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. et.al: Positive pressure in the buccal cavity during high
flow gas delivery via nasal cannula. Submitted, Resp Care Open Forum
2004.