Langtidsbehandling med oksygen - Jubileumsbok for Norsk forening for lungemedisin

Elin Tollefsen

Langtidsbehandling med oksygen i hjemmet defineres som døgnkontinuerlig eller minst 15 timer i døgnet bruk av oksygen i riktig tilpasset dose. I Norge har ambulant

langtidsbehandling med oksygen vært i bruk fra slutten av 1970-tallet.

Fritt, ubundet oksygen (O₂), både i atmosfæren og løst i vann, er av vital betydning for alle levende organismer for å opprettholde åndedrettet og tilsvarende forbrenningsreaksjoner. Oksygen som gass er smakløs, fargeløs og luktfri, som væske og fast stoff har oksygen en svakt blålig farge. Atmosfæreluft inneholder 21 volumprosent oksygen. Atmosfærens oksygeninnhold er en forutsetning for at et stoff kan brenne. Hvis oksygeninnholdet øker med 1–2 % øker forbrenningshastigheten dramatisk. Nesten alle stoffer, også metaller, kan brenne i ren oksygen.

Oksygen produseres i dag ved å kjøle ned luft til den blir flytende. Luften destilleres og oksy-gen skilles ut. Oksyoksy-gen lagres under trykk som gass på flasker eller nedkjølt som flytende oksyoksy-gen på vakuumisolerte tanker. Oksygen brukes i industrien (metallurgisk, kjemisk og mekanisk industri) og i medisinsk behandling. Oksygen i medisinsk behandling innebærer tilsetning av ekstra oksygen til inn-åndingsluften, slik at den får et høyere prosentvis innhold av oksygen enn vanlig atmosfæreluft. Til-setning av oksygen øker gasstrykket av oksygen i lungesekkene (alveolene) (PAO2), noe som igjen øker oksygentrykket i arterieblodet (PaO2).

Historikk

Oksygenets oppdager var engelskmannen J. Joseph Priestley som i 1774 fremstilte oksygen ved å spalte kvikksølvoksid ved oppvarming. Franskmannen Antoine Laurent Lavoisier erkjente at oksygen er et grunnstoff (1). I en publikasjon fra 1777 beskrev Lavoisier oksygen relatert til forbrennings-prosessen og til åndedrettet slik vi kjenner det i dag. Over ett århundre senere beskrev Haldane bruk av oksygen ved klorgassforgiftning under første verdenskrig (2).

Bruk av oksygen i sykehus økte raskt på 1900-tallet. Fra slutten av 1950-tallet var også ambu-lant oksygen i vanlig bruk i England og Amerika. Ambuambu-lant, transportabelt oksygen ved kronisk respi-rasjonssvikt ble beskrevet i 1956 (3). Langtidsbehandling med oksygen i moderne form ble utviklet i Denver, Colorado (4). Rundt 1970 kom flere publikasjoner om langtidsbehandling med oksygen, men vitenskapelig evidens for effekt i forhold til økt overlevelse ved kronisk obstruktiv lungesykdom ble først publisert i 1980 og 1981 med henholdsvis «Nocturnal oxygen therapy trial» (NOTT) (5) og

«Medical research council working party trial on domiciliary oxygen» (MRC) (6). Oksygenbehandling gis til pasienten via maske eller nesekateter. Utviklingen av nytt og mer brukervennlig utstyr førte til at man etter hvert kunne tilby pasientene oksygenbehandling hele døgnet.

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K A P I T T E L 2 5

Non-invasiv ventilasjon ved

In document Jubileumsbok for Norsk forening for lungemedisin (sider 161-166)