PAC conference – Long on High Flow Oxygen Therapy

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We have teamed up with APLS to share the videos from their Paediatric Acute Care Conferences. These videos have never been open access before, so if you weren’t able to attend the conferences, then now’s your chance to catch up.

The PAC Conference is run each year by APLS and consists of presentations on a range of topics relevant to paediatric acute and critical care.

Elliot Long is a Paediatric Emergency Medicine Consultant at the Royal Children’s Hospital in Melbourne, Victoria.  In this talk, from 2013, he talks about the use of high flow oxygen therapy (HFOT), something that has become commonplace in most emergency departments.

 

  • The theory is that high flow oxygen therapy reduces upper airway resistance. With the flow rate delivered exceeding inspiratory flow there is minimal entrainment of room air. It also reduces physiological dead space and may lead to decreased metabolic requirements.
  • The positive pressure delivered is variable both within different patient populations but also within the same patient during differing stages of their underlying disease process. This is 4 +/- 2cm of H2O.
  • HFOT is not the same as CPAP. In HFOT the flow is constant and so pressure varies throughout the respiratory cycle.
  • Most data regarding the use of HFOT relates to its use in cases of bronchiolitis where it may reduce work of breathing and rates of intubation.
  • Predictors of failure of HFOT include a high initial pCO2, and failure of respiratory rate to fall or SpO2 to rise.
  • There are case reports of air leak syndromes with high flows so caution is required.

 

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