Heated and Humidified High Flow Oxygen

What is the Role of Heated and Humidified High Flow Oxygen In Respiratory Support?

by with No Comment HFO

Generally, there are two common ways of administering oxygen therapy. One of these is the high-flow device method like air entrainment masks or non-rebreathers. While the other known as low-flow devices use nasal cannulae or masks. Many a time, the high-flow nasal cannulae are often administered during surgical procedures. Evidence also suggests that this humidified oxygen therapy is safer at a stand-alone surgical IMCU. 
Therefore, why is heated and humidified high-flow oxygen (HFNC) necessary for respiratory support? Continue reading to know more.

Heated and Humidified High Flow Oxygen

Understanding Heated and Humidified High-Flow Oxygen Therapy

High-flow oxygen is a respiratory therapy that supplies oxygen at a significantly higher rate. It is a medical device that usually serves as a breathing support for ICU patients. Additionally, it delivers oxygen continuously through a tube inserted into the nostrils. This ventilation supply often aids patient comfort, because they are always humidified and warmed to 37°. 

On most occasions, this therapy is mostly used to treat patients experiencing respiratory distress. Also, heated and humidified high-flow oxygen therapy is always provided if standard oxygen therapy isn’t working. Hence, it helps lessen the effort your body must expend on breathing. Apart from reducing respiration effort, it also produces slight positive pressure in the upper airways.

How Does Heated and Humidified High-Flow Oxygen Work?

Unlike conventional low-flow oxygen, HNFC delivers its maximum oxygen rate beyond 30 L/min. Also, this High-flow oxygen isn’t merely a regular nasal cannula but one that’s increased extremely. However, there are some key steps in which heated and humidified high-flow oxygen is produced. Some of these are:

  1. Oxygen Heat-Up: In most cases, HNFC always heats oxygen to the same temperature as the body. Furthermore, they often provide 37 degrees Celsius of air during inspiration.
  2. High flow of gas: Additionally, this breathing support works by providing oxygen gas (FiO2) at an elevated inflow rate. It supplies about 1.00% fiO2 at up to 60 liters per minute of flow.
  3. Provides Humidified Air: Because high-flow therapy is often administered at a high standard, the gas is always humidified. Therefore, inhaled air often contains moisture that is the same as normal air.
  4. Supplied through Device: Just like any other assisted ventilator, this ventilation support is also supplied via devices. Also, depending on the patient’s fiO2 requirement, the delivering device might be nasal cannulas or masks.
Heated and Humidified High Flow Oxygen

Indication for Using Heated and Humidified High-Flow Oxygen

Sometimes, when standard oxygen therapy fails to improve low oxygen levels, HFNC may be used. In most cases, this heated and humidified high-flow oxygen is often used to support patients experiencing respiratory distress. Nevertheless, some of the breathing issues that always indicate high-flow oxygen usage are as follows:

  • Congestive heart failure
  • Respiratory distress syndrome (RDS)
  • Non-small cell lung cancer (NSCLC)
  • Bronchial asthma
  • Bronchopneumonia
  • Pulmonary edema
  • Intensive phase of Chronic obstructive pulmonary disease (COPD)
  • Broken ribs and other types of chest trauma 
High-Flow Oxygen

Benefits of Heated and Humidified High Flow Oxygen in Respiratory Care

When compared to traditional oxygen therapy, HFNC offers numerous advantages. They are known as a heated and humidified system that enables easy flow of oxygen. In addition, the fraction of inspired oxygen (fiO2) can be regulated at an extreme inflow rate. Therefore, what are the benefits of high-flow oxygen for patients with respiratory disease?

1. Accurate Oxygen Distribution

In normal circumstances, the oxygen delivery rates of HNFCs are usually higher than those with traditional nasal cannulas. As a result of this, there is always a limited room air retainment. Besides, it also provides a high amount of oxygen that overcomes the patient’s peak inspiratory flow rate. Therefore, it doesn’t dilute the oxygen wished to give a patient. 

2. Improves Functional Residual Capacity (FRC)

By supplying a varying amount of positive pressure, high-flow therapy also affects the FRC rate. This is often determined by the placement of manometers at the posterior oropharynx. On most occasions, the readings of this pressure are not always very high during closed-mouth breathing. However, when patients open their mouths, the impact nearly disappears. Additionally, research indicates that the application of HFNC readily results in a 25% improvement in FRC.

3. Dead space Clearance

Additionally, with heated and humidified high-flow oxygen breathing is usually more efficient. Why? This is because the continuous high oxygen flow often eliminates anatomical dead spaces present in the airways. In addition, the warm, heated air always assists with mucus and foreign particles and also reduces the energy for breathing.

