high flow therapy (hft) adult population nursing educational series
Post on 15-Dec-2015
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Agenda
• Respiratory Patient Tx Model ( Old & New )
• Review of High Flow Therapy (HFT®)
• Clinical Applications & Benefits
• Precision Flow® Demonstration
• Q & A
Oxygen Therapy -vs- Ventilation
Oxygen Therapy Goals –
- 1. Correct hypoxemia- 2. Decrease symptoms associated with hypoxemia- 3. Decrease workload on cardiopulmonary system
N.I.V.Therapy Goals –
- 1. Improve Gaseous Exchange (02-CO2)- 2. Decrease intrapulmonary Shunt- 3. Assist the Pt’s Spontaneous Respiratory Effort & Alleviate Dyspnea- 4. Reduce Work of Breathing- 5. Avoid Intubation & Ventilation
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Continuum of Care: Old Model
4
General 02Therapy
Acu
ity
Choice of Therapy
General 02Therapy
Bi-Level
MechanicalVentilation
CPAP
Rescue Weaning
Bi-LevelCPAP
Continuum of Care: Old Model
5
Low FlowCannula
Oxygen Mask CPAP / Bi-Level MechanicalVentilation
Flows limited to 1 – 5Lpm
Higher Fi02Achieved
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
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Continuum of Care: New Model
7
General 02Therapy
Acu
ity
Choice of Therapy
General 02Therapy
Bi-Level
MechanicalVentilation
CPAP
High Flow Therapy
Rescue Weaning
Bi-Level
CPAP
High Flow Therapy: Precision Flow
8
High Flow TherapyVia 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.
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High Flow Therapy: Mechanisms of Action
Humidify / Warm Airways
Supports Inspiration
Flush Dead Space
●CO2 Elimination●Oxygen Efficiency
●Cannula Flow > inspiratory●Work of Breathing
●Mobilization of Secretions●Nasal comfort
Mechanisms: Humidity
●Nasopharynx is highly efficient at conditioning inspiratory gas
●Anatomical Structure
●Mucosal Architecture
Inspiratory Gas Conditioning
Conditioning Prevents Injury
Inadequate warming and humidification can cause:
● Thickened Secretions
● Decreased mucocilliary action
● Thermal challenge
● Bloody secretions
● Lung atelectasis
Mechanisms: Humidity
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)
●High nasal flow, unimpeded at mouth, fills the upper airways – storing O2 during exhalation and flushing CO2
●High nasal flow, unimpeded at mouth, fills the upper airways – storing O2 during exhalation and flushing CO2
Flush Dead Space & Support Inspiration
● High mask flow, impeded by pressure at the mouth - stores less O2 in the upper airways during exhalation and adds prosthetic dead space
● High mask flow, impeded by pressure at the mouth - stores less O2 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 CO2 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
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
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Mechanisms by Application
Oxygen Flush Humidity Mild Pressure
COPD
Fibrosis
Asthma
CHF
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
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