Is This the Right Time to Consider Using Oxygen-conserving Devices in Clinical Practice?

The ongoing threat of viral mutation and emerging respiratory pandemics underscores the urgent need to strengthen healthcare systems, particularly in medical oxygen supply. During the COVID-19 crisis, the critical role of oxygen became evident. India’s medical oxygen demand surged dramatically – from a baseline of 700 MT (metric tons)/day to 3100 MT/day in the first wave – and, surprisingly, rose 12-fold to 8900 MT/day in the second wave.[1,2] This brought attention to address the existing oxygen-conserving devices (OCDs). From the 1980s, various OCDs have been developed to reduce waste, including the transtracheal cannula, reservoir cannula, and oxymizers.[3] Demand oxygen delivery systems, developed by various institutions in the USA, which deliver oxygen only during inspiration. Later, they were modified over the years, but not utilized in current clinical practice. The EconO2mizer is another low-flow OCD designed for hospital use, with limited data. From 2021, the COVID-19 pandemic led to the design of new OCDs, such as the AMLEX device, designed by IIT Ropar, which underwent limited clinical trials, lacked large-scale validation and commercialization, despite being offered for free mass production.[4] The Defense Research and Development Organization OCDs were initially developed for use in war zones by soldiers, but were not widely adopted by hospitals until the pandemic. Hybrid flowmeters are still under the development by various institutions with limited trial data and unspecified, requiring further validation and research. Recently, in 2024 (USA), OXFO systems integrating a selenoid valve and reservoir in high-flow nasal cannula were studied in a smaller population in an unblinded randomized crossover study; they need global validation, and the cost is not disclosed.[5] Despite their potential benefits, one significant limitation is that many OCDs are designed for portable cylinders, making them unsuitable for critical care settings where central pipeline systems dominate. Most studies are preliminary, involve healthy volunteers or stable patients, and lack validation in critically ill populations that exhibit irregular, shallow breathing. Many OCDs have technical complexities, such as needing calibration and maintenance, no battery backup, and further restricting adoption. Cost is another concern, as incorporating expensive components such as sensors, microcontrollers, and selenoid valves. Many OCDs focus on “on-demand” oxygen supply, which delivers oxygen only during inspiration, and have shown mixed results. Delays in delivery and poor synchronization with patient effort further compromise safety and comfort. A way forward: Redesign and research Device design-simple, understandable mechanism, compatible with both central pipelines and cylinders, requiring minimal training and maintenance, and user-friendly for frontline users Clinical trials - OCDs should undergo testing across a variety of intensive care unit patients, with measurable outcomes Collaboration - involving clinicians, biomedical engineers, manufacturers, and hospital staff to increase the utilization and acceptance Government and institutional support-it can speed up the bulk production of OCDs, training initiatives, and future preparedness Global validation - device should be tested across multiple healthcare settings to ensure safety and adaptability. Any newly developed OCD should undergo thorough testing and validation by recognized regulatory authorities. Device safety, reliability, and compliance with standard biomedical regulations must be assured before routine clinical use. Limitations The text lacks the specific details on the outcomes or limitations of current clinical trials or OCDs and it does not adequately address the potential barriers to implementation within existing healthcare frameworks that could hinder their widespread adoption. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.