Oxygen concentrators: Everything you need to know about it

With the second wave of the Coronavirus pandemic wreaking havoc in India, oxygen concentrators are in demand, as they are considered as a life-saving equipment for patients with breathing difficulties. Oxygen concentrators are now the most wanted medical device in India, as it can help COVID-19 patients, when their oxygen levels drop and oxygen cylinders are in short supply.

What should be your normal blood oxygen level?

Different methods are used, to measure the blood oxygen levels. Blood testing and pulse-oximeter monitoring, are the common means to estimate oxygen saturation levels. Oxygen saturation (SpO2) that is the amount of oxygen in the blood for adults, should be 95% to 100%. A SpO2 level below 90% is known as ‘hypoxemia’. For patients who have chronic lung conditions and other breathing problems, the normal SpO2 range of 95% to 100% does not apply. Such individuals should consult with their doctors, to determine the acceptable oxygen levels for their unique state of health. If the blood oxygen saturation level is below 80%, then, it may impair the functioning of the heart and brain, which could lead to respiratory failure or cardiac arrest.

Oxygen concentrators are meant to provide oxygen for patients with chronic obstructive pulmonary disease (COPD) and in higher concentrations, for chronic hypoxemia and pulmonary edema.

However, not all COVID-19 patients need oxygen, points out Dr Nikhil Kulkarni, consultant – internal medicine, Fortis Raheja, Mumbai. “Some COVID-19 patients experience shortness of breath and oxygen deprivation. Patients with fluctuating oxygen levels may require hospitalisation. The SARS-COV-2 virus can cause inflammation in the lungs that impacts the supply of oxygenated blood in the body. In such cases, the use of oxygen concentrators can raise the oxygen level,” Kulkarni explains.

See also: COVID-19: Home setup for caring for a patient at home

What is an oxygen concentrator?

Air is made up of 78% nitrogen and 21% oxygen. An oxygen concentrator works by absorbing the oxygen from the air and filtering out the nitrogen. It concentrates the oxygen, which is then dispensed through a pressure valve that regulates the flow to the nasal cannula. An oxygen concentrator cuts down the need for constant refilling, as it draws oxygen from the surrounding air.

Should you buy or rent oxygen concentrator for home?

Although blood oxygen levels below 90% are considered as concerning, experts maintain that not all cases of oxygen imbalance require intensive care support or hospitalisation. Mild cases can be managed with oxygen concentrators, under proper guidance from a doctor, especially at a time when securing hospital access is difficult. Nevertheless, an oxygen concentrator is also no substitute for situations where hospitalisation is necessary. If a patient requires more than five litres of oxygen per minute, then, he/she needs to be medically supervised.

“An oxygen concentrator is prescribed as a temporary respite or stop-gap till hospitalisation or to aid recovery at home for patients with low oxygen, depending on the patients’ health. Use of oxygen therapy at home can help raise oxygen levels. It is compulsory to have a doctor’s approval to use the device and should be used only as advised. An oxygen concentrator can help in those critical hours, between oxygen levels dropping and the patient being admitted to the hospital. A doctor’s guidance is needed on how much oxygen has to be given, as oxygen toxicity can have adverse effects,” cautions Kulkarni.

Dr Ajay Sankhe, director, Bhakti Vedanta Hospital and Research Centre, Mumbai, further adds: “For up to five litres of oxygen per minute, home use of oxygen concentrator is acceptable, if it is approved by an experienced COVID physician. No nurse is required till five litres. Above that, in case a patient needs, say, 10 litres of oxygen per minute, then, hospitalisation is needed and one must avoid managing the patient at home, as the patient’s condition can deteriorate any time due to the disease.”

What is the difference between oxygen concentrator and oxygen cylinder?

Oxygen concentrators can serve as alternatives to cylinders in some cases but it can only supply five to 10 litres of oxygen per minute. Critical patients may need 40-50 litres of oxygen per minute. Concentrators are moveable and need no special temperature to operate. While oxygen cylinders can run out of oxygen and need to be refilled, a concentrator will never run out of oxygen, as long as power supply for the unit is available. Oxygen concentrators can produce oxygen 24 hours and last five years or more.

Oxygen concentrators generate up to 95% pure oxygen. They are equipped with sensors that indicate when the purity level reduces.

Oxygen concentrators are a viable option to provide oxygen at home or in a mobile clinic, especially where liquid or pressurised oxygen is inconvenient to use. Oxygen concentrators can be used at the convenience of patients, under the supervision of a doctor or healthcare personnel.

