RT Clinic : Heated High Flow Cannula

Heated high flow cannulas are becoming much more popular in adult respiratory therapy. Here's a description of one brand of heated HF cannula. These devices can passively ventilate patients by washing out anatomical deadspace while creating low levels of CPAP to improve oxygenation.

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[kellyphillips]

I was hospitalized for severe COVID and was hooked up to high flow oxygen. They eventually began weaning me down to the lower level type of oxygen. I had some serious problems with oxygen. It would severely dry my nose out. The dryness would cause nose bleeds all the time. That blood would choke and gag me. At times I had Hell breathing because my nose was so stopped up with huge blood clots and dried snot build up. It was awful. Glad they are tinkering with things to make life easier on patients.

[alismom]

We use a vapotherm at our hospital and it's very similar. It's fairly new but getting popular among the physicians. Especially with our closterphobic patients that cannot tolerate bipap. Great tutorial 👍

[shanshan]

This is awesome! Have my midterms for RT tomorrow

[ranajit]

Excellent. Very relevant in 2020
A practical aspect is the management of oxygen supply which is very high when large number of patients are connected in a Covid-19 hospital. One can refer to a video " HFOT Calculator" on YouTube as a supplement to this nice video.

[feiyunxu]

Great video, learn a lot, thank you!

[Suzi_P]

This is so much helpful. Thank you so much. Could you please post more videos please?

[rt.asmaalshammari]

Jimmy you are amazing !! Thank you so much for this video!!

[Kitzishot]

Thank you for the tutorial but when I hear an RT talk about hypoxic drive and treating every CO2 retainer as being on one it really speaks volumes that the RT has never really seen a patient that truly is on a hypoxic drive (what RT's should be worried about is V/Q mismatch resulting in the Haldane effect in those end stage COPD patients who can't increase their VE but once again those are very end stage COPD) When you actually meet one you never ever forget it. You are looking at Co2 in the 120+ range with the ph in the acidic range of normal. It isn't as simple as just keeping their Saturations between 88 to 92. They'll require a lot of Oxygen just to maintain those saturations. What happens is they will stop breathing, their saturation will drop to around 84 or lower, they will take a breath, and it will shoot back up to the high 80's to low 90's, and the cycle repeats. Because their Co2 is so high you really want to minimize Metabolic Acidosis and if you don't get the O2 right you can send them spiraling. It is really really high maintenance to keep their work of breathing down (even though their work of breathing will be high) and their skin will be dusky, grey, and they will be thin and malnourished. It's the very end of end stage. I've only had one patient that I believe was on a hypoxic drive and I'll never forget it. It's very rare and it takes a hell of a lot to burn out the Hypercapnic drive and even then I'm so sure it's actually burned out. In short: You should really only worry about keeping the O2 saturations between a certain range in those end stage COPD patients who can't increase their VE and it will be really evident on what type of patients those are when you see them.

[edgarp]

Thank you so much. It was clear and extremely useful

[LegioXIVGemina]

Thanks, new ED design underway and we want to get it right

[catherineasadi]

Really useful as we enter the acute phases of the corona virus and these will I guess become more familiar in previously less critical areas. Thank you

[anuarvind]

Thanku so much sir !!
This has been very helpful 😊

[ma.teresaasprec]

Hi Sir Jimmy! I have a question. When refilling the humidifier, can we use PNSS as a substitute for sterile water?Thank you!

[fucyahoo]

Please do a tutorial on weaning off airvo 2 High Flow with supplemental oxygen.

[justinhapner]

Thank you for the tutorial!! I'm a critical care RN and we are now commonly using OptiFlow devices for COVID patients. I have talked to many of our RTs about these devices in the past, but your explanation gave me a whole new level of understanding. I def feel more confident in my knowledge-base, as I am constantly attempting to wean patients. I was wondering your perspective on the appropriate level to wean patients to a traditional (15L) HFNC? In my setting, it seems that we tend to do this when the patient has been adequately tolerating the OptiFlow on 40%/40L for some time... what is your take??

[rflf]

Most of the patients in the hospital complain when the heat is on 37. They say it is to hot.

[ADGMoNy]

If the heater isn’t turned on is it considered “cold flow”.

[connercollins]

where did you get your research from saying it has to be on invasive 37*???

[HtSauceGG]

How would you incorporate a neb treatment on a patient on a heated high flow device?

[hunk]

What is the danger of using high flow. My father died after taking high flow in 3 days. Does aviola damage due to high flow. How many dosages patient should take.