High flow cannula oxygen delivery and the hypoxemic patient

Slides:

Advertisements

Similar presentations

O 2 RESPIRATORY TO BREATHE OR NOT TO BREATHE, THAT IS OUR QUESTION! Hope Knight BSN, RN.

Advertisements

Educational Resources

High Flow Therapy (HFT)

Mechanical Ventilation in the Neonate RC 290 CPAP Indications: Refractory Hypoxemia –PaO2 –Many hospitals use 50% as the upper limit before changing.

Faisal Malmstrom, Critical Care Department SKMC

1 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license.

High Flow Therapy (HFT) NICU Population Nursing Educational Series.

High Flow Therapy (HFT)

OXYGEN THERAPY Dora M Alvarez MD Oxygen Delivery Systems A-a Gradient Oxygen Transport Oxygen Deliver to Tissues.

Pathophysiology of Respiratory Failure Fern White & Annabel Fothergill.

Noninvasive Oxygenation and Ventilation

Part I: Noninvasive Positive Pressure Ventilation in the Acute Care Facility By: Susan P. Pilbeam, MS, RRT, FAARC John D. Hiser, MEd, RRT, FAARC Ray Ritz,

High Flow Nasal Cannula for Patient Care Units- ACH

Mechanical Ventilation POS Seminar Series December 2008 Dr. J. Wassermann Anesthesia, Critical Care St. Michael’s Hospital University of Toronto.

Positive Pressure Ventilation in Acute Respiratory Failure

BASIC VENTILATION Dr David Maritz.

CPAP Murila fv. Respiratory distress syndrome 28% of neonatal deaths are due to prematurity The most common respiratory disorder in the preterm is Respiratory.

DR MUHAMMAD BILAL NON INVASIVE VENTILATION. DEFINITION : - DELIVERY OF MECHANICAL VENTILATION TO THE LUNGS THAT DON’T REQUIRE ET.T. OR TRACHEOSTOMY IRON.

Respiratory Equipment Most Often Used in Hospice Care Mark Schroedel, CRT Walgreens Home Care.

Effect of different cycling off criteria and positive end-expiratory pressure during pressure support ventilation in patients with chronic obstructive.

Respiratory failure 31/08/2011 Vivian Ho. Contents Definition Types Pathogenesis Effects Blood gases Management.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Respiratory Respiratory Failure and ARDS. Normal Respirations.

นพ. ธรรมศักดิ์ ทวิช ศรี หน่วยเวชบำบัด วิกฤต ฝ่ายวิสัญญีวิทยา รพ. จุฬาลงกรณ์

Mechanical Ventilation Mary P. Martinasek BS, RRT Director of Clinical Education Hillsborough Community College.

Highlights of RSPT 2414 Mechanical Ventilation: Unit 1 By Elizabeth Kelley Buzbee AAS, RRT- NPS, RCP.

Physiology of respiratory failure:

Is the failure of pulmonary gas exchange to maintain the normal arterial O2 and CO2 level. It is divided in to type I and II in relation to the presence.

BY: NICOLE STEVENS.  Primary objective of mechanical ventilation is to support breathing until neonates own respiratory efforts are sufficient  First.

High flow oxygen therapy

Respiratory Failure. 2 key processes ■ Ventilation ■ Diffusion.

Complex Respiratory Disorders N464- Fall Ventilator-Associated Pneumonia (VAP) Aspiration of bacteria from oropharynx or gastrointestinal tract.

NON INVASIVE VENTILATION IN OBESE HYPOVENTILATION SYNDROME:

Principles of Mechanical Ventilation Mazen Kherallah, MD, FCCP.

( Noninvasive Positive Pressure Ventilation)

Simon Barry Cardiff November 2015

Principles of Mechanical Ventilation Mazen Kherallah, M.D., FCCP Internal Medicine, Critical Care Medicine, and Infectious Diseases Initial Ventilatory.

Rusu Gabriel- General Medicine.  Major interventions significantly affects the functions of more systems such as respiratory one, increasing the risk.

Principles of Mechanical Ventilation Magdy M Khalil, MD, EDIC Prof. Pulmonary& Critical Care Medicine.

+ Non-invasive Positive Pressure Ventilation (NPPV) Basheer Albahrani, RT.

Acute Respiratory Failure: 5 types of Hypoxemia

Invasive Mechanical Ventilation

Acute respiratory failure

Indication and use of Domiciliary NIV

Weaning From The Ventilator

CPAP and High-Flow Nasal Cannula Oxygen in Bronchiolitis

Oxygenation Chapter 50.

