This is important as patients in acute respiratory failure can be extremely tachypneic, and therefore their peak inspiratory flows, which may normally be 30L/min – 60L/min, can reach up to 120 L/min (3). One obvious benefit, but worth mentioning is that high flow can give you a very high flow of gas. HFNC can warm (to 37 oC) and humidify gas, which can decrease airway inflammation, maintain mucociliary function, improve mucous clearance and reduce the caloric expenditure in acute respiratory failure (1-2). Also, a significant amount of calories can also be expended in individuals to both warm and humidify gas during normal breathing (2). This can lead to airway inflammation, which can increase airway resistance and impair mucociliary function possibly leading to decrease secretion clearance (1). Standard oxygen therapy delivered through a nasal cannula or another device such as a non-rebreather, is cold (not warmed) and dry (not humidified). Heated and Humidified oxygen has a number of benefits compared to standard oxygen therapy. Each manufacturer will also have a max flow rate for each cannula size corresponding to the size and age of the patient. Each cannula should snuggly fit into the patient’s nares and prevents entrainment of room air around the cannula, which can occur with standard nasal cannulas. There are 2 main companies, which manufacture these devices: Vapotherm which has a device that can deliver flow rates of up to 50 liter/min flow rates and Fisher Paykall who offers both the Optiflow as well as the AIRVO 2 devices which can both deliver flow rates of up to 60 liter/min.Įach company offers smaller cannula sizes for premature neonates as well as children of various ages to adult cannulas. The flow rate and fi02 can be independently titrated based on your patient’s flow and fi02 requirements. It actually takes gas and can heat it to 37 o C with a 100% relative humidity and can deliver 0.21 – 1.00% fi02 at flow rates of up to 60 liters/min. Heat and humidified high flow nasal cannula or as most call it, Hi Flow Nasal Cannula (HFNC), isn’t just a standard nasal cannula cranked up to very high flow rates. In this part we will summarize how it works and for part 2 we will discuss the main indications for its use in adult and pediatric patients. It seems over the past several years many studies have come out reviewing the mechanisms of action as well as its use in a variety of conditions. I noticed a few years after using it successfully in children, mainly with severe bronchiolitis, that we began to use it in the adult intensive care unit as well. I first started using it as a pediatric intensive care fellow, but had little knowledge of how it actually worked. They are at risk for social isolation and mood disturbance.The use of heated and humidified high flow nasal cannula (HFNC) has become increasingly popular in the treatment of patients with acute respiratory failure through all age groups. Remember, even high-flow oxygen is not a death sentence! Nonetheless, people with IPF may feel afraid, anxious or depressed and be short-tempered with this new stage. High-flow oxygen cannot be delivered by portable oxygen concentrators, so many people with IPF feel even more constrained. Eating well, exercising and getting plenty of high quality sleep can help. It may only occur when the person with IPF talks for long periods of time or when they are exerting.įatigue is not uncommon at this stage and can be challenging to treat. Even though they need oxygen at rest, they will not usually be short of breath at rest.Ĭough can be frequent and bothersome. The person with IPF in Stage IV is short of breath with exertion or activity. What to expect from the person with IPF in this stage Remember to stay active and continue living a full life with IPF. Your health care provider may talk with you about the possibility of a lung transplant. Talk with your health care provider about palliative care. Learn the dose and time the medicine is taken, how it may be helpful and what side effects to watch for. Maintain an oxygen saturation equal to or greater than 89 percent when you rest and are active.Īsk about the medications that may be used for IPF. Use your pulse oximeter to monitor your oxygen level. Work with the DME company regarding the change in oxygen needs. Learn how long the portable oxygen system will last at higher liter flows. Learn about stationary oxygen systems and portable oxygen systems that will meet your oxygen needs at high liter flows. High liter flow is described as greater than 4 liters. Work with your health care provider regarding the oxygen prescription change and the best oxygen system to meet your needs for using oxygen as the liter flow increases 24 hours a day.
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