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Optiflow TM via Airvo TM High/Low Flow Oxygen Delivery System. Devika Cook Charge Nurse Adult and Emergency PACU Auckland City Hospital. What is the definition of a double blind study?. Two Orthopaedic Surgeons trying to read an ECG!. Objectives. Optiflow TM. - PowerPoint PPT Presentation
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OptiflowTM via AirvoTM
High/Low FlowOxygen Delivery System
Devika Cook Charge Nurse
Adult and Emergency PACUAuckland City Hospital
What is the definition of a double blind study?
Two Orthopaedic Surgeons trying to read an ECG!
Objectives
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
AIRVOTM
• High-performance humidifier and integrated flow generator Consistent temperature & humidity levelAccurate FiO2 with a constant flow rate
Ability to alter flow rate (15-45 lpm and oxygen percentage 21-60%)
Indications for Use
• Increased respiratory demand
• Intolerance of conventional face mask
• Hypoxia/Emergence Agitation
• Major surgery – abdominal, head and neck
• High BMI
• Obesity
• Smoker
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
Benefits - cont• Warm humidified oxygen
Less damage to mucosa
• Improved gas exchange and O2 saturation
• Decreased LOS in PACU
• Transferable system for ward useReduced care costs
Disadvantage• No battery pack, dependent on AC power
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
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
CPAP Circuit“Dolly Parton”
OptiflowTM/AirvoTM Circuit
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
• ABG’s at 30 minute intervals
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 lpmSaturations constant in mid 90’s
• Constant monitoring of ABG’s & pulse ox• OptiflowTM/AirvoTM titrated for effect
AIRVOTM Table
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
Resolution
• 24 hours laterCXR Pulmonary Oedema resolved
completely
• Maintaining adequate saturations on air
• 48 hours – discharged home
• Unable to complete the Marathon
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”
Acknowledgements
• Product Specialist F & P Annelise La Roche
• Materials Management ACH
• Nurse Educators PACU Liz Boucher & Penny Jones
• Level 8 PACU RN’s For embracing the technique and
ongoing support of the system
The A, B, C of Anaesthesia
• Airway
• Bagel
• Coffee
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