2004 OPEN FORUM Abstracts
HIGH FLOW OXYGEN VIA NASAL CANNULA DURING RESPIRATORY INSUFFICIENCY FOLLOWING PNEUMONECTOMY
Lesley
Manning, RRT, Linda Dominy, RRT, MHA, Van Nguyen, RRT, M. Douglas
Mullins, MD, FCCP, Memorial Health University Medical Center,
Savannah, Georgia
Introduction: High flow supplemental breathing gases are traditionally associated
with mask delivery systems. During severe conditions, prior to
noninvasive positive pressure ventilation or invasive mechanical
ventilation, high flow gas systems may incorporate masks and cannulas
used in tandem. Such combinations are integrated during attempts to
improve oxygenation and meet respiratory demands in acute situations.
Here we present a case whereby high flow breathing gas is delivered
by nasal cannula (NC), traditionally a low flow system, during high
demand respiratory insufficiency. This intervention was made
subsequent to patient’s poor response following attempts to
improve his respiratory compromise using traditional systems.
Case Presentation: A
64-year-old male with a history of COPD and stage III large cell
carcinoma underwent a left pneumonectomy. On post-op day 3, he
developed pulmonary edema, decreased Sa02%, high
respiratory rate, and dyspnea. In an effort to improve his
respiratory decompensation, he was placed on a double-flow aerosol
mask. This did not improve his worsening condition. We then advanced
him to NRB mask with NC in series at 6 LPM. He remained dyspneic,
with a respiratory rate of 28 bpm, and then became diaphoretic, with
elevated heart rate and 83% Sa02. In an attempt to avoid
intubation, he was placed on the Vapotherm™ (Vapotherm 2000i)
high flow system via nasal cannula at 20 LPM, temperature at 37°C,
and 100% FI02. Within 15 minutes his oxygen concentration
had decreased to 40%, followed by traditional NC at 3 LPM within 48
hours.
Discussion: New high flow technology permits oxygen therapy via nasal
cannula at
non-traditional flow rates. In this case of respiratory
insufficiency, the high flow NC system, Vapotherm™, was
associated with rapid improvement in Sa02%, normalized
respiratory rate, and relief from dyspnea. In patients with
respiratory insufficiency, high flow NC may be considered over
traditional mask systems.