humidified nasal prong oxygen...2013/08/09 · • nasal prong • oxygen • “high flow” –...
TRANSCRIPT
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Humidified Nasal Prong Oxygen
Arjun Rao Sydney Children’s Hospital, Randwick
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Outline
• Terminology • Basic setup • Background • Does it work? • How does it work? • When should I use it? • How to set up? • Transport implications
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Terminology
• Humidified • Nasal prong • Oxygen • “High Flow”
– > 1L/kg/min
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Basic Setup
Intensive Care Med (2013) 39:247–257
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Background
• Initially studied in neonates
PEDIATRICS Vol. 107 No. 5 May 2001
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Does it work?
• Depends on our outcome measures • Apnoeas • Work of breathing / physiology • Comparable to CPAP • Reduced intubation • Length of admission
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• Flow rate 7L/min generated positive pressure throughout respiratory cycle
• Mean partial pressure and flow correlated • Flow >2L/kg/min -> PP >4cmH20 • Increased flow from 1 -> 7L/min led to
improved work of breathing and decreased RR • Problem of generating PP throughout cycle
with fixed flow
Intensive Care Med (2013) 39:1088–1094
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• Retrospective cohort study • HHFNC reduced intubation rate from 16% to
8% • ED intubation rate fell from 11% to 2% • No increased length of ventilation for failed
HHFNC • No mention of use of CPAP
Pediatr Emer Care 2012;28: 1117Y1123
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How does it work?
• No definitive mechanism proven • Theories include: • “Washout” of nasopharyngeal dead space • Reduction of upper airway resistance • Positive pressure effects • ? Benefits over CPAP
– Easier setup and monitoring – CPAP may require sedation, problems with nasal
trauma
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When should I use it?
• Most studied in infants with bronchiolitis • Infant with respiratory distress secondary to
bronchiolitis • Trial more extended population where access
to PICU/CPAP/Invasive Ventilation more limited
• If no benefit in physiology after 60-90 minutes, then unlikely to be useful
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Our set up
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Tubing
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Heating / Humidifier base
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Flow meter
Blender or Y-connector with air/oxygen
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Trouble shooting
• Leak around nasal prongs (sizing) • Mouth breathing • Nebulisation port
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Transport implications
• NETS ability to transfer • Children < 6kg can possibly be transported on
humidified nasal prong oxygen • Others may need CPAP for transfer • Sedation implications
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QUESTIONS?
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Summary
• Terminology • Evidence around HHFNC • Practicalities of setup • When to use • Troubleshooting • Transport implications