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