44 Continuum of Care: Old Model 4 General 02 Therapy Acuity Choice of Therapy General 02 Therapy Bi-Level Mechanical Ventilation CPAP Rescue Weaning Bi-Level CPAP
Continuum of Care: Old Model 5 Low Flow Cannula Oxygen MaskCPAP / Bi-Level Mechanical Ventilation Flows limited to 1 – 5Lpm Higher Fi02 Achieved Pressure Support Patient Completely Ventilated Fi02 typically <.40 Easily Tolerated Poorly Tolerated Claustrophobia Cannot Eat, Take Meds Off more than On Tight Fitting Mask Not well tolerated Over Utilized Used when Patients Fail CPAP/ BiPAP Some Patients Hard To Wean Invasive
Continuum of Care What if there was a therapy that was a bridge between 02 Therapy and Bi-Level?
77 Continuum of Care: New Model 7 General 02 Therapy Acuity Choice of Therapy General 02 Therapy Bi-Level Mechanical Ventilation CPAP High Flow Therapy Rescue Weaning Bi-Level CPAP
High Flow Therapy: Precision Flow 8 High Flow Therapy Via Nasal Cannula 5 – 40 Lpm Precision Flow ® -Precise Temperature, Blending, & Flow -Humidification with no Rainout -Patient’s Demands Met -Easily Tolerated by Patient -Higher Fi02s than a Mask - Audible Alarms
High Flow Therapy: Definitions - Flow rate that exceeds patient flow demands at various minute volumes ● A method to achieve actual FiO2 of 1 ● Eliminate entrainment of ambient air - Accomplished in the nasopharynx only with proper gas conditioning ● Conventional cannula therapy limited by nasal damage ● HFT becomes more than oxygen therapy - Combination of technologies to achieve optimal temperature, humidity and flow rate at the point of delivery
Control the Factors that Matter… Combination of proprietary technology to achieve optimal: Flow Fi02 Temperature Humidity at the point of delivery.
11 High Flow Therapy: Mechanisms of Action Humidify / Warm AirwaysSupports Inspiration Flush Dead Space ● CO 2 Elimination ● Oxygen Efficiency ● Cannula Flow > inspiratory ● Work of Breathing ● Mobilization of Secretions ● Nasal comfort
Mechanisms: Humidity ● Nasopharynx is h ighly efficient at conditioning inspiratory gas ● Anatomical Structure ● Mucosal Architecture Inspiratory Gas Conditioning
● Williams et al, 1996, Crit Care Med 24(11): 1920-9 Why BTPS?
Vapor Transfer Cartridge: ● Key to efficient, high performance humidification and gas conditioning ● Also serves as filter--pore size much smaller than 0.05 microns Patient Delivery Tube: ● Patented triple lumen design ● Design prevents rain-out ● Keeps gas conditioned out to patient ● Safer than traditional heater wire design Mechanisms: Humidity (How We Do It)
Flush Dead Space & Support Inspiration Mechanisms: Physiology & Dead Space
Pulmonary Physiology and Dead Space
21 Mechanisms: Standard Oxygen Therapy
● High nasal flow, unimpeded at mouth, fills the upper airways – storing O 2 during exhalation and flushing CO2 Flush Dead Space & Support Inspiration ● High mask flow, impeded by pressure at the mouth - stores less O 2 in the upper airways during exhalation and adds prosthetic dead space Tiep, et al: Resp Care, 2002: High Flow Nasal vs High Flow Mask oxygen delivery: Tracheal Gas Concentrations Through an airway model
Dead space washout ● Supports CO 2 ventilation ● Enhances oxygenation Matched inspiratory flow ● Attenuates nasopharyngeal resistance Adequate gas conditioning ● Improves conductance and compliance ● Reduces energy cost of gas conditioning Mechanism of Action Review
Flow First ™ Early Intervention Is The Key 26 HFT Clinical Review
Indications for Use: Indications: ● Spontaneously breathing patients who are requiring supplemental oxygen therapy ● Any patient who is on an oxygen mask that is: 1. Not compliant, 2. not improving, 3. Or has an increase in work of breathing ● Post- extubation support or weaning from NPPV ● Patients requiring supplemental heat & humidity for artificial airways Contraindications: ● Patients not spontaneously breathing ● Patients that have a deviated septum ● Patients with severe facial trauma or disfigurement
28 Mechanisms by Application HFT DOES NOT TREAT A DISEASE, THE MECHANISMS TREAT SYMPTOMS Here are a sample of some disease states and how the mechanisms of action treat the symptoms. Can you think of other respiratory insufficiencies where the symptoms can be treated by HFT?
HFT Conclusions – Patient Care Aspects ● Non-invasive Interface – Nasal Cannula - No Masks to Fit - No Leaks to Worry About - Patient Can Eat, Talk, Take Meds ● Ability to Control Factors Independently - Can Deliver Temp, Flow, Fi02 to Meet Patients Exact Needs - Can Deliver High Flow and Low Fi02 for “Retainers”
HFT Conclusions – Patient Care Aspects ● Ability to Oxygenate Better than a Mask - No Need to Use Pressure Devices Just to Oxygenate Patients - Excellent Weaning Tool for Patients on BiPAP ● Can Be Used on Multiple Diagnosis - Used to Treat Entire Spectrum of Respiratory Compromised Patients - Mouth Breathers & Difficult to Treat Patients ● Low Maintenance While on Patient - No Masks to Keep Tight - No Rainout in Patient Delivery Tube - Circuit Good for 30days LOS - Easy to Read Display