The Science Journal of the American Association for Respiratory Care

2004 OPEN FORUM Abstracts

Case Report: Vapotherm use in preventing nocturnal oxygen desaturation in severe obesity.

Thomas Brennan, CRT, Eric Gluck, MD, Peter Werner, MD Swedish Covenant Hospital, Chicago, IL.

Introduction: Obesity has been well documented to increase the risk of obstructive sleep apnea and nocturnal oxygen desaturation (NOD). Nasal CPAP (nCPAP) is used to prevent upper airway collapse to reduce the risk of obstruction and NOD. In this case we report, a male patient 52 years old, weighing 392 pounds, and being 74 inches tall, BMI = 50.3, non-compliant with nCPAP treated with high flow therapy.

Case Presentation:
While the patient was institutionalized we applied a high flow device, the Vapotherm, in place of nCPAP to prevent upper airway collapse. The patient was placed on the Vapotherm device at 40-lpm flow via nasal cannula, 35% blended FiO2, and 100% relative humidity. Overnight cardiopulmonary sleep data was collected, downloaded and analyzed. Seven hours and thirty minutes of valid data was obtained. The patient’s average arterial oxygen saturation was 96% with the SaO2% above 90% for 99% of the time recorded. There were 6 apneas and 28 hypopneas noted for a RDI (AHI) = 6.9.

Discussion: Patients with high BMI are at risk for OSA. OSAs primary mode of treatment is nasal CPAP. Patients using nCPAP are often not compliant. The Vapotherm device delivers a high flow of gas via a nasal cannula at 100% relative humidity and FiO2% that can be controlled by blender. High flow of gas via nasal cannula has been reported to generate low levels of nCPAP.1 Patients diagnosed with OSA are often placed on the maximal nCPAP level to prevent break through apneas and hypopneas. This high level of nCPAP may in part be a cause of discomfort to the patient leading to non-compliance. In this case, high gas flow and FiO2% of .35 where used to prevent apneas, hypopneas and NOD, resulting in an RDI (AHI) of 6.9. The patient stated he was much more comfortable with the high flow system than with nCPAP. This case of a severely obese patient treated nocturnally with the Vapotherm high flow system resulted in a mean nocturnal oxygen saturation of 96% with a RDI (AHI) = 6.9 / hr.

1. Bamford, O. Positive pressure in the buccal cavity during high flow gas delivery via nasal cannula. Submitted, Resp Care Open Forum 2004.