The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts


Clint Swanson1, Louis M. Kaufman1, Robert Hof1, Robert Rice1, Michael J. Fields2; 1Roberts Home Medical, Inc., Germantown, MD; 2Pediatric Lung Center, Fairfax, VA

Introduction: Oxygen therapy via heated, humidified, high-flow nasal cannula (HHHFNC) has become common practice in hospitals but has not been available in the homecare setting due to the complexity of available equipment and the lack of adequate reimbursement. We report on the successful use of HHHFNC in the home. Case Summary: A 760 gram 24 week gestation female born 06/26/08 with severe chronic lung disease, pulmonary hypertension, and hypoxemia experienced a complicated hospital course until initial discharge home on 02/02/09 at 5.8 Kg. Discharge orders included continuous oxygen 0.5 L/min via nasal cannula, apnea monitor, pulse oximeter, systemic steroids and feeds via gastrostomy tube. She was re-admitted to the hospital on 04/15/09 for respiratory distress, and required oxygen via HHHFNC to maintain airway patency and prevent hypoxemia. By the middle of May it was apparent she would need this support for a prolonged period. We were contacted by the family and the healthcare team and accepted the challenge to provide this therapy to a low birth weight infant in the home. Respiratory therapists from our company, the manufacturer, and the hospital collaborated to configure an appropriate system. System design challenges including pressure variability between the air compressor and oxygen concentrator, air compressor flow oscillation and accurate flow measurement were met by adding a copper coil water trap, multiple flowmeters and varying lengths of extension tubing proximal to the humidifier. A Fisher & Paykel MR850 heated humidifier, RT329 heated wire circuit with pressure relief and a pediatric BC3780 nasal cannula completed the circuit. Because there was no established reimbursement code for this system in the home, a single case agreement was negotiated with the patientÂ’s insurance company. The system was set up in the hospital for 48 hours for patient acclimation prior to her discharge on 05/29/09 on 4.5 L/min FIO2 0.30 HHHFNC @ 32? C. The patient has received regular monthly respiratory therapist visits with no hospital admissions. She has been weaned to nocturnal HHHFNC and oxygen via standard nasal cannula while awake, is now on oral feeds and is making appropriate developmental gains. Her care plan currently includes complete weaning of HHHFNC by August 2010. Discussion: With appropriate planning and clinical intervention, HHHFNC can be used safely and effectively in the home environment with pediatric patients. Sponsored Research - None