It's so generous of people like George, to go through the bother of setting up a camera and lighting, all for the purpose of helping others to understand what they wish to know. My hat is off to George!
Great visual illustration of the difference. I'm teaching O2 admin devices and looking for additional resources. Great presentation @George O. RRT! Thanks!
Great video, thanks! Question: When deciding on weaning a patient off the high flow systems, what metric do you change first (Fio2 or flow rate) and what's the rationale? Does the need for high flow automatically suggest high Fio2 needs? or do these both go independently?
Excellent presentation George thank you . PIFR is it 20 L/sec or /min. and how can we estimate the PIFR in a sick child are there age appropriate normal values?
Thank you for the informative video, I am a patient and trying to figure out which device to get I am about 58 yr old and my weight is about 81kg, can you help figure out what kind of machine should I get?
Hi, thanks so much for this video, genuinely the best explanation on this topic! I have a question about the titrating of oxygen therapy e.g for a patient on airvo. Say the patient is on AIRVO 30L with 30% FiO2… but their saturations are still low…. Which of the parameters should you increase first? Flow rate, or Fi02? Thanks!
Thanks George. How does an HFNC device adjust the FiO2 delivered to the patient at a given flow rate, for instance 40 lpm ? I mean at a single flow rate of 40 lpm, how can it vary the FiO2 according to our settings, say 60% and 40% !
Hi: That depends on what device your using. With an Airvo for example, you would program the flow rate and FiO2 into the device, then increase the titrated flow of O2 (from the flowmeter) into the device till the required FiO2 was attained. There are certain limitations or max values to the Airvo with flows and FiO2's deliverable to the patient. With HIgh Flow Blender setup, you would simply set the required O2 concentration on the blender then adjust your flow with the flowmeters on the blender till the required flow was attained. Always verify concentration with an O2 analyzer with the blender setup. The Airvo has a built in analyzer. Hope this helps.
For an ET tube, or a trach, if you want to do some high flow, the simplest way would be to set the ventilator in CPAP/PS, with a PEEP of 5, and a Pressure Support of 5-7, and there you go. You have high flow, Glorified that is, and you have the FiO2 you want, and not only that, you have yourself the ventilatory monitors. Now it's not as fancy as per say the High Flow I was on a few weeks ago, with the Hamilton ventilator, but it's something. And just as you said in your extubation video, It's a glorified High Flow System.
Wife here - studying midwifery - so looked for this and found your video - makes sense - probably most likely only use low flow in a home birth setting. Thanks.
When the O2 system (high flow) is set to 100% and you run the O2 to the patient at a flow that exceeds their inspiratory flow rate, the delivered O2 concentration will be what you have set it to on the high flow system....so in this case 100%....it will remain so until you either chance the set concentration, the patients inspiratory flow are or breathing pattern exceeds the set flow or you run out of oxygen. Let me know if this answers your questions.
U said bigger the oxygen device is (in low flow) that much fio2 it can give. If we take a simple oxygen mask though it has big surface area it accumulates co2. So how could we make it useful.
Hi: If I understand your question correctly, Your asking how you could make a simple mask (low flow O2 therapy effective). O2 masks are effective when used properly but have their own limitations. If you are using a simple mask for example, the effective range of flow is usually between 5-10 LPM. Sometimes higher than 10 but never lower than 5 LPM (adults). When used this way, there is sufficient O2 flow coming into the system to wash out any exhaled CO2. Using flows lower than 5 greatly increase the chances of rebreathed exhaled CO2. When using masks with bags on them like the PRB mask and NRB mask (partial and non rebreathing masks respectively), maintain the rule of thumb that says when the patient inhales, ensure that those reservoir bags remain inflated.....so use enough O2 flow to keep the res bag inflated as that is where the gas comes from for the next breath, plus the flow helps to wash out any potential CO2. The design of the mask and bag and valves (NRB mask) reduce the chances of rebreathing of CO2 when used properly. Hope this helps. George
oxygen (fio2) should be at 100% starting and flow should be placed at around 35 lpm cuz normal human lpm is 20-30 lpm so u want to exceed that. once patients sats are normal, start titrating fio2 down until patients sats at around 92-96%
Hi My mom is on the high flow oxygen because of Covid pneumonia. I am concerned that her spO2 is fluctuating a lot on high flow ( 79%-99%). She is in India currently in ICU. Please advice 🙏
Sorry to hear of your moms situation. Although lower SPO2's are not the best situation, hopefully they are somewhere between 90-99%. That would be best. Its hard to advise without knowing what interventions have been taken and what equipment they have. I hope she recovers quickly.