Experts are of the opinion that the oxygen generated by oxygen concentrators, is good enough for mild and moderate COVID-19 patients with oxygen saturation levels above 85%. However, this oxygen is not advisable for ICU patients, who need 99% Liquid Medical Oxygen (LMO).

Oxygen concentrator vs oxygen tanks

Oxygen concentrator price

Oxygen concentrators are available in various sizes, models, styles and brands. Oxygen concentrators cost around Rs 40,000 to Rs three lakhs and more, whereas cylinders are priced between Rs 8,000 and Rs 20,000. Concentrators are usually a one-time investment, besides the electricity / battery and maintenance that it may need. In India oxygen concentrators are imported from China, Taiwan and the USA. The two leading manufacturers of domestic-use oxygen concentrators in the country are BPL Medical Technologies and Philips.

The demand for oxygen concentrators is high in India now, due to the surge in COVID-19 cases. Consequently, there is a shortage of oxygen concentrators and there are cases of panic hoarding and black marketing. If one is unable to buy, then, one can also opt for an oxygen concentrator on rent.

See also: COVID-19: How to sanitise vegetables, milk packets, deliveries and more

How to choose an oxygen concentrator  based on flow rate

When buying an oxygen concentrator, always check the ‘flow rate’ capacity. The oxygen concentrator must be used, based on the doctor’s prescription – the doctor will recommend the flow requirement in litres per minute (LPM), based on the patient’s condition and how much supplemental oxygen therapy is needed. Some oxygen concentrators may have flow rates in the range of 250 to 750 millilitres per minute, while others may offer flow rates in the range of two to 10 liters per minute. It is advisable to opt for a unit that has more capacity than necessary – for example, if one needs 3.5 LPM, then, choose an oxygen concentrator with 5 LPM flow rate.

Portable oxygen concentrator

There are mainly two types of oxygen concentrators – large stationery ones, which cannot be moved around and are made to supply more oxygen and small oxygen concentrators, which can be transported during traveling and for outdoor use. Portable oxygen concentrators typically weigh between two and four kgs and come with pulse flow and continuous flow modes, depending on one’s need and doctor’s advice. Pulse flow portable oxygen concentrators supply oxygen only when the patient inhales. Continuous flow oxygen concentrators supply oxygen at a constant rate, regardless of the patient’s breathing.

How much power does an oxygen concentrator need?

It is better to opt for a concentrator that has the lowest power consumption. There are various models that also work on batteries. The battery time varies per product. Also, continuous flow oxygen concentrators have a shorter battery life than pulse flow oxygen concentrators, because they put out more oxygen.

Oxygen concentrator operating noise level

All oxygen concentrators make noise but due to progress in technology, the products have become quieter. One should ideally opt for models where the sound levels range from 31 to 60 decibels.

Additional tips for buying an oxygen concentrator

• An oxygen concentrator can only be used under a doctor’s prescription and under medical supervision. It is not to be considered as a treatment for COVID-19.
• If power supply is an issue, then, also buy a standby generator, a solar power inverter or a back-up battery and voltage stabiliser, to keep it safe during power fluctuations.
• Always choose a reputed brand and one which offers warranty.
• The government of India has now allowed the import of oxygen concentrators for personal use, through post, courier, or e-commerce portals, under the gift category. According to a notification of the Directorate General of Foreign Trade (DGFT), this exemption for personal use is permitted till July 31, 2021.

How to set up and use an oxygen concentrator at home

• Place the oxygen concentrator one or two ft away from the wall and furniture, so that it has free space to draw in oxygen. Moreover, this will help to dissipate the heat, as the machine gets hot when in use.
• Next, connect the oxygen tube to either the humidification bottle (if prescribed) or an adapter.
• Check if the oxygen concentrator’s air filter, which is used to remove particles and allergens from the air, is in place.

Steps to switch on the oxygen concentrator

• Turn on the oxygen concentrator at least 15-20 minutes before using it.
• Plug it into a socket of a grounded electrical outlet and ensure that the oxygen concentrator is singularly plugged into that outlet, as it will use a lot of power.
• Switch on the power button. When you turn on the machine, you will hear the sound of the machine being processed. Always check the light indicator to ensure if the machine is working properly.

How to adjust the oxygen flow rate in an oxygen concentrator?

Locate the control liter knob and turn the knob to the prescribed litres per minute (LPM), as advised by the doctor.

