What is the better option for a patient requiring supplemental oxygen, an oxygen concentrator or an oxygen tank?

Oxygen Concentrators vs. Oxygen Tanks for Home Oxygen Therapy

For patients requiring long-term supplemental oxygen at home, oxygen concentrators are the preferred option for flow rates of 4 L/min or less, while oxygen tanks (cylinders) should be reserved for ambulatory use or as backup systems. 1, 2

Primary Recommendation for Stationary Home Use

• Oxygen concentrators should be the standard delivery system for long-term oxygen therapy (LTOT) at home when patients require flow rates ≤4 L/min 1, 2
• Concentrators are more cost-effective than cylinders, with studies showing 75% cost savings (0.17 vs 0.79 US cents per liter) 3
• They eliminate logistical supply chain problems inherent to cylinder delivery systems, particularly important in areas where cylinder supplies are unreliable 4
• Concentrators require only an electrical power source (<400W), which can be provided by standard electricity, generators, or solar/wind systems 3

When to Use Oxygen Tanks Instead

• Portable cylinders are indicated for ambulatory oxygen therapy to allow patients to maintain mobility outside the home 1, 2
• Cylinders provide approximately 2 hours of use at 2 L/min flow rate 1
• They serve as essential backup systems when concentrators malfunction or during power outages 1
• For patients requiring high flow rates (>4 L/min), cylinders may be necessary as concentrators become less efficient at higher flows 1, 2

Critical Technical Considerations

Oxygen Concentration Differences

• Concentrators deliver lower oxygen concentrations than piped or cylinder oxygen at equivalent flow rates 5
• At 2-5 L/min flow rates, concentrators maintain >80% oxygen concentration, compared to nearly 100% from cylinders 3
• This difference means patients assessed on hospital piped oxygen may require higher flow rates when switched to home concentrators 5
• Blood gas measurements must be repeated with the actual home concentrator to ensure adequate oxygenation (target PaO2 >8 kPa or 60 mmHg) 1

Device Selection Algorithm

1. For stationary home use requiring ≤4 L/min: Use oxygen concentrator as primary source 1, 2
2. For mobility needs: Provide portable cylinders or oxygen-conserving devices 1, 2
3. For flow rates >4 L/min: Consider cylinders or liquid oxygen systems (where available) 1, 2
4. For patients with cognitive impairment or high respiratory rates: Consider Venturi mask systems with concentrators to ensure accurate oxygen delivery 1, 2

Delivery Interface Recommendations

• Nasal cannulae are the first-choice delivery device for both concentrators and cylinders 1, 2
• Venturi masks provide more accurate oxygen concentration and should be used for patients at risk of hypercapnic respiratory failure 1, 2
• Oxygen-conserving devices can extend cylinder duration for ambulatory patients requiring high flows 1, 2

Common Pitfalls to Avoid

• Never prescribe over-the-counter portable oxygen concentrators without FDA clearance, as studies show many fail to provide adequate oxygenation 6
• Do not assume concentrator settings established in hospital will translate directly to home use—formal reassessment is mandatory 5
• Avoid prescribing humidification for non-tracheostomy patients, as it provides no benefit and increases infection risk 1, 2
• Ensure patients understand fire safety: no smoking, no open flames, and keep oxygen sources away from heat sources 1

Monitoring Requirements

• Six-monthly follow-up with home visits by respiratory healthcare workers is essential to assess equipment function and patient compliance 1, 2
• Arterial blood gases should be rechecked annually to adjust flow rates as disease progresses 1
• Patients must use oxygen for minimum 15 hours daily (including sleep) to achieve mortality benefit 1, 2

Special Populations

For patients with chronic lung disease requiring ambulatory oxygen, demand oxygen delivery systems (DODS) can be considered, but 20% of patients show clinically significant desaturation (≥4% drop) with DODS compared to continuous flow 7. Individual testing is mandatory before prescribing DODS devices 7.