The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts


Cynthia White, James Johnson, Robert Wackenthaler; PICU, Cincinatti Children’s Hospital Medical Center, Cincinatti OH, OH

Background: Historically, recommendations for Heliox delivery has been to utilize a non-rebreather or closed system for gas delivery. Getting a small child or infant to wear a mask for a length of time is often a challenge for the bedside clinician. Due to lack of alternative interfaces, we have successfully used 70:30 Heliox via a HFNC device on several small children who presented at our institution with upper airway obstruction and stridor. In theory, the HFNC system should meet most of the minute ventilation requirements of a small child or baby who is an obligate nose breather. With differences in the density of the gas, we became interested i n trying to determine the optimal flow to set with Heliox via the HFNC. We also sought to determine how utilizing standard conversion factors for 70:30 Heliox would affect the company developed pop-off set at 40 cmH20 that comes packaged with the system. Method: The Fisher Paykel (F&P East Tamaki, New Zealand) HFNC device was set-up according to manufacturer recommendations. The F&P 850 heater setting was set on invasive at 37 degrees Celsius. The nasal cannula prongs were connected to a tubing device which was then connected to a standard air flow meter to measure flow. Baseline set vs. delivered flow measured were obtained at all three pediatric NC sizes (ranging from neonatal to pediatric.). A pressure manometer was also placed in line adjacent to the pop-off and the pop off was briefly removed from the system to test its function ability. Results 2-2.5L was the maximum flow that could be measured from the the neonatal HFNC prongs with or without Heliox. Both the infant and pediatric NC appeared limited to a delivered flow of 7-8LPM despite variances in set flow settings from a range of 6- 15LPM. In scenarios where back pressure did not meet the 40 CMH20 threshold of the pop-off; measured flow with Heliox averaged 1LPM higher than set flow. Discussion: HNFC with the Fisher Paykel humidified HFNC system may be reasonable to use for small infants or children who cannot tolerate wearing a non- rebreather, but set flow is limited to 6L with the use the manufacturer’s pre packaged silent pop-off. Flow limitations and flow delivered to the patient may be slightly altered with other Heliox mixtures or a FiO2 requirement greater than 30%. Sponsored Research - None

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