HFNC weaning

[Hamhock]

How are folks TYPICALLY weaning HFNC?

Although there are some rare cases where HFNC is used for faux-PEEP (high flow rates), I am wondering about your typical weaning of HFNC. That is, are you weaning oxygen or flow rate? or both?

I ask because at my community site, the RTs are convinced that both oxygen and flow rate should be decreased step-wise. When I explain my technique and logic, they mostly look at me like I am anaerobic.

HH

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[McPoyle]

I think there really is something to the high flow “washing out”the dead space and leading to subjective decrease in work of breathing, so I generally drop the FiO2 first until I get to some arbitrary percentage. Then, I might cut flow in half and try taking it off.


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[tartesos]

Vapotherm is the bomb. I Drop fio2 before flow. And then it's intuitive how fast to go, patients will tell you.
Hopefully your Rt will actually wean and nurses won't freak when sats are no more than 98%


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[jdh71]

I don't care as long as they are trying to wean.

 

[Psai]

FiO2 first then flow. If you're dropping the flow what's the point of having high flow? Just put a facemask on lol

 

[Hamhock]

FiO2 first then flow. If you're dropping the flow what's the point of having high flow? Just put a facemask on lol

I find the variation of opinion from many intelligent intensivists curious.

Regarding the quote above, the typical (ie not my) response would be:

Why decrease the flow? Under no other circumstances do we do this with oxygenation?

Traditional nasal cannula or NRB? These supply 100% oxygen at variable "flow rates" (ie mixed with room air).

Please explain. Not because I necessarily disagree, but because I feel this is an uncertain area in critical care that shouldn't be uncertain.
(for the "typical" case; see above)

HH

 

[Bostonredsox]

I don't care as long as they are trying to wean.

this is more less my opinion and the opinion of my partners whoe are all pulm. I am unaware of any data which really demonstrates a difference but as long as both the FiO2 and flow rates are being weaned I think it is all fine. Personally, if I am asked directly by RT, which virtually never happens as they do all this on their own, I try to get them down under 50% FiO2 so that it would be more equivalent to an 8 L nasal cannula in terms of oxygen, and then I tell them to wean the flow rates. But to be honest I do not think it really matters

The biggest issue is nurses understanding that an O2 sat of 90 is just fine, please dont crank the HHF back up overnight.

 

[jdh71]

this is more less my opinion and the opinion of my partners whoe are all pulm. I am unaware of any data which really demonstrates a difference but as long as both the FiO2 and flow rates are being weaned I think it is all fine. Personally, if I am asked directly by RT, which virtually never happens as they do all this on their own, I try to get them down under 50% FiO2 so that it would be more equivalent to an 8 L nasal cannula in terms of oxygen, and then I tell them to wean the flow rates. But to be honest I do not think it really matters

The biggest issue is nurses understanding that an O2 sat of 90 is just fine, please dont crank the HHF back up overnight.

Yeah. 40L and 40% is about 6L NC. Get there and switch over.

 

[Hamhock]

Yeah. 40L and 40% is about 6L NC. Get there and switch over.

Isn't 6L at 100% about 6L NC?

HH

 

[jdh71]

Isn't 6L at 100% about 6L NC?

HH

I guess. It's all about how the folks you are trusting with the wean think about it all though. May seem silly. But if it's being weaned, it's being weaned yeah?