Systems differ in their ability to deliver optimal humidification

Transcription

1 Average Absolute Humidity (mg H 2 O/L) Systems differ in their ability to deliver optimal humidification 45 Flows Tested Optiflow Airvo 2 Vapotherm Vapotherm 5 L/min 10L/min 20L/min 30L/min 40L/min Fisher & Paykel 20 L/min 40 L/min 50 L/min Waugh JB, Granger WM. An evaluation of 2 new devices for nasal high-flow gas therapy. Respir Care. 2004;49(8): Chikata Y, Izawa M, Okuda N, et al. Humidification performance of two high-flow nasal cannula devices: a bench study. Respir Care. 2014;59(8):

2 Absolute Humidity mg/l Exposure to Suboptimal Humidification Leads to Dysfunction Adapted from: Williams, Robin; Rankin, Nigel; Smith, Tony; Galler, David; Seakins, Paul, Relationship between humidity and temperature of inspired gases and the function of airway mucosa, Critical Care Medicine. 24(11): , November 1996.

3 Importance of Humidification to the Respiratory System: Review Assists natural defense mechanisms in the airway Promotes efficient gas exchange and ventilation Increases patient comfort and tolerance to therapy Promotes smooth muscle relaxation

4 Mitigating Rainout Heated Wire Water Jacket

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6 Relevant Clinical Research

7 High-Flow Oxygen Adult Study Frat et al. High-Flow Oxygen through Nasal Cannula in Acute Hypoxemic Respiratory Failure New Engl J Med. Group Flow / Pressure Mask FiO 2 Duration / Application Outcome: Intubation Rate 13 L/min > 0.80 Continuous or until recovery or 100% O 2 intubation HFNC 48 L/min 0.82 Continuously for at least 2 days 38% 47% NIPPV PIP/PEEP 8/5 cmh2o hr /day for at least 2 days; HFNC between applications 50% 4,777 Patients admitted to the ICU in respiratory distress 582 Patients excluded for hypercapnia 313 Underwent randomization

8 Memorial Herman Poster Data R Graham RRT1, B Melton RRT1, S Croft RRT1, T Green RRT1, O Easton RRT1, B Bauer RRT1, P Doshi MD2 1Memorial Hermann Healthcare System, Houston, TX 2UT-Houston Medical School, Houston, TX

9 Initial Presumed Diagnosis 3% 3% 3% 29% 31% 14% 6% 11% COPD CHF Asthma Pneumonia General Dyspnea Pulmonary Fibrosis Sarcoidosis Other

10 Disposition Decision Floor Admission ICU Admission Discharged Home Known Disposition % Discharged Home 12% ICU Admission 32% Floor Admission 56%

11 Multicenter Emergency Dept. Experience Data from 6 centers compiled in publication with 128 forms Athens Regional Medical Center, Athens GA Memorial Hermann TMC, Houston TX Memorial Hermann Northeast, Humble TX Memorial Hermann The Woodlands, TX Erlanger Health System, Chattanooga, TN Missions Hospital, Asheville, NC Demonstrated clinical & economic benefits Expertise and clinical pathways for use (protocol developed)

12 Initial Presumed Diagnosis 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% COPD General Dyspnea CHF Pneumonia Asthma Overdose Sarcoidosis Unreported

13 Initial Respiratory Assessment Increased WOB Combined Failure Hypercapnia Hypoxemia 0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

14 Disposition Decision Discharged Home General Care Floor ICU 0% 10% 20% 30% 40% 50% 60% Known Disposition % ICU 41% General Care Floor 54% Discharged Home 5%

15 Who Are The Right Patients? Symptoms General Dyspnea Bi-level intolerant Hypercapnia Refractory Hypoxemia Increased cardiac workload Increased Work of Breathing Conditions Acute COPD Exacerbation Mild/Moderate Congestive Heart Failure Asthma Pneumonia Bronchitis Bronchiolitis (RSV) Influenza

16 Applications Emergency Department NICU PICU Post Acute Care Palliative Care General Respiratory Failure Bronchiolitis COPD Pneumonia Asthma CHF

17 Requirements for Effective Therapy Nares are not obstructed Adequate flow and velocity to flush dead space Patient is spontaneously breathing & able to protect airway Facilitates CO 2 ventilation by reduction of dead space

18 Choose the Appropriate Interface Cannula should be sized not to occlude greater than 50% of the nares Cannula prongs should be spread enough not to pinch the nasal septum Allow the system to reach at least 33 before connecting delivery tube to the cannula or trach adapter

19 Where do I start???

20 Patient Safety

21 Summary HVNI is a refined form of HFNC which is able to flush expiratory gas from the dead space to facilitate oxygenation and alveolar ventilation using higher velocity HFNC is primarily an oxygen therapy Patient comfort and adherence are optimal with HVNI when compared to conventional respiratory modalities HVNI may be used in the Emergency Department with patients in respiratory distress and/or impending respiratory failure 21

22 Questions? Thank you!