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LIQUID MEDICAL OXYGEN is a brand name for Oxygen. The medicine, its uses, side effects and dosage are the same regardless of brand.
Used for: Liquid Medical Oxygen 100 % medicinal gas, cryogenic is in a physical form which is not intended for use. Medical gas is used after gasification for normobaric and hyperbaric oxygen therapy. Normobaric oxygen therapy: - Treatment or prevention of acute or chronic hypoxia. - Treatment of cluster headache. Hyperbaric…
Verbatim from this product's MHRA label. Tap a section to expand.
Posology The concentration, flow and duration of the treatment will be determined by a physician, according to the characteristics of each pathology. Hypoxemia refers to a condition where the arterial partial pressure of oxygen (PaO2) is lower than 10 kPa (<70 mmHg).
An oxygen pressure level of 8 kPa (55 / 60 mmHg) will result in respiratory insufficiency. Hypoxemia is treated by enriching the patient’s inhalation air with extra oxygen. The decision to introduce oxygen therapy depends on the degree of hypoxemia and the patient’s individual tolerance level.
96 kPa) or oxygen saturation in the arterial blood ≥ 90%. If oxygen is administered diluted in another gas, the oxygen concentration in the inspired air (FiO2) must be at least 21%.
Oxygen therapy at normal pressure (Normobaric oxygen therapy):
Administration of oxygen should be performed cautiously. 0 kPa (or 60 mmHg) and oxygen saturation of haemoglobin should be > 90%. Regular monitoring of arterial oxygen tension (PaO2) or pulsoxymetry (arterial oxygen saturation (SpO2)) and clinical signs is necessary.
The aim is always to use the lowest possible effective oxygen concentration in the inhaled air for the individual patient, which is the lowest dose to maintain a pressure of 8 kPa (60 mmHg)/saturation > 90 %. Higher concentrations should be administered as short as possible accompanied by close monitoring of blood gas values.
Oxygen can be administered safely in the following concentrations, for the periods indicated: Up to 100% less than 6 hours 60-70% 24 hours 40-50% during the second 24-hour period Oxygen is potentially toxic after two days in concentrations in excess of 40%.
Neonates are excluded from these guidelines because retrolental fibroplasia occurs with a much lower FiO2. The lowest effective concentrations should be sought in order to achieve an adequate oxygenation appropriate for neonates. • Spontaneously breathing patients: The effective oxygen concentration is at least 24%.
Normally, a minimum of 30% oxygen is administrated to ensure therapeutic concentrations with a safety margin. The therapy with high oxygen concentration (> 60%) is indicated for short periods in case of serious asthmatic crisis, pulmonary thromboembolism, pneumonia and alveolitic fibrosis, etc.
Tissues present different degrees of sensitivity to hyperoxaemia; the most sensitive are lungs, brain and eyes. Description of selected adverse reactions Respiratory adverse reactions At ambient pressure, the first signs (tracheobronchitis, substernal pain and dry cough) appear after for 4 hours of exposure to 95% oxygen.
A reduction in forced vital capacity can occur within 8 to 12 hours of exposure to 100% oxygen but severe injuries require much longer exposure periods. Interstitial oedema can be observed 18 hours of exposure to 100% oxygen and with a possible evolution towards pulmonary fibrosis.
Respiratory side effects of hyperbaric therapy generally resemble those observed during treatment with normobaric oxygen, but the time of onset of symptoms is shorter. Inhalation of high concentrations of oxygen can cause atelectasis due to the reduction in alveolar nitrogen and direct effect of oxygen on alveolar surfactant.
Development of atelectasis in the lungs generates a risk of low oxygen saturation in arterial blood, despite good perfusion, due to the lack of gas exchange in atelectatic areas of the lungs. The ventilation/perfusion ratio worsens, causing intrapulmonary shunts.
In patients with long-term diseases associated with chronic hypoxia and hypercapnia a change in the way to control ventilation may occur. 4). The administration of oxygen in patients with drug-induced respiratory depression (opioids, barbiturates) or with COPD might further suppress ventilation since, in these conditions, hypercapnia is unable to stimulate central chemoreceptors, while hypoxia is still capable of stimulating peripheral chemoreceptors.
Toxic effects on the CNS Toxic effects might occur when patients are inhaling 100% oxygen at pressure levels over 2 bars. Early signs include blurred vision, reduced peripheral vision, tinnitus, respiratory disorders and localized muscle contractions, especially of eyes, mouth and forehead.
Administration of oxygen should be performed with caution. The dose should be adapted to the individual needs of the patient, oxygen tension should remain higher than 8 kPa (or 60 mmHg). Higher concentrations should be administered as short as possible accompanied by close monitoring of blood gas values.
Oxygen can be administered safely in the following concentrations, for the periods indicated: Up to 100% less than 6 h 60-70% 24 hours 40-50% during the second 24-hour period Oxygen is potentially toxic after two days in concentrations in excess of 40%.
Low oxygen concentrations should be used in patients with respiratory failure who depend on hypoxia as a breathing incentive. In such cases, careful monitoring of the treatment is required, by measuring the arterial oxygen pressure (PaO2) or through pulsoxymetry (arterial oxygen saturation (SpO2)) and clinical assessment.
