High Flow Nasal Cannula (Airvo, Vapotherm, Optiflow etc)
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- Опубликовано: 11 июл 2024
- Here's a short(ish) introduction video on High Flow Nasal Cannula.
We dive into the mechanisms, clinical effects, set up and evidence behind these devices.
Couple of the trials i talked about:
Frat JP, Thille AW, Mercat A, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med 2015; 372:2185.
Ou X, Hua Y, Liu J, et al. Effect of high-flow nasal cannula oxygen therapy in adults with acute hypoxemic respiratory failure: a meta-analysis of randomized controlled trials. CMAJ 2017; 189:E260.
Excellent Talk. Thanks so much. Precise. Very informative. Not too long. And no silly dramatics and theatrics!!!
I love love love your video.. you explain it so well with details. Thank you 🙏
Thank you, Thank you, Thank you, informative and to the point
I truly thank you for making these videos, they have been so helpful. You are a wonderful teacher, you give a thorough foundation which is what truly helps us to understand. Please don’t stop making these video, they are helping me through school. Can you make a video on the different oxygen masks you mentioned in this video and how and when we would know to use each mask?
Great video and education. Thank you!!
Big thanks
Thank you for good practical review! Tell me, did you find any data about oral or enteral nutrition during HFNC?
Hi, this is a very interesting system. And your talk was very good. I'm interested in it from the engineering point of view.
I understand the reasoning behind keeping the RH and temperature below the dew point to prevent virus/microbe entrainment, and condensation.
And the design of the Optiflow is pretty elegant with respect to maintaining that.
But how is a constant flow rate achieved?
As I can understand it, there's not any significant pressure drop from the pump discharge and all through the main system, then via the breathing tube.
I can see that the fit of the cannula with each patient would vary, and thus you'd get differences there, and also as they moved, and during their breathing cycle.
But is that small compared to that from the outlet of the Cannula itself?
I think it just be, because otherwise I see very little chance to keep a steady flow rate with a gas, where you have no feedback from anywhere near where the actual pressure drop is.
To make it clear, I think you could model this as having one large fixed pressure drop from the Cannula itself, and one you start the system, with the desired flow rate setpoint, it remains stable, regardless of what the patient does.
If not, I think the patient would experience sudden changes in flow as they tried to breathe in and out, or as the shifted position.
Thank you
really great review! thanks. Can you elaborate what is it exactly that is better for patients being on those high flows? What do those high flows do for patients if its not, in fact, PEEP? thanks
Hey thanks for posting, glad you liked the video. The high flows are thought the beneficial as they allow better matching of the delivered flow to the patients inspired flow. We know that when people are sick their inspired flow rates a very high (up to 40+ lpm). So having a delivered flow higher than that allows more precise fio2 titration, and helps alleviate WOB.
Hello, excellent video! I was wondering if Teleflex's High Flow Nasal Cannula Therapy System using the Hudson Neptune Heated Humidifier and ComfortFlo cannula would also fit into this product segment? Or if it is something different because it also needs to use a blender, and isn't just a singular device like Fisher & Paykel's Airvo 2 w/ Optiflow or Vapotherm's Precision Flow? Thank you in advance!
I haven’t come across the device you mentioned, so can’t speak with much authority on its specifics. I would say however that the principles underlying these heated hi flow products are the same. There are blender systems in many of the other products available. If its marketing itself as a heated HFNC then id say you’re safe to assume it employs the principles I’ve described.
Does a HHFNC provide pressure support?
What could be the reason for oxygen fluctuation (79%-99%) Sp2o on high flow oxygen therapy 6 liters? My mother has Covid pneumonia. Please advice 🙏
Love the lecture thank you. My question is this when placing a patient on High Flow and they have COVID-19 is it more dangers for the staff as the patients don’t normally keep their mouth closed. Does the High Flow become a a water cannon filled with particalized droplets that can travel a farther distance. Or is the water particle to small to carry the virus with it.
This is an interesting question. The question really is “is High Flow Nasal Prongs an aerosol generating procedure?”
At most centres I know people at they are considering it an aerosol generating procedure given the high flows. So patients with covid on it would be ideally in negative pressure rooms and have staff in full PPE. This is hugely variable however, and many centres are managing high flow prongs differently. It is also changing rapidly. At my centre I believe the current policy is that COVID patients on high flow NP are airborne precautions so full PPE with N95s. I’d encourage you to look up what your local institutions are recommending, and if in doubt wear full PPE.
We had a lot of success keeping people out of ICU and off ventilators using HFNP during our covid waves.
In a classic CPAP machine - you do not set an inspiratory pressure - and since the patient is breathing spontaneously - during inspiration - the pressure of the system will go below the CPAP pressure (because inspiration by the patient will create a negative pressure) but it will be above zero.. so it prevents collapse of alveoli..hence its also a type of PPV. If you set an inspiratory pressure with a PEEP/EPAP - then your system pressure will not go below PEEP/EPAP.. I feel this is the major difference.. otherwise rest of the areas you covered were great !!!!
DrDilipsMMS Thanks for your comment glad you took the time to watch. This wasn’t a video on CPAP systems. You do not set an insp or exp pressure on HFNC. To have PPV you need 2 levels of pressure so that a deltaP is created, so pure CPAP is not PPV. It’s positive pressure, but it’s not ventilating the patient. Also setting an inspiratory pressure does not guarantee the system pressure will not go below peep depending on the insp effort of the patient. Either way, I’m not really sure your comments on CPAP/PEEP really pertain to this video.
RespiratoryReview Do make a session on NIV’s and PPV ! In fact my comment was based on your statement at 14:32. Thanks for your time to reply ! Cheers
and they're probably low on vitamin D or Zinc