TABLE 1.

Advantages and Considerations of Oxygen Sources

SourceAdvantagesConsiderations
LOX
  • Enormous production capacity (can supply countries and hospital systems).19,22

  • Maintenance responsibilities are often outsourced to businesses that are skilled in maintaining plants.

  • Lower production costs than PSA plants.19,24

  • Can be stored in large tanks or cylinders, or piped directly to beds.23

  • Capable of providing high flow rates.23,25

  • Can be stored for use in unstable power situations.19,23

  • Plants are extremely expensive, creating high barriers to entry with one or few LOX supplier options.19

  • LOX plants typically located in central cities: transportation to very remote areas can be as expensive if not more so than the cost of the oxygen itself. Size of transportation vehicle or number of cylinders can also limit the amount of oxygen which can be transported.19,26

  • Recurring costs every time tanks or cylinders are refilled; tank or cylinder rental costs may also occur.23

PSA and VSA plants
  • Moderate production capacity (can supply a network of health care facilities).

  • Can be located in more geographically diverse areas, meaning plants can be constructed on-site or near target hospitals, reducing transportation distance, costs.19,23,24

  • Can be stored in cylinders if cylinder filling capacity is included, or piped directly to beds.19,23

  • Cylinders can be used in unstable power situations.19,23

  • Capable of providing high flow rates.23

  • Requires regular maintenance, technical expertise, tools, test equipment, and spare parts to remain operational.19

  • Responsibilities and budget requirements often fall to the plant’s host hospital. Without them, the plant will fail.19,23,24

  • Requires reliable power supply, and a back-up generator with fuel is strongly recommended.19,2224

Oxygen concentrators
  • Can provide a small, continuous supply of oxygen (can supply 1–2 patients at a time).19,23

  • Only recurring costs are power and maintenance.19

  • Very low capital barriers to entry, making it easier to acquire in resource-constrained settings.27

  • Very small production capacity.

  • Flow rates not suitable for high flow patients.19,23

  • Dependent on a steady power supply; back-up power supply is strongly recommended, or back-up cylinders.23

  • Requires regular maintenance, technical expertise, tools, test equipment, and spare parts to remain operational; responsibilities and budget requirements often fall to the hospital. Without them, the concentrator will fail.25

  • Can be difficult for clinicians to identify when concentrators are only producing room air and not oxygen.

  • Abbreviations: LOX, liquid oxygen; PSA, pressure swing adsorption; VSA, vacuum swing adsorption.