Oxygen administration in patients with drug-induced respiratory failure (opioids, barbiturates) or with chronic obstructive pulmonary disease (COPD) could further aggravate respiratory failure due to hypercapnia caused by the high blood levels of carbon dioxide, which neutralises the effects of oxygen on receptors.
High concentrations of oxygen in air or in the inhaled air will cause the concentration and pressure of nitrogen to fall. This will also reduce nitrogen levels both in tissues and the lungs (alveoli). If oxygen is absorbed into the blood through the alveoli faster than it is supplied through ventilation, the alveoli may collapse (atelactasis).
This may hinder the oxygenation of arterial blood, because no gas exchange takes place despite perfusion. In patients with reduced sensitivity to carbon dioxide pressure in arterial blood, high oxygen levels can cause carbon dioxide retention.
In extreme cases, this may lead to carbon dioxide narcosis. g. patients with chronic obstructive pulmonary disease (COPD), cystic fibrosis, pathological obesity, chest wall deformities, neuromuscular disorders, breathing depressants overdose).
Normobaric oxygen therapy There are no absolute contraindications. Hyperbaric oxygen therapy • Bullous emphysema • Developmental age asthma • Pneumothorax, past history of pneumothorax • Chronic obstructive pulmonary disease (COPD) • Pneumonia caused by Pneumocystis carinii • Status epilepticus • Claustrophobia • Normal pregnancy (first trimester) for non-acute diseases • Upper airway infections • Hyperthermia • Hereditary spherocytosis • Optical nerve neuritis • Malignant tumours • Acidosis • Concomitant use of certain medications such as doxorubicin, adriamycin, bleomycin, daunorubicin, cisplatin, steroids, disulfiram, and substances such as alcohol, aromatic hydrocarbons and nicotine • Pre-term infants
Not medical advice. Always read the patient information leaflet and follow your prescriber or pharmacist.
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A low oxygen concentration is indicated for the treatment of patients with chronic respiratory insufficiency due to a chronic obstructive upheaval of the airways or other causes. The oxygen concentration must not be more than 28%, for some patients even 24% can be excessive.
Administration of higher oxygen concentrations (in some cases up to 100%) is possible, although when using most administration devices it is very difficult to obtain concentrations > 60% (80% in the case of children). The dose should be adapted to the individual needs of the patient, at flow rates ranging from 1 to 10 litres of gas per minute.
5 to 2 liters/minute, rates should be adjusted on the basis of blood gas values. The effective oxygen concentration will be kept below 28% and sometimes even lower than 24% in patients suffering from breathing disorders who depend on hypoxia as a breathing stimulus.
) or other conditions: The treatment is adjusted on the basis of blood gas values. Arterial partial oxygen pressure (PaO2) should be > 60 mm Hg (7,96 kPa) and oxygen saturation in the arterial blood ≥ 90%. The most common administration rate is 1 to 3 liters/minute for 15 to 24 hours/day, also covering paradoxical sleep (the most hypoxemia-sensitive period within a day).
During a stable disease period, CO2 concentrations should monitored twice every 3-4 weeks or 3 times per month as CO2 concentrations can increase during oxygen administration (hypercapnia). 5 to 15 liters/minute, flow rates should be adjusted on the basis of blood gas values.
In case of emergency, considerably higher doses (up to 60 liters/minute) are required in patients with severe respiratory difficulties. • Mechanically ventilated patients: If oxygen is mixed with other gases, the oxygen fraction in the inhaled gas mixture (FiO2) may not fall under 21%.
In practice, 30% tends to be used as the lower limit. If necessary, the inhaled oxygen fraction can be raised to 100%. • Paediatric population: New-born infant: In new-born infant, concentrations of up to 100% can be administered in exceptional cases; however, the treatment must be closely monitored.
The lowest effective concentrations should be sought in order to achieve an adequate oxygenation. As a rule, oxygen concentrations in excess of 40% in inhalation air must be avoided, considering the risk of eye damage (retinopathy) or pulmonary collapse.
3 kPa (100 mmHg). Fluctuations in oxygen saturation should be avoided. By preventing substantial fluctuations in oxygenation, the risk of eye damage can be reduced. ) • Cluster headache: In the case of cluster headache, 100% oxygen is administered at a flow rate of 7 liters/minute for 15 minutes using a close-fitting facial mask.
The treatment should begin in the earliest stage of a crisis.
Hyperbaric oxygen therapy:
Dosage and pressure should always be adapted to the patient’s clinical condition and therapy should only be given after doctor’s advice. However, some recommendations based on current knowledge are given below. 4 […]
Prolonged exposure can cause dizziness and nausea, followed by change of behaviour (anxiety, confusion, irritability), reduced consciousness (up to the loss of conscience) and generalized convulsions. It is deemed that discharges induced by hyperoxia are reversible, do not cause any residual neurological damage, and clear when the partial pressure of inhaled oxygen is reduced.
