2010 OPEN FORUM Abstracts
ONE HOUR INTERVENTIONAL ALGORITHM USING HUMIDIFIED HIGHT FLOW THERAPY (HHFT)OPTIFLOW NASAL CANULA IN ACUTE RESPIRATORY FAILURE.
Stephane Delisle1, Paul Ouellet2; 1Respiratory Therapy, HÃ´pital du SacrÃ©-Coeur de MontrÃ©al, MontrÃ©al, QC, Canada; 2Respiratory Therapy, VitalitÃ© Health Network, Edmundston, NB, Canada
Background: Following observations from two case studies we propose an interventional algorithm using HHFT Optiflow nasal canula in Acute Respiratory Failure. Method: Clinical decisions are focussed on a two arms algorithm: Arm 1 for Type 1 ARF based on PaO2/FiO2 and Arm 2 for Type 2/Mixed ARF, based on pH and PaCO2. For further desciption of decision making, refer to the algorithm. Results: Case 1: Two days after upper abdominal surgery, a 45 years old man develops a Type I Acute Respiratory Failure; on FiO2 0.8 with a PaO2/FiO2 of 200 mmHg. Arm 1 of the algorithm is solicited with instauration of HHFT Optiflow 40 L/min during 30 minutes. After 30 minutes on FiO2 0.75, ABG reveals PaO2/FiO2 of 231 mmHg (15.5% increase). Flow is increased at 60 L/min for 30 minutes and after 30 minutes at 60 L/min on FiO2 0.45, PaO2/FiO2 is now 324 mmHg (38% increase from original). This intervention is well tolerated, patient reacted positively in spite of clinical indications for Non Invasive Ventilator support. After one hour, PaO2/FiO2 remained above 260 mmHg; therapy is continued. Case 2:66 year old man, known COPD consults with upper airways infection and respiratory distress; RR 35/min, SpO2 93% on room air. FiO2 0.28 is instituted; after 30 minutes, ABG reveals PaO2 75 mmHg, PaO2/FiO2 of 268 mmHg, pH 7.32, PaCO2 66 mmHg. Arm 2 of the algorithm is solicited with instauration of HHFT Optiflow at 40 L/min during 30 minutes. After 30 minutes on FiO2 0.28, ABG reveals a PaO2/FiO2of 329 mmHg, pH 7.37, PaCO2 59 mmHg (PaCO2 decrease â¥ 10%). Optiflow is maintained unchanged for another 30 minutes; ABG values unchanged and RR decreased from 35 to 24/min; therapy is continued. Conclusions: We believe the Optiflow has a niche in the therapy of ARF. As Non Invasive Ventilation often precedes Invasive Ventilation support, we are tempted to think that Optiflow therapy could fit as first line treatment before instituting Non Invasive Ventilation. Further investigation is needed to valide this algorithm. Sponsored Research - None Arm 1: If PaO2/FiO2 >200 mmHg, institute Optiflow 30-40 L/min for 30 min thereafter if PaO2/FiO2 increases by 20%, keep Optiflow unchanged for 30 min then attribute âSuccess/Failure. If after 30 min, PaO2/FiO2 increases by <15%, consider NIV; if PaO2/FiO2 increases by >15%, increase Optiflow 50â60 L/min for 30 min then attribute âSuccess/Failureâ. Arm 2: If pH >7.32, institute Optiflow 30â40 L/min for 30 min thereafter if PaCO2 decreases by >10%, keep Optiflow unchanged for 30 min then attribute âSuccess/Failureâ. If after 30 min, PaCO2 decreases by <5%, consider NIV; if PaCO2 decreases by >5%, increase Optiflow 50 â 60 L/min for 30 min then attribute âSuccess/Failureâ(see algorithm).