Humidified Oxygen

Comparing Heated and Humidified High-Flow Oxygen to Traditional Oxygen Therapy

When comparing high-flow oxygen to traditional oxygen, several differences and similarities can be extracted. However, some following points indicate the similarities of both systems.

  1. Most of the time, both devices supply FiO2 at a variable concentration
  2. They also serve as respiratory support
  3. Neither traditional oxygen nor HFNC are delivered in the invasive mode
  4. In most cases, they are simple to administer and easily adjustable
  5. Either of the two systems can be used effectively in similar clinical conditions e.g. COPD cases, acute respiratory failure etc.

Although, heated and humidified high-flow oxygen provides some similar functions to traditional oxygen. Hence, this high-flow device also has some specialty when compared to the low-flow. Some of these significant features are:

  1. The ability to provide oxygen gas at a very high rate that ranges between 30 to 60 L/min
  2. Capacity to actively moisturize inflow air
  3. Provision warm oxygen that complies with body temperature
  4. Prevent airway problems and complications by maintaining and clearing respiratory dead spaces
  5. HFNC is also more effective at improving oxygenation, especially in hypoxemic patients.

Considerations for Implementing Heated and Humidified High-Flow Oxygen

Normally, heated and humidified high-flow oxygen is easy to use. Nonetheless, some integral factors must be considered while implementing this device. Hence, I would like to give you some basic “DEDEVUS” processes that must be considered while using HFNC.

  • Determine your patient condition and device compliance rate
  • Ensure a proper setting of the system: You must make sure the high-flow device is in good form. Additionally, thighs like the flow rate, FiO2 level, filter, battery, and ventilation slot should be examined thoroughly.
  • Don’t place a patient on high-flow oxygen immediately after the device is turned on.
  • Examine your oxygenation channels: It’s very important to verify the O2 tube connection and adjust flow to prevent FiO2 delay and regulate the flowmeter. In addition, ensure to set your internal alarm menu and avoid smoking.
  • Verify humidification supply: Things like sterile water, plastic bags, and caps should be checked thoroughly. Also, the water bag must not be empty and the permeable circuit must be monitored at every interval.
  • Use the appropriate tube and cannula with the correct placement
  • Set alarm 

Future Directions and Innovations in Heated and Humidified High-Flow Oxygen Technology

In the modern world, almost every aspect of life is gradually evolving. Some of these have led to several innovative improvements in the medical world and assisted ventilation to be precise. Hence, heated and humidified high-flow oxygen isn’t left aside. Also, most scientists believe they are one of the best and most dynamic mechanical ventilation systems. Therefore what are high-flow oxygen future trends? 

Be informed that several innovative directions of HFNC are yet to be seen. However, some of these potential features and trends, such as precise delivery, flexibility, patient compliance, personalized treatment, etc are expected to emerge soon.

Take Away

Heated and humidified high-flow oxygen therapy is a modern method that provides a great deal of warmed and moisturized oxygen. It is a special device with significant advantages that plays a key role in patient outcomes. Additionally, this system is a breathing support that requires proper examination before implementation as it differs from traditional oxygen therapy. Above all, it’s also a ventilation system with diverse emerging future directions. 

However, high-flow oxygen is a medical therapy that requires professionalism. So, if you are looking for a reliable source of respiratory support, you can reach out to Biosys Biomedical today. With no more ado, schedule an appointment for effective HFNC support today!

References

https://tsaco.bmj.com/content/3/1/e000179

https://www.accjournal.org/journal/view.php?doi=10.4266/acc.2021.01571 

https://www.svhlunghealth.com.au/procedures/procedures-treatments/high-flow-oxygen-therapy 

https://rebelem.com/high-flow-nasal-cannula-hfnc-part-1-how-it-works/ 

https://www.medmastery.com/guides/noninvasive-ventilation-clinical-guide/how-does-high-flow-nasal-cannula-hfnc-work 

https://ejb.springeropen.com/articles/10.4103/1687-8426.211399 

https://clinmedjournals.org/articles/ijccem/international-journal-of-critical-care-and-emergency-medicine-ijccem-4-048.php?jid=ijccem#:~:text=  

https://www.biosysmed.com/innovative-approaches-high-flow-oxygen-therapy-in-the-icu/

Innovative Approaches: High-Flow Oxygen Therapy in the ICU

Innovative Approaches: High-Flow Oxygen Therapy in the ICU

by with No Comment Uncategorized

Intensive Care Unit (ICU) is different, whereby individuals suffering from acute and critical respiratory conditions demand complex assistance. Mechanical ventilation has proved crucial for the medical care of these cases for decades. Mechanical ventilators are frequently used in pathological situations such as low oxygen levels or high carbon dioxide levels where the patient has difficulty breathing. Nevertheless, over recent years, there appears to be a new therapeutic way called high-flow oxygen therapy, which is likely to substitute or serve with traditional respiration practices. The goal is to create a particular focus on optimizing humidification to enhance patient comfort and respiratory support. 

