An assessment needs to be conducted by a suitably qualified assessing health provider to determine the clinical need and the most suitable treatment.
Chronic Airways Disease, Pulmonary Fibrosis and other respiratory disease Oxygen will be provided where the following criteria is met. The client’s:
- PaO2 is equal to or less than 55 mmHg in the absence of complicating factors.
- PaO2 is equal to or less than 60 mmHg where significant complicating factors such as chronic anaemia, pulmonary hypertension, or polycythaemia exist.
- Treatment of the respiratory condition should be optimised, and a stable state achieved where possible, before blood gases are obtained.
The oxygen flow that maintains a PaO2> 60 mmHg (SaO2> 90%) should be identified where possible.
Asthma – A client that has experienced repeated episodes of sudden life-threatening asthma despite compliance with appropriate maintenance therapy.
Terminal Malignancy – The client has cancer, with lung involvement causing hypoxaemia, and a life expectancy of less than six months.
Nocturnal Hypoxaemia – The client has isolated nocturnal hypoxaemia with nocturnal oxygen saturation equal to or less than 90 percent for more than 5% of the night, based on continuous overnight SaO2 monitoring during sleep, and secondary effects of chronic hypoxia such as daytime somnolence, polycythaemia or right heart failure are present. Where possible, an oxygen flow that maintains SaO2 greater than 90% should be identified.
Hypoxia with exercise (Exertional Hypoxaemia) –The client experiences exercise induced oxygen desaturation on either a walk or step test to SaO2 < 90% while breathing room air, PLUS a demonstrable improvement in exercise performance on supplemental oxygen.
Please provide the results that demonstrate this as justification. An oxygen flow to achieve improvement should also be established.
The client will be provided with equipment best suited to their needs to facilitate 2 hours use/day in the most cost efficient manner. Should additional supplies be required, these should be requested by the assessing health provider.
Cardiac Disorders - The client’s PaO2 at rest is less than 55 mmHg on room air in the absence of significant complicating factors, or 60 mmHg where significant complicating factors exist (see above).
In isolated cases of extreme cardiac disability, oxygen may be prescribed without blood gas measurements in the following circumstances:
- Severe intractable angina on maximal drug therapy where further surgery is not clinically appropriate.
- Recurrent episodic pulmonary oedema, severe pulmonary hypertension or severe chronic cardiac failure where no other drug therapy or interventional procedures are possible.
These indications are to be primarily thought of as palliative care.
Nebuliser Therapy - It is considered inappropriate for oxygen cylinders to be used for nebuliser therapy, as a nebuliser pump is adequate, and avoids any risk of hyperoxia.
Other - Assessing health providers may prescribe a variety of oxygen therapies including portable oxygen.
Special Circumstances - Requests for HMOT outside the Guidelines should be discussed with the DVA Rehabilitation Appliances Program on
1800 550 457 (option 1).