High Flow Therapy (HFT)

Adult Population

Nursing Educational Series

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

Continuum of Care

What if there was a therapy that was a bridge between

02 Therapy and Bi-Level?

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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

Mechanisms: Humidity

●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

Pulmonary Physiology and Dead Space

Pulmonary Pathophysiology

Pulmonary Pathophysiology

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Mechanisms: Standard Oxygen Therapy

●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

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Mechanisms: High Flow Therapy

Illustrates HFT Therapeutic Flow Ranges:

25-35Lpm

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

HFT Clinical Review

Clinical Applications & Benefits

Flow First™Early Intervention Is The Key

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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

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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

Q & A