High flow nasal canula

[VentdependenT]

How are yall in incorporating this device into your clinical practices?

I would assume in COPD/CHFers in whom NIPPV is too uncomfortable.
As an immediate postextubation device for folks who have failed extubation in past?
As a way to dodge NIPPV in those with exacerbation of chronic hypoxia.

Do you, or SHOULD you, use it for hypoxic RF in place of CPAP.
IS it useful for hypERcapnic failure? after all it washes out dead space and provides some peep given pt keeps mouth closed and if prongs are snug?

I do like the fact that the FiO2 is precise because of the high flows and that the o2 delivered is in enough quantity to match thier minute volume.

Any other thoughts?

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[Bostonredsox]

How are yall in incorporating this device into your clinical practices?

I would assume in COPD/CHFers in whom NIPPV is too uncomfortable.
As an immediate postextubation device for folks who have failed extubation in past?
As a way to dodge NIPPV in those with exacerbation of chronic hypoxia.

Do you, or SHOULD you, use it for hypoxic RF in place of CPAP.
IS it useful for hypERcapnic failure? after all it washes out dead space and provides some peep given pt keeps mouth closed and if prongs are snug?
I do like the fact that the FiO2 is precise because of the high flows and that the o2 delivered is in enough quantity to match thier minute volume.

Any other thoughts?

We use it as a stepdown device from bipap for respiratory failures whose primary process is hypoxia and who require more than 6Lflow from a cannula. If I cannot maintain sats on cannula alone and there is no hypercarbic component, high flow seems to be far better tolerated/ more comfortable to the pt than bipap for certain patients who don't like wearing the mask. We very rarely have nasal bipap masks in stock. Not sure on the data, just what I've seen.

 

[bigtuna]

Anyone used the NIOV? I haven't personally but have anecdotally heard good things.

http://www.breathetechnologies.com

 

[VentdependenT]

Friggen cool man

 

[Hernandez]

Define high flow NC. I use that descriptor in the larger bore regular cannulas, it I'm guessing you're refereing to something like the opti-flow (http://www.fphcare.com/respiratory/adult-and-pediatric-care/optiflow/) frankly, it's almost a waste of effort, I've seen it used as a bridge, and it almost always fails, and I've seen it used as a weaning tool to get someone out of an ICU, but honestly, if they're too tenuous to put on a simple face mask or even a Non-rebreather, their ass belongs in a high level step down or ICU.

I had an attending who was a wall and would not accept anyone into the unit that wasn't actively dying who loved those damn things, and he'd **** around with them till they were damn near dead.

 

[jdh71]

How are yall in incorporating this device into your clinical practices?

I would assume in COPD/CHFers in whom NIPPV is too uncomfortable.
As an immediate postextubation device for folks who have failed extubation in past?
As a way to dodge NIPPV in those with exacerbation of chronic hypoxia.

Do you, or SHOULD you, use it for hypoxic RF in place of CPAP.
IS it useful for hypERcapnic failure? after all it washes out dead space and provides some peep given pt keeps mouth closed and if prongs are snug?

I do like the fact that the FiO2 is precise because of the high flows and that the o2 delivered is in enough quantity to match thier minute volume.

Any other thoughts?

I won't use this stuff as a bridge to anything. If their hypoxic failure is that bad, they also look pretty hypoETtubemic to me.

I use these highflow contraptions in chronic conditions - bad ILD/IPF, and pulmonary hypertension.

I suppose I'd consider it in the right situation for someone who was DNR/DNI, but that type of patient who goes acute hypoxic respiratory usually just isn't fixed by some simple high flow nasal canula.

 

[VentdependenT]

Define high flow NC. I use that descriptor in the larger bore regular cannulas, it I'm guessing you're refereing to something like the opti-flow (http://www.fphcare.com/respiratory/adult-and-pediatric-care/optiflow/) frankly, it's almost a waste of effort, I've seen it used as a bridge, and it almost always fails, and I've seen it used as a weaning tool to get someone out of an ICU, but honestly, if they're too tenuous to put on a simple face mask or even a Non-rebreather, their ass belongs in a high level step down or ICU.

I had an attending who was a wall and would not accept anyone into the unit that wasn't actively dying who loved those damn things, and he'd **** around with them till they were damn near dead.

30-60 LPM via a device with a blender and heating/humidity system.

 

[lura]

Used it as a bridge alot of times in the post-extubation COPD patient. Also in pateints with multiple rib fractures (either unilateral or bilateral), but in both cases, only in the ICU, not on the regular ward. I consider it another adjunct like BiPAP. However, in the non-COPD routine trauma patient it usually I've found it does not prevent the patient who needs either intubation or re-intubation from avoiding that eventuality - only delays it so I pick my patients carefully.