New Oxygen Use Guidelines for Acute & Chronic Heart Failure Patients

New Oxygen Use Guidelines for Acute & Chronic Heart Failure Patients

Emergency rooms around the world see a number of Heart Failure patients presenting with breathlessness and other associated symptoms. The usual treatment of these patients is often times oxygen therapy with the use of diuretics to clear the pulmonary edema. Patients with heart failure have also been prescribed supplemental oxygen therapy for home use. Let’s see if portable oxygen concentrators are something that these patients should be going for. 

What is Acute Heart Failure & Chronic Heart Failure?

Acute Heart Failure

Acute Heart Failure is the inability of the heart to function properly, all out of blue. The body simply doesn’t get enough oxygen because the heart is unable to pump out proper amounts of blood. 

Chronic Heart Failure 

 In this disease, the heart starts to slow down over a period of time. This results in the heart being unable to pump oxygenated blood to the body. This condition shows up in the patient as persistent coughs, swollen feet, palpitations, crepitation noise from lungs, increased breathing rate, long term sense of tiredness. Most importantly a patient with chronic heart failure appears to be out of breath quite frequently. 

Both of these types see a rise in edema in the periphery and the lungs.

How is the Oxygen Level Affected in Heart Failure Patients?

A patient with heart failure has a heart that is unable to pump blood properly throughout the body. This means that the blood that goes into the lungs is unable to get out of the lungs efficiently. The vessels that run across the lungs, with the tiny air sacs (alveoli), are filled with blood to the extent that the fluid leaves the veins and collects in the lung tissue. This fluid collection in the lungs is termed Pulmonary Edema.

This symptom can occur in both acute and chronic heart failure. The fluid inside the lungs makes it hard for the lungs to absorb the appropriate amount of oxygen. These patients have a hard time breathing and keep on coughing out sputum.   

Guidelines for Oxygen Use in Acute & Chronic Heart Failure Patients

You need to understand the disease to know when to allow the use of oxygen devices at the hospital or oxygen concentrators at home. A lot of research has been done to understand the effects of oxygen on the body of a person with or without normal blood levels. It is the acute presentation that is seen in the hospital emergency rooms. Let’s have a look at the two types of presentations of heart failure. 

Normal/Preserved Ejection Fraction 

In this case, the ejection fraction is normal which means the systolic function is not affected. This means that the heart can perfectly pump out oxygenated blood to the body.

What is the Effect of Oxygen on a Heart Failure Patient with Normal Oxygen Levels?

There are times when a patient is wrongly prescribed high amounts of oxygen just because they appeared in the emergency room or because someone didn’t fully check the oxygen levels. This situation often causes far more damage than was previously believed. Hyperoxemia is dangerous in the following ways: 

  • An increase in reactive oxygen species lowers nitric oxide levels. This results in the narrowing of blood vessels (vasoconstriction). 
  • ATP- sensitive K channels close down and this cause the narrowing of the vessels that supply to the heart tissues. 
  • High production of vasoconstricting 20-HETE. 
  • Angiotensin I converts to Angiotensin II and that encourages endothelin-1 spread that causes constriction of blood vessels. 

The capillaries are simply unable to let the blood out to the heart tissues. While the blood oxygen levels increase, the oxygen is unable to reach the different organs because of narrowed blood vessels.

While early times didn’t have the best testing facilities, it was not contraindicated to give oxygen therapy via oxygen tanks or oxygen concentrators at the hospital. With current research and awareness, it is necessary to choose a treatment that doesn’t deteriorate the patient’s health. 

Lessened/Reduced Ejection Fraction

The issue is reversed in this case, the heart’s systolic function is not working as it should and as a result, a lower amount of blood is sent out to the body. The body receives less amount of oxygenated blood than it should and this makes it difficult.

Current Treatment Guidelines for Heart Failure Patients With Low Oxygen Levels  

ESC guidelines state that oxygen therapy should be given to patients who present with acute conditions and SpO2 < 90% or PaO2 <60 mmHg. The provision of oxygen helps in increasing the blood oxygen level. It is best if they provide 1-6 LPM of oxygen if nasal tongs are used. Face masks need to have a higher oxygen flow of up to 5-10 LPM.

Patients that present with tachypnea are provided additional support via CPAP that works with HFNO. This option tends to improve lung functions. However, if the situation doesn’t get better, the NIPPV with Bi-PAP is used. The ultimate goal is to keep the lungs responsive to breathing and absorption of oxygen.

Nowadays, oxygen is given with a humidifier. The gas is administered at a temperature of 31 to 37 C. This treatment helps clean up the airways through the action of cilia. Patients feel better and adhere to the treatment.  Further, the humidifier makes it less dry for the patient. 

If all of the above-mentioned options don’t function, the patient is treated with invasive positive pressure ventilation. 

Nocturnal Oxygen Therapy for Heart Failure Patients  

There are patients with heart failure that face sleep-disordered breathing that causes issues when they are up and about. Research supports the use of Nocturnal Oxygen Therapy in patients with ventricular issues. These patients are issued this oxygen therapy because of the fear of low oxygen levels at night.

The patient who presents with the above-mentioned condition is given up to 1 to 2 LPM oxygen at night time. Their symptoms are assessed for further treatment planning.  If the oxygen levels get better as noted by the pulse oximeter, the therapy ends. 

What is the Verdict on Using Oxygen Devices for Heart Failure Patients?

 It is important to understand disease progression to make an educated decision on whether or not a patient needs an oxygen concentrator for home use. We know that using a portable oxygen concentrator at home can alleviate some symptoms but the benefits are short-term if prescribed wrongly. It is best if the expert physician prescribes oxygen devices themselves. 

Even when you are prescribed these oxygen concentrator devices, make it a point to keep a check on your oxygen levels.  

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