is not an argument against TTO therapy. Transtracheal oxygen offers several advantages over nasal oxygen therapy in addition to oxygen conservation. Reported benefits of TTO therapy include improved comfort, mobility, cosmetic appearance and exercise tolerance, as well as improvement in cor pulmonale, reduced erythrocytosis, reduced hospitalization and improved compliance. With the increased efficiency through pulsing oxygen into the trachea, mobility should be further improved due to even longer duration of portable systems and potential for the development of smaller, lighter weight sources.
In this study we included some patients with restrictive lung disease. A recent study determined that this patient population, although maintaining a different respiratory pattern, achieved the same degree of efficacy from the Oxymatic as patients with COPD during both rest and exercise. In this study there were no differences in their response to the Oxymatic as compared with COPD patients, as noted by Carter and co-workers.
In conclusion, early inspiratory oxygen delivery improves the efficiency of pulsed nasal oxygen therapy. Small reductions in response time are critical in nasal oxygen delivery, but are not as important in TTO delivery. This difference between pulsed nasal and TTO therapy is probably due to the fact that TTO delivery occurs early in inspiration and that all of the delivered oxygen is contained within the tracheobronchial tree. Viagra Super Active
By pulsing oxygen into the trachea, efficiency is significantly improved over continuous flow transtracheal oxygen delivery. Pulsed transtracheal oxygen should substantially improve ambulatory oxygen therapy and patients will likely enjoy even greater mobility. Also, there should be a reduction in financial cost— adding to the multiple benefits reported with TTO administration.