The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts


Tatjana P. Calvano1, Joshua M. Sill2, Kenneth R. Kemp2, Kevin K. Chung2

Context: A humidified high flow oxygen nasal cannula device was used when high oxygen concentration was necessary in a patient who could not tolerate tight-fitting masks for noninvasive oxygen supplementation.

Case Presentation: A 92 year old female with delirium and dementia was treated in the intensive care unit for multilobar pneumonia resulting in severe hypoxemia. Multiple attempts were made to oxygenate the patient, all resulting in failure as the patient was unable to tolerate a variety of facial and nasal oxygen delivering devices. The Vapotherm 2000i (Vapotherm Inc, Stevensville, MD) device was used for high flow oxygen delivery, which the patient tolerated well, with significant improvement in gas exchange and quality of life.

Discussion: The patient had severe healthcare associated pneumonia, accompanied by delirium and hypoxemia. It became apparent that the patient's death was imminent and the goal of therapy was palliative. The patient clearly desired not to undergo intubation and mechanical ventilation. In a situation where the patient was agitated and unable to tolerate masks necessary to deliver high oxygen concentration in the conventional noninvasive manner, the high flow oxygen delivery device was used to reduce dyspnea at the end-of-life. Use of the device reduced the work of breathing, significantly improved oxygenation and tolerance of oxygen therapy, and facilitated patient comfort. Relevance to Clinical Practice: Use of the high flow oxygen delivery system may enhance quality of life by reducing symptoms of hypoxemia in patients who are unable to tolerate conventional noninvasive methods of delivering high oxygen concentration.