2013 pediatric fellows boot camp_oxygen delivery devices

Julia Lawrence RRT-NPS

By the end of this workshop, the learner will be able to compare and contrast the various types of oxygen delivery devices according to flow requirements and fractional inspired oxygen delivered

By the end of this workshop, the learner will be able to discuss and determine which oxygen delivery device(s) would be most appropriate given case-based examples  

High-flow Venti-masks (air entrainment masks) Mechanical aerosol systems Non-rebreathing masks High flow nasal cannula

Low-flow Nasal cannula Simple masks Partial rebreathing masks

oxygen

room air

exhaled gas

O2 Flow rate FiO2 O2 Flow rate FiO2 O2 Flow rate FiO2

Nasal cannula Oxygen mask Mask with reservoir1 0.24 5-6 0.4 6 0.62 0.28 6-7 0.5 7 0.73 0.32 7-8 0.6 8 0.84 0.36 9 0.80+5 0.4 10 0.80+6 0.44

• Nasal Cannula• Heated high flow Nasal Cannula• Simple Face mask• Venturi mask• Non rebreather mask

Nasal Cannula up to 4 lpm (adults 6 lpm) Approximately 24-45% Fio2

Uses Optimal heated humidified O2 Higher flow which causes a “splinting”

effect to the airways Reduces WOB Flow rates exceed patients inspiratory flow rates

Patient size Color of Cannula

Flow rate Size of outer diameter cannula

< 1400 gm Red 6L/Min 2.4

>1400 gm Yellow 6 L/min 2.4

Infant Violet 7 L/min 2.7

Infant Intermediate

Blue 7 L/min 2.7

Pediatric Green 8 L/min 3.7

Sizes of Nasal CannulaSizes of Nasal Cannula

Infant/ Pediatric cannula up to 8 lpm

Adult Cannula 10 to 60 lpm

The following criteria are for patients being admitted to the acute care floors.

< 4 CRS (Clinical Respiratory Score) < 40% FiO2 > 4kg > 4 weeks

Flow Rates 6-10 lpm Approximately 35%-55%

Allow for a set O2 concentration Entrain Room Air Liter flow depends on Set Fio2 Can deliver up to 100%

Has a one way valve Can deliver close to 100% Fio2 Liter flow enough to keep the bag inflated

Weaning Highflow Nasal Cannula on Acute Care

Is patient on pediatric or adult circuit?

Pediatric Adult

Wean FiO2 to keep saturation > pre set saturation limit

Once FiO2 is decreased to 40% begin to wean liter flow

(Note: In CVICU wean according to MDs order to maintain saturation, may be to 21%)

If CRS is <4 wean flow by at least 1 lpm every 4 hours to a minimum of 4LPM

When at a flow of 4 lpm then transition to a bubble humidifier.

Wean FiO2 to keep saturation > pre set saturation limit

Once FiO2 is decreased to 40% begin to wean liter flow

(Note: In CVICU wean according to MDs order to maintain saturation, may be to 21%)

If CRS is < 4 wean flow by 5 lpm until you reach an end point of 10 lpm (Circuit RT 202 has a low flow limit of 10 lpm)

Once at 10 liters transition to another Oxygen delivery device.

Pre-determined Sat limit

Asthma > 92%Pneumonia > 90%Bronchiolitis > 90%Sickle Cell > 94%All others > 92%

Weaning patients on HFNC in Special Care Areas

Patient started on High flow(Document Clinical Respiratory

Score)

Has CRS decreased by 1 within 60 mins of initiation?

YES NO

Continue to support the patient.

Assess patient Q1-2 h and Document CRS

Increase Flow to decrease WOB

Notify Practioner if CRS increases by > 2 from initiation of HFNC

Assess patient Q1-2 h and document CRS

Wean if patient meets criteria.

Wean Fio2 to 40%, Keeping Sats greater than pre-determined level

Begin weaning flow every hour if CRS < 4

Once the patient is tolerating < 4 LPM change to regular Nasal cannula

Criteria for weaning HFNC

Sats above pre-determine sat limit

CRS < 4

Intervention Why Liter flow

14 y/o male with end-stage CF and recent sinus surgery is admitted to your service. His blood gas is as followed pH 7.35 Pco2 60 Pao2 85, HCO3 26

Vital signs O2 sat 88%, RR 30 HR 95 BP 130/90

What would you do?

16 year old soccer player is admitted to the ICU, following an acute onset of SOB after a coughing spell. His recent chest x-ray shows a moderate right sided pneumothorax. Pt is hemodynamically stable.

What would you recommend?

A 6 month old RSV+ is admitted to the ICU with increase WOB. His vital signs are as followed

HR 180 RR 80 Sat 90 What would you recommend?