OptiflowTM via AirvoTM High/Low Flow Oxygen Delivery System

1
OptiflowTM via AirvoTMHigh/Low FlowOxygen
Delivery System
Devika Cook Charge NurseAdult and Emergency
PACUAuckland City Hospital
2
What is the definition of a double blind
study?
3
(No Transcript)
4
Objectives
5
OptiflowTM

• Nasal High/Low Flow Oxygen Therapy
• Designed to meet inspiratory demand
• Provides natural balance of temperature and
  humidity
• Low level positive airway pressure
• Used in conjunction with the AirvoTM

6
AIRVOTM

• High-performance humidifier and integrated flow
  generator
• Consistent temperature humidity level
• Accurate FiO2 with a constant flow rate
• Ability to alter flow rate (15-45 lpm and oxygen
  percentage 21-60)

7
Indications for Use

• Increased respiratory demand
• Intolerance of conventional face mask
• Hypoxia/Emergence Agitation
• Major surgery abdominal, head and neck
• High BMI
• Obesity
• Smoker

8
Benefits

• Easy to implement
• Comfort ? patient compliance
• Not affected by NGT
• Can prevent less invasive ventilation
• Direct Delivery to Naso/Oro-Pharynx
• Less dilution effect

9
Benefits - cont

• Warm humidified oxygen
• Less damage to mucosa
• Improved gas exchange and O2 saturation
• Decreased LOS in PACU
• Transferable system for ward use
• Reduced care costs
• Disadvantage
• No battery pack, dependent on AC power

10
Case Study

• 34 year old male caucasian
• Post-Op Lap Appendicectomy
• ASA 1 training for Auckland Marathon
• ? Aspirated on induction
• CXR slight Pulmonary Oedema
• Decreased saturations in PACU

11
Clinical Presentation

• Patient not distressed
• Breathing not laboured
• Hudson Mask on 15 litres
• Persistent low sats 88-90
• Nil complaints of Pain or PONV
• Circulation stable
• Medical request for CPAP circuit

12
CPAP Circuit

• Dolly Parton

13
OptiflowTM/AirvoTM Circuit
14
Treatment

• 1400 - OptiflowTM via AirvoTM commenced
• Initially set for high oxygenation
• 15 lpm of oxygen (piped via flow meter)
• 15 lpm flow rate (generated by AirvoTM)
• Approximate oxygen concentration 63
• Arterial line inserted
• ABGs at 30 minute intervals

15
Treatment - cont

• 1500 sats slight improvement to 92
• 1600 sats up to 94
• 1630 commenced weaning of O2
• ?Oxygen flow 7 lpm(50)
• ?Flow rate to 30 lpm
• Saturations constant in mid 90s
• Constant monitoring of ABGs pulse ox
• OptiflowTM/AirvoTM titrated for effect

16
AIRVOTM Table
17
Outcome

• Referred to HDU ? wait see
• Oxygen flow decreased incrementally
• Steady improvement in saturations
• Re-routing of ward
• Six hours later stable
• Oxygen flow ? 5 lpm
• Flow rate maintained at 35 lpm approx 32
• Maintaining saturations at 97-98
• 2000-transferred to Gen Surg ward with
  OptiflowTM/AirvoTM

18
Resolution

• 24 hours later
• CXR Pulmonary Oedema resolved completely
• Maintaining adequate saturations on air
• 48 hours discharged home
• Unable to complete the Marathon ?

19
Conclusion

• Early intervention with OptiflowTM/AirvoTM O2
  delivery and humidification does have an impact
  on patient outcomes
• Works relatively quickly sustained effect
• Suitable for patients when conventional masks are
  not feasible
• Can decrease LOS in PACU
• Simply Better Oxygen Therapy

20
Acknowledgements

• Product Specialist F P
• Annelise La Roche
• Materials Management ACH
• Nurse Educators PACU
• Liz Boucher Penny Jones
• Level 8 PACU RNs
• For embracing the technique and ongoing support
  of the system

21
The A, B, C of Anaesthesia

• Airway
• Bagel
• Coffee