Understanding High-Flow Oxygenation (HFO)

In clinical applications, oxygen therapy can be given as low flow (with mask or nasal cannula) or high flow (Venturi mask or nonrebreathers). However, in conventional methods, some of the oxygen inhaled by the patient is not delivered completely. Since the oxygen is not heated and humidified, the patient may not tolerate it for long periods. High-flow oxygen therapy, which is mainly used for respiratory diseases in pediatric patients, has found a serious place, especially in the COVID-19 pandemic and has begun to be widely used in adult patients as well.  

High-flow oxygen/cannula therapy is gaining widespread attention as an alternative approach to respiratory support in intensive care patients. This method is applied via air or oxygen mixer (rate up to 60 L/min at 21% to 100% oxygen fraction), humidifier, patient circuit and nasal cannula. The high-flow, warmed, humidified oxygen removes carbon dioxide from the anatomical dead space, making breathing easier and increasing patient comfort.

Benefits of HFO in ICU

The benefits of HFO go further than simple improvement in gas exchange. Compared to traditional mechanical ventilation, HFO offers numerous advantages:

  • Comfortable for patients: The nasal prongs are soft and small. Several studies stated that patient comfort is higher with HFNC than with a conventional nasal cannula or face mask
  • Warming and humidification of secretions: There is no chance for warming and heating oxygen when applying with a nasal cannula or face mask. In HFNC, oxygen is humidified and warmed before being administered to the patient. This increases the patient’s ability to tolerate treatment over a long period. This can facilitate the removal of mucus and other secretions from the airway. 
  • PEEP effect: Although the HFNC is an open system, the high-flow nasal cannula provides resistance to expiratory flow and increases airway pressure. PEEP decreases lung compliance, residual capacity reduction and elimination of refractory hypoxia. PEEP allows collapsed lung alveoli to open. It improves oxygenation and lung compliance.
  • High flow rate: Access to 60 L/min oxygen flow, which is not possible with normal oxygen devices, is possible with HFNO devices. Flow rate, humidity and temperature can be adjusted with the device. This allows the treatment to be adapted to the individual’s condition, increasing effectiveness.

Mechanism Of Action And Clinical Applications

Nasal high-flow therapy contributes to improving the fractionation of alveolar gases by reducing nasopharyngeal dead space. The expandability of the nasopharynx provides significant inspiratory resistance relative to expiratory effort. HFNO provides adequate flow rates to accommodate inspiratory flow and thus significantly reduces the inspiratory resistance associated with the nasopharynx and thus eliminates the associated work of breathing. Delivery of heated and humidified oxygen to the respiratory organs increases pulmonary compliance and reduces metabolic load compared to dry and cold gas. The high flow in the nasopharynx provides positive tensile pressure to activate the lungs.

High flow oxygen therapy indicates for hypercapnic respiratory failure, hypoxemic respiratory failure, post-extubation, preintubation oxygenation, acute heart failure and sleep apnea. In pediatric patients, it is mainly indicated for bronchiolitis, but also for pneumonia, croup, asthma and post-extubation.

Patient-Centered Care and Comfort

Patient comfort and satisfaction in the rigorous conditions of the ICU are critical aspects of providing quality health care. From the patient’s perspective, HFO significantly reduces discomfort associated with traditional mechanical ventilation.

  • Reduced Discomfort: A soft nasal cannula and gentle airflow take away distress caused by the endotracheal tube, making patients more tolerant and less anxious.
  • Improved Communication: Additionally, the methodology enables patients to communicate freely with each other during their stay, which facilitates an improved atmosphere.
  • Enhanced Sleep Quality: Compared to mechanical ventilation, HFO allows for better rest and, consequently, better recovery of patients because it is less noisy and does not cause disruption.

Clinical Outcomes and Cost-Effectiveness

HFO therapy has been studied extensively and proven clinically beneficial. One of the most comprehensive studies investigating the effectiveness of nasal high-flow therapy is the Clinical Guideline published by the American College of Physicians. According to this guideline, compared to NIV, it has been shown to improve clinical outcomes as an initial treatment for acute respiratory failure and improve patient comfort by reducing re-intubation compared to standard oxygen therapy. It is stated that it causes fewer complications in patients than NIV or COT.