How to put on the mask or nasal cannula?

• The tubing should not be bent or twisted, as it can hinder the flow of oxygen.
• Place the mask over the patient’s face in a way that there are no gaps around the ends of the mask. Adjust the tubing to fit comfortably under the chin. Slide the tubing over and behind both ears.
• Fit the nasal cannula upward into the nostrils for high levels of oxygen. Breathe through the mask or nasal cannula. Take breaths as you normally would.

Safety tips for using oxygen concentrator at home

• Keep the oxygen concentrator at least 10 ft away from gas stoves. It should be placed in a well-ventilated area, away from sources of ignition.
• Never keep a matchbox, lighters, burnt candles or diffusers, near it.
• Do not smoke or let anyone smoke near the oxygen concentrator.
• Keep it at least two ft away from the walls and furniture when in use, to allow sufficient air intake.
• Avoid using anything flammable near the unit, including hand sanitisers and aerosol sprays, petroleum-based products like vaseline or air fresheners. Ensure that alcohol-based solutions and oil do not come into contact with oxygen supply devices.
• As the oxygen concentrator becomes hot when in use, keep it in a well-ventilated area, away from curtains.
• Avoid using an extension cord; use a proper electrical outlet.
• Keep the oxygen container upright and turn off the system when it is not being used.
• Always have a fire extinguisher nearby.

See also: 20 things housing societies must know to fight Coronavirus

When using an oxygen concentrator, keep in mind the following tips:

• When using a concentrator at home, an oximeter (that measures oxygen saturation) is an essential device. It is advisable to use a pulse oximeter to check the readings, preferably every two hours (or as advised by the doctor). In case of fluctuation in the oxygen levels or if there is no improvement in spite of the external oxygen supply, then, the patient may require hospitalisation.
• The concentrator takes time to begin cycling the correct concentration of air. So, turn it on 15 to 20 minutes before use.
• Always check where the litre control knob is positioned. It will be marked with numbers that indicate litres per minute (LPM), such as 1, 2, 3, etc. Adjust the button to the prescribed LPM. If in doubt, clarify with your physician. Never change the oxygen concentrator’s flow rate, without consulting with a doctor first.
• Ensure that the tube is not bent before using the concentrator. Any hindrance may cause inadequate oxygen supply.
• If one is using a nasal cannula to get elevated levels of oxygen, place it upward in the patient’s nostrils.
• If a humidifier is recommended by a doctor, replace the water in the humidifier with distilled or boiled water, daily.
• Clean the exterior of the machine once a week with a damp cloth and mild soap. Before cleaning, always switch off the machine. Ensure that water does not spill over the machine.
• Wash the filter once a week and always dry it properly, before use. Follow proper hand hygiene, when cleaning the filter.
• The concentrator’s inlet filter that removes particles from the air is removed or changed for cleaning. So, always check that the filter is in place before using it.
• Its is advisable to keep spare oxygen tubing and cannulas at home, in case either piece is damaged during use. Replace the nasal cannulas and tubing once a month, if the oxygen concentrator is used constantly.
• The sieve beds on the concentrator have to be replaced every one or two years, depending on the model.
• Read the manual carefully, to see if the oxygen concentrator has a gross particle filter and the recommended time mentioned to change it.
• If the filter is choked, then, the oxygen’s purity will drop. Most of the machines have an alarm, when this happens. The filters need to be replaced periodically, in such cases.

Oxygen concentrator in India

Philips Oxygen Concentrator

The Philips Respironics Everflo Oxygen Concentrator provides up to five litres of airflow which is up to 93%-96% pure and weighs 14 kgs.

BPL Oxy 5 Neo Oxygen

It provides up to five litres of oxygen supply with up to 93% oxygen purity level. It also has a built-in nebuliser, displays the operation time on LCD and has a timer with turn off function.

Airsep New Life Elite Oxygen Concentrator

It provides up to five litres of continuous flow of oxygen. It has a battery-powered alarm system that sounds in case of a power failure. It has an ‘Economy Mode’ for low power consumption.

Inogen One G5

It is a lightweight model which has smart Bluetooth connectivity and has six oxygen flow levels that can be adjusted as per the need. It has a battery run-time of up to 13 hours.

Dedakj DE-1S Oxygen Concentrator

It is lightweight and can provide upto six to eight litres of oxygen at up to 93% purity levels. It supports double oxygen absorption function, which enables two people to use it simultaneously.

FAQ