Mechanical Ventilation

Advanced Ventilation Research

So you want to start a ventilator program? What you should know!

Mechanical ventilator

EFFECTS OF INTRAPULMONARY PERCUSSIVE VENTILATION AS COMPLEMENTARY TECHNIQUE IN NONINVASIVE MECHANICAL VENTILATION DURING COPD EXACERBATIONS.

Respiratory Failure Dr. Nick Weatherley Respiratory Registrar.

Review of supplemental oxygen and respiratory support for paediatric emergency care in sub-Saharan Africa Andreas Hansmann, Brenda May Morrow, Hans-Joerg.

Session 4: Living with and managing nocturnal hypoventilation in MND

Session 4: Living with and managing nocturnal hypoventilation in MND

Catherine Jones Practice Educator

Aerosol Therapy & HFNC Natalie Napolitano, MPH, RRT-NPS, FAARC

Respiratory Disorders

You could ventilate a patient

Mechanical ventilator

Ennis James, M.D. Wednesday May 8th, 2018

Focus on Respiratory Failure

Session 3: Living with and managing nocturnal hypoventilation in MND

Ventilator Strategies and Rescue Therapies for Management of Acute Respiratory Failure in the Emergency Department Jarrod M. Mosier, MD, Cameron Hypes,

Oxygen, carbon dioxide, breathing and hypoxia

Oxygenation Chapter 32.

MECHANICAL VENTILATION

Kaplan–Meier survival curves for outcomes among chronic obstructive pulmonary disease (COPD) patients without obstructive sleep apnoea (OSA) (COPD group),

Presentation transcript:

High flow cannula oxygen delivery and the hypoxemic patient Eustace S Fernandes MD Lutheran Medical Group Pulmonary and Critical Care

Objectives Discuss rationale for high flow nasal cannula (HFC) usage Discuss physiologic implications of high flow cannula oxygen delivery Discuss the use of HFC in particular disease states COPD OSA High risk extubation

Why do we need oxygen?

Causes of hypoxemia V/Q mismatch Shunt Diffusion disorder Alveolar hypoventilation Altitude Abnormal Hb

Special Patient Populations CO2 retainers Nocturnal vs continuous in severe COPD

Modes of Oxygen Delivery Spontaneous respiration Nasal cannula High Flow NIV Mechanical ventilation ECMO Patient effort

Why High Flow?

What is high flow delivery? What affects the volume of oxygen inhaled? Gas flow Concentration of oxygen from flow meter Inspired volume RR and VT Respiratory pattern

What is HFC delivery? Requirements: Gas delivery system Humidification Heater Patient interface Cannula must accommodate 60LPM flow 4mm-6.5mm diameter

What is HFC delivery? Increased FIO2 CPAP effect Comfort Warmth /humidification Improved mucociliary clearance

Int Care Med 2011; 37 (11): 1780-1786

Specific Diseases COPD OSA High risk extubation

COPD

Burden of COPD exacerbation COPD effects 1/10 globally 15M in US 3rd leading cause of death 13.2 billion in annual HC costs COPD exacerbations causes worsening of underlying chronic condition and may increase mortality

Chronic Obstr Pulm Dis. 2014; 1(2): 166-184

Outpatient HFC? 6.2 kpa=46mmHg 8.9kpa=66.8mmHg

Why?

OSA

Positive pressure therapy remains standard of care

Compliance remains an issue…..

Could HFC delivery be an alternative to CPAP?

TNI: HFC delivery

Children? Often associated with a broader medical syndrome Therapeutic options Tonsillectomy Wedge Oral appliance Nasal steroids CPAP/BiPAP

HFC delivery in children

High risk extubation

Who is high risk? Age > 65 APACHE II score > 12 BMI > 30 Airway patency problems Secretions (suction > 2 x prior to extubation) Difficult/prolonged wean Prior failure Co-morbid conditions

Is HFC superior to conventional oxygen therapy?

Conclusions Oxygen is necessary Multiple modalities of oxygen delivery tailored to the patient’s need and ability to participate High flow nasal cannula is a unique delivery system that may help struggling patients “bridge the gap.” High flow nasal cannula has applications in acute and chronic settings that may improve patient comfort, outcomes and morbidity More studies are needed to define the role of HFC in treatment of the hypoxemic patient