COVID-19: When should a person opt for oxygen support at home?


When it comes to treating a Covid-positive patient at home, there is a lot of confusion as to which course of action is the best, and how one can make a person feel comfortable at home, without having to worry about getting admitted in the hospital.

It has to be kept in mind that among other things, there are some tell-tale signs as to when hospitalisation is required. This includes a six-minute walk test for patients who are getting treated at home and whose oxygen levels are normal at room air and during resting. It is recommended the patient walks in the room for 6 minutes at a normal pace and rechecks the oxygen levels. If oxygen levels drop after the walk, then it’s a sign of early hypoxia and this patient should look for beds in the hospital, or get an oxygen concentrator at home with the advice of their doctor.

Dr Sanjay Shah, consultant, general physician, Fortis Hospital Mulund explains that oxygenation should be preferred when blood oxygen levels (SpO2) readings drop below 94 per cent.

“Ideal oxygen levels should be between 95-99 per cent. While no oxygen therapy can instantly boost oxygen levels or restore them to normal, Covid patients should aim to achieve a saturation of up to 92 per cent. Achieving 100 per cent saturation shouldn’t be done when the body is sick. This may exhaust your resources quicker — whether it is a concentrator or cylinder that you use,” he says.

What is an oxygen concentrator?

The doctor goes on to explain that an oxygen concentrator is an electronically operated device that separates oxygen from room air. It provides a high concentration of oxygen directly to you through a nasal cannula. “These devices work on the principle of ‘rapid pressure swing absorption’, which is where the nitrogen is removed from the air using zeolite minerals which absorb the nitrogen, leaving other gases to pass through and capturing oxygen as the primary gas. The collected oxygen is 92-95 per cent pure.”

Things to keep in mind

Dr Shah says normal air will have 21 per cent oxygen. If 1-litre oxygen is provided to the patient through the concentrator, the oxygen percentage in lungs rises to 24 per cent, with 2 litres it rises to 28 per cent, and with 10 litres, it rises to 60 per cent.

“There is a need for monitoring this from time-to-time to ensure the flow of oxygen is proper and the patient is not over oxygenated. Seek your doctor’s advice to decide how many litres per minute of oxygen is required for the patient. Keep a pulse oximeter handy to check oxygen levels from time to time.”

Who is eligible for an oxygen concentrator?

According to Dr Shah, “only mild to moderately-ill patients”, who have “an oxygen saturation level between 90-94 per cent”, should depend on an oxygen concentrator and can use it at home.

“We must understand hoarding of such life-saving equipment will only worsen the country’s problem. Anyone with oxygen saturation depleting below 80-85 per cent may need a higher flow of oxygen and will have to switch to a cylinder or liquid medical oxygen supply and may eventually need hospitalisation,” he cautions.

Another way to improve oxygen level is the prone position. Read all about it here.

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