Hi. This sounds like the exact condition that my Dad is now. He has pneumonia covid as well. Just recently taken off the bipap machine after 2 weeks, and now on an airvo machine. He's currently at 60lpm and o2 level at 90% Hope you're Mom is OK 🙏
@@malena7362 He was taken out of ICU and into a regular room after 4 long weeks thank God. He has a long road to recovery but all signs are starting to point in the right direction. Thanks for asking
Generally speaking yes, the lower the percentage the better. The percent indicates Fraction of Inspired Oxygen. So if they are breathing the same with 60% vs 70% then their lungs are likely doing better. We can use their Fi02 and put it into the P/F ratio. The P is going to be their Pa02 (obtained via arterial blood gas) and the F is their Fi02. We divide their arterial o2 by the Fi02 percentage. A Pa02 of 100mmHg (perfect score)/0.21% Fi02 (room air) gives a top score of 476mmHg on the P/F ratio. The lower the number, the worse the lungs are. Below 300 is indication of ARDS, below 200 is really bad, below 100 is GREAT BADNESS. A patient with severe ARDS might only have a Pa02 of 45 (this is pushing into the severe hypoxia range) and might be getting 100% oxygen. Their P/F ratio would be 65. A P/F ratio this low is associated with a 45% mortality rate. Long answer short, the Fi02 in your example is kind of an arbitrary number to indicate their lungs working better or not by themselves. If we add a little context to it then it becomes a much more important number.
I'm not a nurse and I loved this. I have a family member in the ICU with COVID on a High Flow. She was talking about being on 15 L with a 91 sats. Last year I was on 2L when I was a 84% bringing me to 91 or 92 and had to learn what I was on was different from what she is on. Not looking to take your job :) just needing some info. Thanks
Thanks for your clear explanation. Why T-piece and Venturi mask are considered high-flow delivery systems though their flow rates are usually 4-10 L/m?
Hi: When you set an oxygen flow to a certain value on the flowmeter, air is going to be entrained through the venturi device increasing the total flow the patient gets.....as long as it exceeds the patients inspiratory flow. For example; the ratio for oxygen and air for a delivered O2 concentration of 40% is 1:3. If you run an O2 flowmeter at 5 LPM, the entrainment system will draw in 15 LPM of roomair. The two gases will mix and deliver to the patient 20 LPM (total flow) with an oxygen concentration of 40%. If the patients inspiratory flow rate is less than 20 LPM, this would be a properly set up high flow system. Hope this helps.
Neonates have a much lower inspiratory flow rate than an adult and so what would be a low flow system for an adult can be an effective high flow system for a neonate. That is the context in which T pieces are typically used.
@@GeorgeORRT I am not sure it's a small risk. At 40 to 60 liter/min flow, the entirety of a dyspnic patients flow comes from the cannula. He is not entraining ambient air. So oxygen is oxygen and, to me, matters not whether it's through an ET tube or high flow cannula. It's the Lorrain-Smith effect...how many CoVid patients may have had fatal oxygen toxicity by incautiously sitting at 75% for days. Pathologically, you could not distinguish it from progressing CoVid. I never let them go above 60%. I added CPAP.
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 RU-vid as a supplement to this nice video.
its all a big $ making raciket! 1. one cannot buy a o2 machine without a prescription? why not? We have now, over 11 people a Day in North America( Canada, USA) that should be on O2 but aren't..! Then we now have companies putting O2 ( compressed Air) in a Can and selling it for $15 a Can! See what the Medical Profession has Done? Wonder why China makes Better O2 Oxygenators and at (50%) Lower cost and are also? -50% smaller and use 50% Less Electricity? Have to Feed the system! what a nice racket and con game..get everyone on the payroll! at all costs!!!! Wonder why we're Drivering Medicare OOB?