Adverse reactions related to hyperbaric oxygen therapy (HBOT) HBOT can trigger barotrauma generated by excessive pressure against the walls of closed cavities, such as the inner ear, with the risk of rupture, oedema or a tear in the tympanum (with pain and even haemorrhage), in paranasal sinuses or in the lungs, with consequent risk of pneumothorax, toothache, implosion or tooth extraction.
Due to the relatively small size of certain hyperbaric chambers, patients can develop close space anxiety, not being a direct consequence of oxygen action. Ocular toxicity Progressive myopia has been observed in multiple hyperbaric treatments.
Mechanism of its occurrence is unknown, but it is assumed to be dependent on the increase in the refraction index of the lens. Majority of cases resolved spontaneously. However, risk of irreversibility has been increased after more than 100 therapies.
Upon cessation of HBOT, remission of myopathy usually is usually rapid during the first weeks and then it slows down for periods ranging from few weeks to one year. Neither the threshold number of hyperbaric therapy sessions nor their duration can be estimated.
4). The administration of oxygen modifies the quantity of oxygen conveyed and released in different tissues. An increase of local oxygen concentration, mainly its dissolved fraction, leads to an increased production of reactive oxygen species, with a subsequent increase in antioxidant enzymes or endogenous antioxidant compounds.
Potential direct oxidative damage caused by oxygen should be assessed in the management of preterm babies who might experience persistent negative effects of lipid peroxidation in cell membranes. In these subjects, who still do not possess protective endogenous antioxidants, the administration of oxygen can contribute to the development of persistent pathological conditions in pulmonary parenchyma (bronchopulmonary dysplasia, pulmonary fibrosis), even leading to respiratory failure.
4). Adverse reactions listed in tables below are presented by system organ class (SOC) and frequencies. Frequency is defined using the following convention: very common (≥ 1/10), common (≥ 1/100 to < 1/10), uncommon (≥ 1/1,000 to < 1/100), rare (≥ 1/10,000 to < 1/1,000), very rare (< 1/10,000), not known (cannot be estimated from the available data).
Within each frequency grouping, adverse reactions are presented in order of decreasing seriousness. Adverse reactions related to normobaric oxygen treatment Very common (≥ 1/10) Common (≥ 1/100 to < 1/10) Uncommon (≥1/1,000 to <1/100) Rare (≥1/10,000 to <1/1,000) Very rare (<1/10,000) Not known (cannot be estimated from the available data) Respiratory, thoracic and mediastinal disorders Pulmonary toxicity: - Tracheobronchitis (substernal pain, dry cough) - Interstitial oedema - Pulmonary fibrosis Aggravation of hypercapnia in […]
8). In these patients, oxygen therapy should be carefully titrated. The target oxygen saturation to be reached can be lower than in other patients, and oxygen should be administered at a lower flow rate. 5). Paediatric population Due to the greater sensitivity of the neonate to supplemental oxygen, the lowest effective concentration of oxygen must be administered to obtain adequate oxygenation for neonates.
8), chronic pulmonary disease and intraventricular haemorrhage. It is recommended to start resuscitation in late-preterm or near-term infants with breathing room air instead with 100% oxygen. For preterm neonates, the optimal concentration of oxygen and the oxygen target are not precisely defined.
When required, supplemental oxygen should be carefully monitored and guided through pulsoxymetry. Hyperbaric oxygen therapy (HBOT) Administration of oxygen in the hyperbaric chamber should be carefully evaluated based on the benefit /risk balance, in the event of: • Recurrent otitis and/or sinusitis, laryngocele, mastoid cavities, vestibular syndrome, loss of hearing and recent middle ear surgery • Ischaemic and/or congestive heart disease; in patients with acute coronary syndrome or acute myocardial infarction also requiring hyperbaric therapy, as well as in the case of carbon monoxide intoxication, hyperbaric therapy must be administered with caution due to the potential vasoconstriction associated with hyperoxia in coronary circulation • Arterial hypertension not treated pharmacologically • Restrictive and/or highly restrictive lung diseases • Glaucoma, retinal detachment even after surgical treatment (compensation manoeuvres) • History of seizures, epilepsy • Uncontrolled high fever • Severe anxiety, psychosis, claustrophobia Patients with diabetes mellitus HBOT may interfere with glucose metabolism.
The vasoconstrictive effects of hyperbaric therapy can also impair subcutaneous absorption of insulin, making the patient hypoglycaemic. The physician may also consider monitoring blood glucose levels between hyperbaric therapy sessions.
Respiratory disorders Due to decompression, at the end of the HBOT, the volume of gas increases, while pressure in the chamber diminishes, and this can generate partial pneumothorax or aggravate an underlying pneumothorax. In a patient with a pneumothorax that has not been drained, decompression could cause tension pneumothorax to develop.
Moreover, considering the risk of expansion of the gas during the decompression phase of hyperbaric therapy, the benefit/risk balance of hyperbaric therapy should be carefully assessed in patients with insufficiently controlled asthma, pulmonary emphysema, chronic obstructive pulmonary disease (COPD), and recent chest surgery.
6) Oxygen is an oxidizing agent and, therefore, supports combustion. ) oxygen may spontaneously activate combustion when exposed to a trigger (sparkle, naked flame, source of ignition), or resulting from adiabatic compression in […]