Background Information: Optiflow High Flow Oxygen Delivery Device

Utilized to treat mild to moderate hypoxemia (low oxygen in the blood)2 Delivers oxygen through a high flow nasal cannula (HFNC) or tracheostomy tube2 Less invasive than mechanical ventilation for improving oxygenation*

*Roca et al compared the HFNC with conventional oxygen therapy via a mask on twenty critical care patients. This study demonstrated that HFNC via Optiflow was better tolerated and more comfortable than an oxygen mask. HFNC was also associated with an improvement of oxygenation and a reduction in respiratory rate.3

High Flow Oxygen (HFO2)

An oxygen delivery system which blends oxygen/air from 35-100% Can be administered via wide bore nasal cannula or trach adapter up to 60 L/min Provides humidity enriched oxygen therapy for patients in mild to moderate respiratory distress It is not a substitute for NIPPV in an acute crisis May provide a bridge from NIPPV to conventional oxygen delivery devices and also may give some patients NIPPV free hours2

Hypothesis

Optiflow may reduce escalation of therapy in specific patient populations that exhibit certain clinical and demographic characteristics

Relevance to Practice

Aid clinical decision making as to whether or not Optiflow is the best option for a specific patient Initiate Optiflow on patients that display characteristics deemed successful Not consider Optiflow for patients that display characteristics deemed unsuccessful Effective and efficient use of respiratory technology

Study Design

Retrospective observational study Analyzed data on patients at LVHN who were placed on Optiflow from May 21, 2011 to May 21, 2012 Sample size: 137 patients Patients less than 18-years-old were excluded Patients on Optiflow were identified from a daily report received by respiratory therapy Metavision and Centricity were used to gather demographic and clinical information regarding these patients

Methods

Patients were separated into two groups: patients who were successful on Optiflow and patients who were not Success was defined as de-escalation in care, meaning the patient maintained clinical end-points on Optiflow or conventional oxygen delivery systems Failure was defined as escalation in care, meaning that in order to maintain desired clinical end-points either NIPPV or mechanical ventilation had to be instituted If a patient was on Optiflow for more than 72 hours they were counted as a failure because Optiflow is not indicated to be a long-term therapy1

Results

All variables which were found to be statistically different (p<0.05) between the two groups were included in the logistic regression model. Patients who had a previously existing co-morbidity of pulmonary disease were 5.81(p=0.023) times more likely to fail on Optiflow compared to patients who did not have a previously existing co-morbidity of pulmonary disease. For every one day increase in ICU length-of-stay the odds of failing on Optiflow increased by 1.14 (p=0.001). Compared to individuals who only had 0 to 1 co-morbidities, those who had 2 to 3 co-morbidities were 6.93 (p=0.025) times more likely to be a success. Compared to those who were on Optiflow for 0 to 4 hours, those who were on Optiflow for greater than 16 hours were 13.11 (p=0.001) times more likely to be a success.

Interpretation/Conclusion

Patients who stay in the ICU for a longer period of time may be more likely to fail on Optiflow because these individuals tend to be sicker. Individuals with 2 to 3 co-morbidities may be more likely to succeed on Optiflow than those who had 0 to 1 co-morbidities because we did not have a variable to control for acuity level of the patient. Those who are going to fail on Optiflow are more likely to do so in the first sixteen hours, therefore, these hours are crucial for the patient. Patients who have a previously existing co-morbidity of pulmonary disease are more likely to fail on Optiflow.

Strengths and Limitations of the Study

Strengths

Limitations

Case and control groups were relatively similar in terms of demographic characteristics All data was collected using standardized guidelines Data came from a reliable source (electronic medical records)

Nature of retrospective studiesneed to rely on data that was previously collected and not all desired variables can be collected Due to a lack of variation in the data we could not analyze race or ethnicity Due to small cell counts when conducting the statistical tests, we needed to combine some categories from several variables

Clinical/Educational Ventures

Attended rounds and shadowed respiratory therapists in OHU, MSICU, PICU, NICU, NSICU, BU, CICU, TNICU

Observed respiratory therapists as they fulfilled and exceeded their everyday responsibilities

Attended rounds in MSICU with Dr. Joseph Paprota Attended acute lung disease lecture presented by Kenneth Miller, MEd, RRT-NPS, AE-C Observed Bronchoscopy with Dr. Robert Kruklitis

Dr. Kruklitis also presented the opportunity to observe a colonoscopy and endoscopic procedure

Attended Robotics Surgery with Rachel Morcrette, PA-C and Kyle Langston, PA-C

2 Hysterectomies

Clinical/Educational Ventures

Visited Surgical Education Center with Robert Ruhf Completed tasks with surgical equipment that medical students and physician assistant students use to prepare for surgical procedures Attended Pulmonary Journal Club Shadowed in AICU with Lorraine Valeriano and Dr. Jennifer Rovella Shadowed Elizabeth Egan, RN A total of 32 monitors were used by the AICU team to provide additional attention and care to patients Observed Craniotomy with Dr. Mei Wong

Dr. Wong removed a tumor which was obstructing the optic nerve of the patients brain

References
1. Kruklitis, R., Miller, K., & Kincaid H. (2012). Identification of Patient Characteristics as Predictors for Success or Failure of Optiflow High Flow Nasal Cannula Oxygen Delivery System. Allentown, PA: Lehigh Valley Health Network. 2. Miller, K. (2011). Humidified High Flow Oxygen Therapy. Allentown, PA: Lehigh Valley Health Network. 3. Roca, O., Riera J., Torres F. et al. High flow oxygen therapy in acute respiratory failure. Respiratory Care; 55 (4): 408-413.