The Science Journal of the American Association for Respiratory Care

2000 OPEN FORUM Abstracts

A HEAT-MOISTURE EXCHANGER WITH AN OXYGEN BLEED-IN PORT CAN IMPROVE SHORT-TERM PORTABILITY FOR AMBULATORY HOME OXYGEN PATIENTS WITH A TRACHEOSTOMY

Georgette Frate-Mikus, RRT, James Stegmaier, RRT, RPFT, Joseph Lewarski, RRT Hytech Homecare, Cleveland, Ohio

Background: Ambulatory home oxygen patients with tracheostomies often have difficulty achieving adequate portability. Typical high-flow oxygen delivery systems generally require oxygen flows ³ 6 l/min. The LTOT consensus recommendation for ideal portable oxygen suggests that systems weigh < 10 lbs. and provide 4-6 hours of portability. Few, if any systems can meet this requirement at such flows ("D" cylinders operating at 6 l/min: < 1 hour; "E" cylinder: ~1.5 hours; 1.2- liter liquid portable [LOX]: ~1.5 hours). Heat-moisture exchangers (HME) with oxygen bleed-in ports are available on the market, however no clinical criteria or suggested protocol is available from the manufacturers. The safe and effective application of low-flow oxygen directly into the trachea via catheter is well noted in medical literature. Our hypothesis: direct input of low-flow oxygen into the tracheostomy tube via a HME would mimic transtracheal oxygen therapy, allowing a significant decrease in inspired oxygen flow while ensuring adequate oxygenation. Method: We developed a simple protocol using the Tracheolife® HME with oxygen bleed-in port (Mallinckrodt, Inc.). A physician order was obtained for each trial. The patients were clinically evaluated (RR, HR, SpO2, and patient's subjective level of SOB) during all activities of daily living, while on their standard oxygen delivery device (venturi tracheostomy collar) and FlO2. The patient was then educated and introduced to the HME. The oxygen liter-flow was titrated to maintain an acceptable SpO2 (³ 90% during all activities, unless otherwise ordered). The complete clinical evaluation was repeated while on the HME with oxygen. The results of the trial are noted in the following table:

Patient Age Pre FlO2 & Flow* O2 Bleed-in w/HME D in Liter Flow
1 67 40% / 6 l/min 2 l/min 4 l/min
2 2 40% / 6 l/min 1 l/min 5 l/min
3 70 50% / 6 l/min 1 l/min 5 l/min
4 79 40% / 6 l/min 2 l/min 4 l/min
5 68 35% / 6 l/min 2 l/min 4 l/min
6 66 40% / 6 l/min 1 l/min 5 l/min
7 80 35% / 6 l/min 2 l/min 4 l/min
8 70 50% / 6 l/min 3 l/min 3 l/min
*Patients were using a Percent-O2-Lock Mask® with a trach collar (Salter Labs, Inc.)



Results: All 8 patients tolerated the HME with oxygen for ambulation. There were no significant differences between pre & post clinical evaluations. Mean HME oxygen bleed-in was 1.75 l/min. Mean decrease in flow was 4.25 l/min (a 71%¯). Oxygen system durations at 1.75 l/min (approximate): 3 hours with a "D" cylinder; 5 hours with an "E" cylinder; and 7 hours with a 1.2 liter LOX. Patient survey supports this new portability translated into a perceived improved quality of life. Patients also found the HME less complex, easier to use, and less cumbersome as compared to the traditional tracheostomy collar. Summary: Appropriate use of HME's with oxygen ports may significantly increase portability and improve the quality of life for select ambulatory home oxygen dependent patients with tracheostomies. Further study is suggested to help standardize this application.
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