Troubleshoot — Cannot Desaturate

Contents

Some customers have issues desaturating. This is nearly always because of specific issues with user physiology. As a rule, only well-trained athletes and conditioned users will have predictable desaturation responses.

This article is split into two sections. The first section explains common issues with the user. The second section is a checklist for issues that may occur over time.

There are a handful of issues that may make a new user think LiveO2 isn’t working properly because a pulse oximeter does not readily show a decrease in oxygen concentration in the blood while using ‑O2. This often leaves the user wondering what is happening…

If the issue is with LiveO2, it’s easy to detect and correct the problems. When the issue is part of the user physiology — It’s more difficult to understand but still easy to test:

If the user ‘feels extra challenge’ on ‑O2 — the system is working properly.

User-specific desaturation problems

Most of the time users cannot desaturate because of one of these reasons.

#1: User metabolism challenge that interferes with blood oxygen exchange or poor hand circulation

Many new LiveO2 users have metabolic issues that interfere with blood gas exchange. There are three common dysfunctions:

Capillary shunting. These users exhibit unusually high O2 saturation levels because issues flow restrictions in capillary beds shunt blood around the tissue. Oxygen levels remain high because oxygen never reaches tissue and is underused.
Nutrient deficiencies. The body requires sufficient amounts of B‑vitamins to affect gas transfer to the tissue. Deficiencies inhibit transfer and may inhibit the ability to saturate or desaturate.

These issues often happen together. Each element reduces the user’s apparent ability to desaturate as read by a pulse oximeter.

Shunting prevents oxygen from leaving the blood
Nutrient deficiencies prevent oxygen from leaving the blood
Carbon monoxide and oxygen are indistinguishable by a pulse oximeter.

But… No matter how these factors interfere with the pulse oximeter there is a very effective test.

The users will feel the ‑O2 challenge. Inefficient respiration makes users very sensitive to reduced oxygen levels. That leads us to…

The simplest test for a new user

If your users feel extra difficulty on the ‑O2 setting then this is a strong and reliable indicator that the system is working properly.

Most users will slow down on ‑O2 and speed up on +O2. Users with compromised respiration will quickly notice the decrease in oxygen from 75% to 14% for LiveO2 AC.

#2 User was exposed to Carbon Monoxide

Carbon monoxide has a higher affinity for hemoglobin than oxygen and may be due to environmental exposure or internally generated as a result of dysfunctional cellular respiration. Pulse oximeters cannot distinguish blood-carrying carbon monoxide from blood saturated with oxygen. Users with carbon monoxide will not desaturate.

Carbon monoxide binds to hemoglobin sites just like oxygen. Pulse oximeters cannot distinguish hemoglobin with Carbon Monoxide from Oxygen. Carbon monoxide can be environmental or endogenic (from inside the body). Carbon monoxide binds to hemoglobin about 240x more readily than oxygen.

Carbon monoxide in the blood will prevent the pulse oximeter from reading correctly. It will read as though the blood is saturated with oxygen when it is not. We have also seen individuals who appear to have carbon monoxide toxicity when there was no known exposure to carbon monoxide as though it was endogenous (made inside the body) from inefficient metabolism.

When training with LiveO2 — the high binding affinity of carbon monoxide makes it look like the person cannot desaturate.

Carboxyhemoglobin

Carboxyhemoglobin is produced by the binding of carbon monoxide (CO) to hemoglobin. CO is generated during incomplete combustion of organic products and has toxic effect because it competes with oxygen for the same binding site in the Fe²⁺ of Hb. Hemoglobin bound to CO is unable to transport O₂. Hb has a 210-fold greater affinity for carbon monoxide than for oxygen, which explains the extraordinary toxicity of CO even when its concentration in the inspired air is relatively low. For example, breathing air containing 0.02% CO for 2 h causes symptoms, such as headache and nausea. A concentration of 0.1% produces loss of consciousness within 1 h and death by asphyxia in only 4 h. Car exhaust gases contain between 4% and 7% CO and toxic concentrations are readily achieved in poorly ventilated environments (garages). Carboxyhemoglobin has a cherry red color. For that reason, subjects intoxicated with CO show apparently “healthy” reddish lips and cheeks.

