2011 OPEN FORUM Abstracts
RECURRENT PLUGGING OF THE TRACHEOSTOMY TUBE: SOLVING THE PROBLEM OF HUMIDITY DEFICIT AND PORTABILITY FOR A HOME CARE TRACHEOSTOMY PATIENT WITH AIRVOâ¢ (FISHER & PAYKEL).
Lynn M. Sullivan1, Plutarco Castellanos2; 1Respiratory Care, Health Alliance Hospital, Leominster, MA; 2Pulmonology, Health Alliance Hospital, Leominster, MA
INTRODUCTION: We report a patient with severe OSA who had elective tracheostomy tube placement secondary to severe claustrophobia with inability to tolerate CPAP. The patient presents to our hospital multiple times with a tracheostomy tube obstructed with dried secretions. The patient has been unable to return to work secondary to this recurrent complication and reported inability to sleep. CASE SUMMARY: Interview reveals patient reported sleep deprivation, chest discomfort and chronic cough, knowledge deficit regarding suctioning, and non-compliance with the aerosol delivery device. Patient reports sleep disruption caused by compressor noise, condensate in the tubing, and the aerosol produced made the patient cold and wet and led to non-compliance. We trialed the AIRVO by Fisher & Paykel with this patient to provide heated humidity with heated wire circuit and a tracheostomy tube connection. The patient found the device easy to use, portable, and quiet. The patient had subjective improvement in chest discomfort and cough, was able to sleep through the night immediately, and had improved secretion clearance with no further issues with tracheostomy tube obstruction reported. Portability of device allowed the patient to return to an executive capacity career which required frequent air and overnight travel and public speaking. The addition of a HME during the day and subsequently capping the tracheostomy tube during the day also significantly enhanced quality of life for this patient once humidity deficit was resolved. DISCUSSION: The AARC Clinical Practice Guidelines recommend the use of supplemental humidity at 33 +/- 2 degree C and a minimum of 30 mg/L of water vapor with a MMAD of 2-10 microns when the upper airway has been bypassed. The standard equipment available for providing heated humidity for tracheostomy patients in the home consists of an air compressor, a yoke-collar or rod type immersion heater, and a nebulizer bottle that aerosolizes through a length of aerosol tubing with a water trap spliced in to collect condensate. The distance the heated aerosol must travel makes it difficult at best to meet CPG recommendations. Patient compliance and meeting CPG recommendations with humidity therapy is a challenge at baseline. The AIRVO simplifies the application of humidity therapy for patients with a bypassed upper airway. Although this device fits a need in the homecare venue this new product is not currently reimbursed through most insurance. Sponsored Research - None