The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts


Tom J. Strait1, Renee' Adamson1, Lawrence R. Roy1, Frank Walsh2; 1Cardiopulmonary Services, Moffitt Cancer Center, Tampa, FL; 2Division of Pulmonary and Critical Care Medicine, University of South Florida College of Medicine, Tampa, FL

Introduction: Patients with lung cancer often experience dyspnea secondary to narrowing of the airway due to tumor growth. Heliox use is one method of reducing turbulence through a narrowed airway and relieving dyspnea. Case Summary: A 63 year old female, with progressive small cell lung cancer and persistent dyspnea was admitted to the ICU due to difficulty breathing with stridor and use of accessory muscles: RR 28, SaO2 94% on 2 lpm. The patient had a large right sided mass with bronchovascular encasement causing severe tracheal, bronchial, and vascular compression. There was a discussion of tracheostomy; however, upon evaluation it was evident the obstruction was too low for a tracheostomy to provide any relief. Within 12 hours of admission the patient was placed on an 80/20 mix of heliox via NRB mask at 10 lpm. The patient's dyspnea was improved, stridor cleared, and use of accessory muscles lessened; RR 20 SaO2 94% on 10 lpm HeO2 NRB. The patient was receiving daily radiation therapy treatments to reduce the size of the tumor. The challenges we faced were: high usage, limited availability of heliox and cost; $120.00 per tank, three tanks per day. Our usage rate would deplete the vendor's supply within two days and additional tanks were not available through any local vendor for 5 business days. In order to conserve gas, we attempted to reduce the heliox flow. The titration began with reducing the flow to the NRB mask to 6 lpm but the patient stated it wasn't enough, we increased to 8 lpm and she stated, "it would be tough" but she thought it might work, although she felt like it was a lot warmer. She was then placed on the OxyMask (Southmedic) with a flow rate of 4 lpm. Due to the design of the mask, the patient felt more comfortable than on the NRB mask at 8 lpm; RR 16 to 20, SaO2 96% on 4 lpm HeO2 OxyMask. We were able to maintain the flow at 4 lpm to 5 lpm for the duration of her stay; in addition we were able to place the patient on a nasal cannula at night while she slept. Thirteen days later the patient was discharged home to hospice care. Discussion: By using the OxyMask we were successfully able to titrate the heliox to achieve a therapeutic level that was comfortable and safe for the patient at half the flow rate effectively doubling our supply and achieving a 50% cost savings. We also have increased the supply of heliox in house and the vendor has increased their inventory in order to be able to care for similar patients in the future.
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