POINT Peri-Operative Insufflatory Nasal Therapy

Transcription

1 PINT Peri-perative Insufflatory Nasal Therapy by Armstrong Medical Helping prevent peri-operative pulmonary complications

2 PST-P RECVERY PERATING RMS Hypoxia; a peri-operative risk Pulmonary complications may present at any stage of the patients peri-operative experience. Pre-op Securing an artificial airway remains a hazardous procedure during the induction of anaesthesia. HIGH RISK PATIENTS High BMI Emergency intubations Difficult intubations Critically ill Intra-op Patients with respiratory disease have an increased chance of developing complications peri-operatively. Cardiac, Thoracic and Abdominal surgery present the highest risk of PPC (*). Cardiac 39.6% Post-op Post-operative pulmonary complications (PPC) are linked to increased length of stay and mortality. HIGHEST RISK F PPC Thoracic 31.4% (*) Abdominal 7.2% 2 *PELSI P, GREGRETTI C, (2010) Perioperative management of obese patients, Best Practice & Research Clinical Anaesthesiology 24,

3 Physiology of PINT. PINT provides 5 physiological benefits to support your patient during the peri-operative period. ACCURATE Fi 2 Flow rates closer to the patient s PIR reduce entrainment of room air and the subsequent dilution of Fi 2 (a). MAINTAINED MUCCILIARY FUNCTIN Heated and humidified oxygen therapy ensures patient comfort and compliance to achieve the physiological benefits at higher flow rates. ALVELAR RECRUITMENT Studies have demonstrated variable PEEP is achieved (2-7cmH 2 ) with Nasal High Flow (NHF) (c). APNEIC XYGENATIN During apnea, external respiration ceases. Diffusion of oxygen from alveoli to capillaries continues as normal while C 2 from the capillaries into the alveoli decreases reducing lung volume and alveolar pressure. This pressure gradient creates aventilatory mass flow from the nasopharynx to the alveoli in the presence of a patent airway (b). ALVELAR RECRUITMENT NASPHARYNGEAL DEAD SPACE WASHUT High flow oxygen therapy delivered via nasal prongs can reduce the patient s dead space by up to one third in adults. (a) GTERA C, LBAT D, PINT T, WINCK JC, (2013) Clinical evidence on high flow oxygen therapy and active humidication in adults, Pneumologia 19(5), (b) PATEL A, NUAEI SAR, (2015) Transnasal Humidified Rapid Insuflation Ventilatory exchange (THRIVE): a physiological method of increasing apnoea time in patients with difficult airways, Anesthesia 70, (c) PARKE et al, (2009) Nasal high flow therapy delivers low level positive airway pressure, British journal of Anaesthesia 103 (6),

4 What s the PINT? Pulmonary complications may present at any stage of the patient s perioperative experience. Appropriate interventions can minimise these risks in the pre, intra and post-operative periods (*). PINT delivers humidified high flow therapy to support your patient during the peri-operative period. PINT Features Adjustable flow rates Integrated 2 analayser Adjustable Fi2 AquaNASE high flow cannula Ultra-PEP therapy AquaVENT humidification 4

5 PINT Applications Pre-op Increased and accurate pre-oxygenation Increased apneic window for management of difficult airways Intra-op Apneic oxygenation during ENT surgery Respiratory support during procedural sedation Post -op Reversal of anaesthesia induced atelectasis Improved secretion clearance Why choose PINT? READY T USE PINT system does not require decontamination between patients PINT starter Flowkit protected by BioCote, for rapid set up when required Rapid heat humidification chamber, achieves optimal temperature quicker Portable for use during transport IMPRVED CNTRL Accurate Fi 2, higher flow rates reduce dilution from room air Adjustable Fi 2, reducing concerns over 2 toxicity or absorption atelectasis Adjustable flow rates for nasal cannula (60L/min) and face mask CPAP (>60L/min) Humidification improves patient comfort and secretion clearance Ultra-PEP aids improved FRC and secretion clearance * CANET J et al, (2010) Prediction of postoperative pulmonary complications in a population based surgical cohort, Anaesthesiology 113, 1-6 5

6 Post-operative therapies Studies have demonstrated variable PEEP (2-7cmH2) can be achieved with Nasal High Flow (a). Variable factors include flow rate, size of prongs in relation to the nares and mouth or nose breathing. The PEEP is pressure due to the resistance generated by the continuous administration of high flow of gas (60L/min). For some patients variable PEEP provided by NHF may not be adequate and high flow CPAP with a face mask is required. Post-operative atelectasis Atelectasis is present in 90% of patients post-op and is associated with increased rates of post-operative pulmonary complications. Atelectasis promotes bacterial growth in the lung (b) increasing the risk of post-operative pneumonia. 6 (a) PARKE et al, (2009) Nasal high flow therapy delivers low level positive airway pressure, British journal of Anaesthesia 103 (6), (b) SQUADRNE V et al, (2005) Continuous Positive Airway Pressure for Treatment of Postoperative Hypoxemia, JAMA, 293 (5),

7 PINT Plus (CPAP) PEEP versus CPAP; what s the difference? PEEP & CPAP are often mistaken as one and the same therapy. Defining the difference helps us understand the benefits and limitations of each therapy. 10cmH 2 7cmH 2 PRESSURE 5cmH 2 2cmH 2 1cmH 2 CPAP NHF PEEP -2cmH 2 TIME NRMAL BREATHING PINT Range *ptional pressure measurement 120L/min flow *Pressure respiratory rate and apnoea alarms Integral digital oxygen display MaxVenturi TM 120 Max flow rate CPAP 140L/min, NHF 60L/min Both MaxVenturi TM 120 and FD140 are supplied with AquaVENT heater humidifier FD min internal battery life AquaVENT heater humidifier *For transition from NHF to CPAP, adequate flow rates and pressure measurement are essential. 7

8 Armstrong Medical Wattstown Business Park Newbridge Road Coleraine BT52 1BS Northern Ireland T +44 (0) F +44 (0) E info@armstrongmedical.net W Codes rdering Information Code Description Box Qty AMH1509/030 Heated Humidified xygen System complete with AquaNASE Nasal Cannula and bacterial viral breathing filter AMH1509/008 AquaVENT Heated Humidified xygen System complete with AquaNASE Nasal Cannula 10 AMPT1001/002 Ultra-PEP Exerciser with manometer 20 AMCPUK01258 CPAP adaptor kit 20 AMNS1004 AquaNASE Nasal High Flow System (4mm) 30 AMNS1005 AquaNASE Nasal High Flow System (5mm) 30 AMNS1006 AquaNASE Nasal High Flow System (6mm) Distributed by: Armstrong manufacture a complete range of disposable respiratory products for anaesthesia and critical care applications. For supply of these products or any product within the Armstrong range, please contact your local representative. AMPINT_V2