Part 4 in Is Our Oxygen Supply System Broken?

“Home oxygen therapy allows patients requiring long-term oxygen therapy to receive care at home and helps improve the prognosis of patients with chronic respiratory failure. The usage conditions of oxygen concentrators, which are used to supply gaseous oxygen, and the effects of oxygen inhaled at a prescribed flow rate have not been confirmed in adequate detail. As a result of advances in information and communications technology, internet communication functions can now be incorporated into medical devices installed in patients’ homes. This allows time-series data on oxygen concentrator usage and biological variables to be stored on a server and accessed remotely by health care providers, enabling them to check the validity of home oxygen therapy and intervene appropriately. In Japan, telemonitoring of home oxygen therapy is covered by social insurance systems and is recognized as a new medical technology.” (N. Burioka,2020

The article explains that……I have no clue what because I cannot access the translated version and I cannot read Japanese.

“However, the issue of oxygen titration is not always properly addressed, since POCs rely on proper use by patients. The robustness of algorithms and the limited reliability of current oximetry sensors are hindering the effectiveness of new approaches to closed loop POCs based on the feedback of blood oxygen saturation. In this study, a novel intelligent portable oxygen concentrator (iPOC) is described. The presented iPOC can adjust the O₂ flow automatically by real-time classifying the intensity of a patient’s physical activity (PA). It was designed with a group of patients with COPD and stable chronic respiratory failure. The technical pilot test showed a weighted accuracy of 91.1% in updating the O₂ flow automatically according to medical prescriptions, and a general improvement in oxygenation compared to conventional POCs. In addition, the usability achieved was high, which indicated a significant degree of user satisfaction. This iPOC may have important benefits, including improved oxygenation, increased compliance with therapy recommendations, and the promotion of PA.” (Sensors 2020, 20(4), 1178; https://doi.org/10.3390/s20041178)

The article acknowledges that the use of long-term oxygen therapy (LTOT) for the treatment of COPD patients and others with severe hypoxia is scientifically proven effective.  It points out that the proper correction of SpO₂ both at rest and during sleep or effort are important factors in the effectiveness of treatment.  The dangers of the oxygen saturation being too low include, but are not limited to short-term symptoms, such as dyspnea, and physio-pathological organic changes, such as tachycardia, increased respiratory rate, arterial hypertension and, in the long term, serious problems such as pulmonary hypertension.

Too much oxygen on the other hand can cause hypercapnic encephalopathy (damage to the brain due to excess carbon dioxide) in some patients. In this regard, the patients receiving LTOT are generally instructed to adjust the oxygen flow according to the activities of daily living. Oxygen flow is therefore routinely targeted to maintaining the desired oxygenation range. However, this task places a burden on patients that often affects adherence to therapy, and the existing methods of oxygen delivery may not be sufficient when the patient’s activity, and therefore the demand of oxygen, increases. 

The researchers propose an alternative approach that enables a POC to be transformed into an intelligent POC (iPOC) to adjust the oxygen flow automatically in patients with COPD and respiratory failure that receive LTOT. The proposed system is based on the automatic classification of the intensity of the patient’s physical activity and can adjust the oxygen flow to individual real-time needs autonomously. It is a transdisciplinary work, rooted in the field of respiratory medicine, with contributions from electronics, control theory, computer science and artificial intelligence.

The study results were much as we might expect.  The patients with the iPOC faired much better as far as their oxygen saturation over time due to different activity levels.  The oxygen saturation rate did not fall below 90% in the patients using the iPOC.  This sounds like something that COPD patients could get behind. 

The limitation of the research lies basically in the number of patients in the study.  This study is based on 5 patients. 

There is hope, but what is it that we can do to promote the research and bring the iPOC to market? #iPOC #COPD Foundation #oxygen360