1. OptiflowTM via AirvoTM High/Low Flow Oxygen Delivery System
Devika Cook Charge Nurse Adult and Emergency PACU Auckland City Hospital

2. What is the definition of a double blind study?

3. Two Orthopaedic Surgeons trying to read an ECG!

4. Objectives

5. OptiflowTM Nasal High/Low Flow Oxygen Therapy
Designed to meet inspiratory demand
Provides natural balance of temperature and humidity
Low level positive airway pressure
Used in conjunction with the AirvoTM

6. AIRVOTM High-performance humidifier and integrated flow generator
Consistent temperature & humidity level
Accurate FiO2 with a constant flow rate
Ability to alter flow rate (15-45 lpm and oxygen percentage 21-60%)

7. Indications for Use Increased respiratory demand
Intolerance of conventional face mask
Hypoxia/Emergence Agitation
Major surgery – abdominal, head and neck
High BMI
Obesity
Smoker

8. Benefits Easy to implement Comfort → patient compliance
Not affected by NGT
Can prevent less invasive ventilation
Direct Delivery to Naso/Oro-Pharynx
Less dilution effect

9. Benefits - cont Disadvantage
Warm humidified oxygen
Less damage to mucosa
Improved gas exchange and O2 saturation
Decreased LOS in PACU
Transferable system for ward use
Reduced care costs
Disadvantage
No battery pack, dependent on AC power

10. Case Study 34 year old male caucasian Post-Op Lap Appendicectomy
ASA 1 – training for Auckland Marathon
? Aspirated on induction
CXR – “slight” Pulmonary Oedema
Decreased saturations in PACU

11. Clinical Presentation
Patient not distressed
Breathing not laboured
Hudson Mask on 15 litres
Persistent low sats 88-90%
Nil complaints of Pain or PONV
Circulation stable
Medical request for CPAP circuit

12. CPAP Circuit
“Dolly Parton”

13. OptiflowTM/AirvoTM Circuit

14. Treatment 1400 - OptiflowTM via AirvoTM commenced
Initially set for high oxygenation
15 lpm of oxygen (piped via flow meter)
15 lpm flow rate (generated by AirvoTM)
Approximate oxygen concentration 63%
Arterial line inserted
ABG’s at 30 minute intervals

15. Treatment - cont 1500 – sats slight improvement to 92%
1600 – sats up to 94%
1630 – commenced weaning of O2
↓Oxygen flow 7 lpm(50%)
↑Flow rate to 30 lpm
Saturations constant in mid 90’s
Constant monitoring of ABG’s & pulse ox
OptiflowTM/AirvoTM titrated for effect

16. AIRVOTM Table

17. Outcome Referred to HDU → “wait & see”
Oxygen flow decreased incrementally
Steady improvement in saturations
Re-routing of ward
Six hours later stable
Oxygen flow ↓ 5 lpm
Flow rate maintained at 35 lpm approx 32%
Maintaining saturations at 97-98%
2000-transferred to Gen Surg ward with OptiflowTM/AirvoTM

18. Resolution 24 hours later CXR Pulmonary Oedema resolved completely
Maintaining adequate saturations on air
48 hours – discharged home
Unable to complete the Marathon 

19. “Simply Better Oxygen Therapy”
Conclusion
Early intervention with OptiflowTM/AirvoTM O2 delivery and humidification does have an impact on patient outcomes
Works relatively quickly – sustained effect
Suitable for patients when conventional masks are not feasible
Can decrease LOS in PACU
“Simply Better Oxygen Therapy”

20. Acknowledgements Product Specialist F & P Annelise La Roche
Materials Management ACH
Nurse Educators PACU
Liz Boucher & Penny Jones
Level 8 PACU RN’s
For embracing the technique and ongoing support of the system

21. The A, B, C of Anaesthesia
Airway
Bagel
Coffee