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Thrive
This document discusses different oxygen therapy techniques including conventional oxygen therapy and high flow nasal cannula (HFNC) oxygen therapy. It provides details on: - How HFNC works by using an air/oxygen blender to deliver high flows of humidified oxygen at variable concentrations. - The physiologic effects of HFNC including improved oxygen delivery to the alveoli and prevention of adverse effects from lack of humidification. - Techniques called THRIVE and STRIVE-Hi that use HFNC to provide apneic oxygenation and tubeless anesthesia, extending the time available to secure an airway without risk of hypoxemia.
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- 1. THRIVE / STRIVE-Hi DrShreyas Kate
- 2. Conventional O2 Therapy •First line therapy for acute resp failure • Nasal Prongs, Non Rebreathing face mask • Limitation: – Mismatch b/w oxygen flow and patient ‘s inspiratory flow – Peak inspiratory flow may vary b/w 30 and 120 L/min during resp failure
- 3. Low Flow HighFLow nasal cannula aerosol masks simple face mask air-entrainment nebulizers partial rebreathing mask air-O2 blenders nonrebreathing mask Venturi masks Tracheostomy collar Conventional O2 Therapy
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- 5. • The endpoints of maximal alveolar preoxygenation – end-tidal O2 concentration (EtO2) of approximately 90% – Endtidal nitrogen concentration (EtN2) of 5% • Factors affecting the efficacy – FIO2, – duration of breathing – and the VA/FRC ratio Preoxygenation
- 7. HIGH FLOW NASALCANNULA HFNC
- 8. • What isHFNC Oxygen therapy? – Uses air/oxygen blender to deliver FiO2 range from 0.21 to 1.0 – Active humidity /temperature controlled -37 Cel and humidified at 44 mg H2O/L – Generates flows up to 40,60,70 L/min HFNC
- 9. • Oxygen deliveryto the alveoli depends on many factors – Oxygen flow rate – FiO2 being delivered – Device interface – Patient demand (Vt, RR, PIFR) HFNC
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- 15. • Adverse Effectsof Lack of Humidification – cessation of the flow of tracheal mucus – widespread loss of the cilia – detachment or sloughing of the epithelium – subepithelial vascular congestion – excessive water loss by the nasal mucosa HFNC
- 16. • USES: – Neonates(counteract a lack of surfactant) – Hypercapnic Respiratory Failure – Hypoxemic Respiratory Failure (FLORALI trial) – Postextubation – Preoxygenation (denitrogenate the lungs) – Acute Heart Failure – Sleep Apnea HFNC
- 17. TRANSNASAL HUMIDIFIED RAPID- INSUFFLATIONVENTILATORY EXCHANGE THRIVE
- 18. • Apnoeic window •Cannot intubate, cannot ventilate • Apnoeic oxygenation Introduction
- 19. • 1909 bySamuel Meltzer : Ventilation without ventilatory movements (direct and continuous intratracheal oxygen insufflation) • Arthur Slutsky using tracheal insufflation of O2 (TRIO) 1980s and 1990s, ‘oscillatory ventilation’, which continues to be used in highly-selected cases in paediatric ventilation, and ‘constant-flow ventilation’ History
- 20. • Aventilatory massflow (AVMF) • Negative pressure gradient of up to 20 cmH2O • Apnoeic oxygenation has been used both experimentally and clinically as a strategy to extend the apnoeic window Physiology
- 21. Physiology rate of riseof carbon dioxide levels was between 0.35 and 0.45 kPa.min1( 2.62 to 3.37 mm Hg/min)
- 22. • Pre-oxygenate for10 min at 40 degrees of head-up inclination with the nasal cannula (70 L/min) • Intravenous induction of anaesthesia then commenced with boluses of propofol, fentanyl, and rocuronium, followed by a peripheral infusion of propofol • Nasal oxygenation maintained at the same rate of 70 l/min until the definitive airway was secured Technique
- 23. Uses of THRIVE •Reduced oxygen reserve • Procedural sedation • Difficult airway • Shared Airway
- 24. SPONTANEOUS RESPIRATION USINGIV ANAESTHESIA STRIVE-hi
- 26. • Spontaneously breathing •HFNO – An increased FiO2 – Generation of positive airway pressure – Improved respiratory mechanics – Reduced upper airway resistance Introduction
- 27. Technique • Tubeless anaesthesia •Use of a standardized propofol titration method • use of HFNO – 30 L/min for 01 min – 50 L/min for 02 min in a 10–20 degrees reverse Trendelenburg position – 70 L/min when loss of consciousness occurred
- 28. – Awake patients •respiratory supportive care • preoperative preoxygenation • postoperative support – Sedated patients • procedural bronchoscopy • awake fibreoptic intubation – Asleep patients with obstructive sleep apnoea (OSA) Clinical Benefits
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