Treatment Highly moisturized therapy ( HHHF ) is a type of respiratory support method that provides high flow (liters per minute) of medical gas to the patient through the interface (nasal cannulae) intended to make wash -out from the upper airway. The gas used is heated to fit the human body temperature (37 Celsius) and moisturizes the target of the ideal saturated body vapor pressure.
Video Heated humidified high-flow therapy
Medical use
High flow therapy is useful in patients who spontaneously breathe but have increased breathing work. Conditions such as general respiratory failure, asthma exacerbations, COPD exacerbations, bronchiolitis, pneumonia, and congestive heart failure are all possible situations where high flow therapy may be indicated. HHHF has been used in patients who breathe spontaneously with during general anesthesia to facilitate surgery for airway obstruction.
Newborn baby
High flow therapy has proven useful in regulating neonatal intensive care for premature infants with Baby Respiratory syndrome, as it prevents many infants from requiring artificial ventilation through intubation, and allows safe breathing management at lower FiO2 levels, thereby reducing risk. retinopathy of prematurity and oxygen toxicity.
Due to the decrease in business stress required for breathing, the neonatal body can spend more time using metabolic efforts elsewhere, leading to day degradation in mechanical ventilators, faster weight gain, and overall overall hospitalization decline.
High flow therapy has been successfully implemented in older infants and children. Kanula increases respiratory distress, oxygen saturation, and patient comfort. The mechanism of action is the application of mild positive air pressure and lung volume recruitment.
Benefits
HFT, doctors may provide higher FiO2 to patients than is possible with typical oxygen delivery therapy without the use of non-rebreather mask or tracheal intubation. The hot humidification of the respiratory gas facilitates secretion expenditure and decreases the development of bronchial hyper-response symptoms. Some patients who require respiratory support for the benefits of bronchospasm use air sent by HFT without additional oxygen. HFT is useful in the treatment of sleep apnea. During the use of HFT the patient can talk. Most patients feel HFT is more comfortable than using an oxygen mask. Since this is a noninvasive therapy, it avoids the risk of ventilator-related pneumonia in situations where it can replace ventilator use.
Maps Heated humidified high-flow therapy
Mechanism
Oxygenation is achieved by providing increased FiO2 in the airflow to the patient. The constant watering of the upper air ducts creates a reservoir that reduces the air-space entrainment for such amounts so that it becomes the true fraction of inspired oxygen as determined by the device.
Ventilation
Through the nasal cannula, a high-flow system provides a flow near (and can meet) the total respiratory needs. This flow, delivered via a small-diameter delivery system and a small-bore nasal cannula, allows streams that traditionally move slowly through the upper airways to move quickly and maintain a constant stream of fresh gas that effectively cleans the upper airway dead space.
This constant flow of fresh gas stream creates an environment that helps the expenditure by removing exhaled air to keep the fresh air reservoir ready to be inhaled.
Humidification
The higher the flow, the more important humidification and conditioning the current becomes. Without moisture, the effects of oxygenation and ventilation from high flow therapy will be quickly overcome by the negative impact of dry air on the lung tissue.
History
The nasal cannula used for medical gas delivery is usually limited to delivering 1-6 liters of flow per minute. The percentage of oxygen inhaled by the patient (FiO2), usually ranges around 24-35% because the pure oxygen delivered from the cannula is diluted by the surrounding air entrainment (21% oxygen). The flow rate for oxygen delivery using an ordinary nasal cannula is limited due to anhydrous medical oxygen, and when sent from a pressurized source, the gas cools as it expands with a decrease in atmospheric pressure. Delivery of cold dry gases irritates the respiratory mucosa, may cause drying and bleeding of the nasal mucosa and may increase metabolic demand by cooling the body.
Even with quiet breathing, the inspiratory flow rate in adult nares usually exceeds 12 liters per minute, and can exceed 30 liters per minute for someone with mild respiratory distress. Traditional oxygen therapy is limited to six liters per minute and does not begin to approach the inspirational demand of adults and therefore oxygen is then diluted with room air during inspiration.
Prior to the emergence of HFT, when increased FiO2 is required for respiratory support; special facial mask or intubation is required. With High Flow Therapy, the goal is to provide sufficient volume of respiratory gas flow to meet or exceed the patient's inspiratory flow rate. The gas is heated and moistened to condition the gas because the increase in flow will damage the tissue if allowed to dry and cool.
HFT, the oxygen source is usually mixed with compressed air. Hospitals typically have 50 psi oxygen and compressed air available for therapeutic use. This allows the delivery of air or a mixture of air and oxygen by using an oxygen blender. The gas is then heated, generally up to about 37 Â ° C, and humidified to close to 100% RH using a humidifier. The gas is transported to the patient via a heated delivery tube to prevent cooling and condensation of water vapor that has been added to the gas of breathing (ice).
HFT requires the use of nasal cannula and systems designed to provide high flow rates and the resulting pressure to do so. At the same time, the nasal cannula should be small enough that it does not cover more than 50% nares, as this allows the flow to have some exit points for the ongoing flush airway effect.
Commercial development
Vapotherm introduced the concept of high flow therapy dampened through the nasal cannula in 1999 after it was originally developed for use on race horses.
References
Source of the article : Wikipedia
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