The effectiveness of HFNO in patients with hypoxia in acute heart failure was investigated in a retrospective cohort study. It has been stated that there is a better improvement in left ventricular parameters in patients receiving HFNO treatment compared to non-invasive positive pressure ventilation. It has been concluded that HFNO may be an ideal model, especially in hypoxemic AHF patients.

In another meta-analysis investigating the use of HFNO in anesthesia induction, it was compared with FMV. The use of HFNo for anesthesia induction has been shown to significantly improve oxygenation compared to FMV.

In addition to those mentioned above, many scientific studies are showing the effectiveness of HFNO.

Cost Savings

In a study conducted in England, the cost-effectiveness of HFNO use was investigated. Three different cost-effectiveness models were used in this study: the pre-intubation model and the post-extubation model in low-risk and high-risk patients. The use of HFNO in first-line treatment is reported to provide estimated savings of £469 per patient compared to standard oxygen therapy and £611 compared to NIV. NHF cost savings for the high severity subgroup were found to be £727 compared to standard oxygen and £1,011 compared to NIV.

For post-intubation low-risk patients, NHF provides an estimated cost saving of £156 compared to standard oxygen. The savings for post-intubation high-risk patients was stated to be £104.

Another study in infants with bronchiolitis compared low-flow oxygen therapy and HFNO therapy. In this study, treatment costs were found to be between $1786-3600 for HFNO, while these figures were found to be between $2175-5125 for standard treatment. Based on this, the cost-effectiveness of high-flow oxygen therapy can be demonstrated.

high-flow oxygen device

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References

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  • Huiying Gao, Lin Chen, Xiaofei Kang, High-Flow Nasal Cannula Oxygen Therapy in Patients With Acute Heart Failure: A Meta-analysis, The Journal for Nurse Practitioners, Volume 19, Issue 5,2023, https://doi.org/10.1016/j.nurpra.2023.104602.
  • Nishimura M. High-Flow Nasal Cannula Oxygen Therapy in Adults: Physiological Benefits, Indication, Clinical Benefits, and Adverse Effects. Respir Care. 2016 Apr;61(4):529-41. doi: 10.4187/respcare.04577. PMID: 27016353.
  • Toffaletti JG, Rackley CR. Monitoring oxygen status. Adv Clin Chem 2016;77:103-24.
  • Emily Eaton Turner &Michelle Jenks (2017), Cost-effectiveness analysis of the use of high-flow oxygen through nasal cannula in intensive care units in NHS England, https://doi.org/10.1080/14737167.2018.1411804
  • Paula Heikkilä MSc, Leena Forma PhD, Matti Korppi MD, PhD (2016), High-flow oxygen therapy is more cost-effective for bronchiolitis than standard treatment—A decision-tree analysis, Pediatric Pulmonology, https://doi.org/10.1002/ppul.23467
  • Kevin Dysart, Thomas L. Miller, Marla R. Wolfson, Thomas H. Shaffer, Research in high flow therapy: Mechanisms of action, Respiratory Medicine, Volume 103, Issue 10,
  • 2009,Pages 1400-1405, https://doi.org/10.1016/j.rmed.2009.04.007.
  • Baldomero, A. K., Melzer, A. C., Greer, N., Majeski, B. N., MacDonald, R., Linskens, E. J., & Wilt, T. J. (2021). Effectiveness and Harms of High-Flow Nasal Oxygen (HFNO) for Acute Respiratory Failure: An Evidence Report for a Clinical Guideline by the American College of Physicians. Annals of Internal Medicine, 174(7), 952. https://doi.org/10.7326/M20-4675
  • Song, Jl., Sun, Y., Shi, Yb. et al. Comparison of the effectiveness of high-flow nasal oxygen vs. standard facemask oxygenation for pre- and apneic oxygenation during anesthesia induction: a systematic review and meta-analysis. BMC Anesthesiol 22, 100 (2022). https://doi.org/10.1186/s12871-022-01615-7
  • Tong, Xiao MDb; Tong, Ningning MDa; Yao, Feifei MDc; Yan, Jing MDd; Ci, Caizhe MDd,*. Clinical outcomes of high-flow nasal cannula oxygen therapy in acute heart failure patients with hypoxemia: A retrospective cohort study. Medicine 101(43):p e31124, October 28, 2022. | DOI: 10.1097/MD.0000000000031124