Contact your trainer for support. We have specialized protocols to expedite carbon monoxide release from hemoglobin.

Physical Failure Checklist

Here are physical failures that can result in failure to desaturate.

#1: Enthusiastic user cranked the oxygen flow meter too high

The oxygen flow meter should be set to 10 LPM or maybe slightly above. Some new users will open the oxygen flow to maximum and the ball will be at the complete top of the oxygen flow range. This error will also cause the air separator to display an amber light that will never go off.

This pushes so much air through the air separator that both the oxygen concentration in +O2 is low, and the oxygen concentration in the ‑O2 is high. The extra oxygen at the ‑O2 setting often prevents users from desaturating.

#3: Ripped breather hose

This occurs when the breather hose is pulled so hard the membrane between the ribs rips and allows room air to leak in when the user inhales.

This leak allows room air to dilute both the +O2 and ‑O2 air which inhibits both oxygen saturation and oxygen desaturation.

The best way to test this is to carefully inspect the hose to assure the membrane between the ribs is intact for the entire length of the hose.

Tutorial: Inspect and replace a damaged breather hose

If you doubt your inspection, remove the breather hose from the reservoir and plug one end with your thumb. Air should not escape when you blow air in from the unplugged end.

If air escapes or you find a tear you will need to replace the breather hose.

#4: Poor Mask Seal

Make sure the mask is sealed properly- suck test. Put the mask on your face and inhale while blocking the upper air inlet port. This should cause the mask to draw to your face.
Use a mirror to make sure the mask valves are opening and closing correctly when the mask is on.
Make sure to not touch the silicone valve flaps when putting on the breather hose.

#5: Pulse Oximeter Issues

Make sure the batteries are not low.
Make sure the user does not have any type of fingernail polish.
Make sure they are not grasping the handlebars too tightly
Change fingers if the reading is slow to respond.
Make sure they don’t have excessive movement of the finger.

#6: Failed Air Separator (LiveO2 AC)

Each air separator has an internal tester to assures air is separated into oxygen rich, +O2, over 75% and oxygen reduced, ‑O2 mixtures, below 16%.

This is the amber light tester assures that oxygen is at least 75% pure. At a 10 LPM flow rate, it also assures that the ‑O2 level is less than 16%.

Amber light is off — the system is working properly.

This test allows LiveO2 users to know their system is always working without need for repeated testing. We test all air separators before shipping, but they can fail over time, and sometimes during transport.

When an air separator fails, the amber light glows like in the image below. If you see this then go to the amber light diagnostic.

#7: Failed Valve

This one is very rare. Every system is pressure tested before shipping.

Switches between +O2 and ‑O2 should cause a distinct and audible latch as the valve locks into the opposite position. This latch mechanism assures three things:

The mechanical components of the valve are working properly each time the user switches;
The valve fully switched between ‑O2 and +O2 air to disallow mixing inside the valve;
The valve is internally sealed.

Demonstration of Proper functioning valve with latch effect

If you there is no distinct latch. Please contact customer service.

#8: Internal Reservoir Leak

If you are still having problems disconnect the breather hose and insert it into the overflow release port.

This isolates the air supply to only ‑O2 bypassing the oxygen reservoir and valve. Exercise breathing this air. If you desaturate with this configuration differently than on the ‑O2 setting please contact customer service.

All else fails Order a Tester

Contact support and we can provide a separate oxygen tester that will enable you to test the actual output of oxygen from the reservoir at the mask.

We put this last because every air separator has a built-in tester that continuously tests the oxygen level created by the air separator. This built-in tester continuously assures proper oxygen concentration.

Our support department can optionally provide an oxygen tester to confirm the levels are correct as delivered to the mask. Oxygen Test Meter Deposit

Updated on May 18, 2022

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