Table of Contents 1. Escaping intubation and pressure ulcers with Optiflow Junior (Dore, USA) 2. Optiflow treatment for respiratory distress secondary to atelectasis (Dore, USA) 1. Escaping intubation and pressure ulcers with Optiflow Junior™ CASE STUDY SUBMITTED BY Optiflow Junior™ Nasal High Flow Amy Dore, RRT-NPS Dell Children’s Medical Center of Central Texas Austin, Texas, USA better tolerate the pressures. On PICU day 8 she was BACKGROUND weaned off BiPAP and remained on Optiflow Junior. Her A six-year-old female was admitted to the PICU for acute flow was weaned to 8 L/min with poor results. The flow chest syndrome secondary to sickle cell anemia. Once in was increased to 20 L/min to maintain her work of the PICU she was started on nasal cannulae (NC) at 2 breathing for the first couple of hours once off BiPAP. L/min; her chest pain and instability worsened. Less than 12 hours after initiation of NC at 2 L/min she became tachypneic with respiratory distress. Optiflow Junior was started at 20 L/min at 40% FiO2. The patient was maintained on Optiflow Junior prior to receiving an exchange transfusion. CLINICAL COURSE By the fourth hour off BiPAP the patient was trialled on room air from 20 L/min; she tolerated the weaning to room air and her work of breathing remained at a low level. She was started on alternative lung recruitment methods scheduled with pulmonary toilet in an attempt to keep her off all BiPAP and Optiflow Junior therapy. DISCUSSION An exchange transfusion was given on day 3 with no adverse reaction. By day 4 she developed bilateral pleural effusions with left necrotic pneumonia. Optiflow Junior was unable to fully meet her respiratory needs, therefore bi-level positive airway pressure (BiPAP) 15 cm/5 cm was also started. Optiflow Junior allowed the patient to take breaks on and off BiPAP for four days. The patient would be put on BiPAP therapy for lung recruitment and then come off for 30 minutes in 4-hour increments. This case study demonstrated that Optiflow Junior is another effective tool for the prevention of complications such as skin-care issues, in addition to supporting the minimal work of breathing for a young school-age child. It is incredibly challenging to use BiPAP for this age group. BiPAP is a challenging therapy to use in paediatrics as these patients often will not tolerate the BiPAP mask. The masks that are used are made for the adult population; therefore they often do not fit our pediatric population. Optiflow Junior was ordered for flows of 15 L/min whilst This can cause skin issues in these patients due to the off BiPAP with a FiO2 set to maintain SpO2 greater than fact that we must tightly fit the mask to their face to 92%. She was maintained at 30 to 40% FiO2. Due to a maintain an adequate seal. This in itself will cause skin prior history of moderate persistent asthma the patient breakdown. Being able to give this patient breaks from was deemed to be at higher risk for intubation than that of BiPAP with an effective tool to maintain some form of a normal healthy child. In addition, there was an intrinsic PEEP was enough to keep her from being increased risk of being intubated due to the inability of this intubated. age group to tolerate tight-fitting BiPAP masks. As the patient was given breaks off the BiPAP she was able to Case Study submitted to Fisher & Paykel Healthcare Ltd 185048058 Rev A Typically pediatric patients do not tolerate the BiPAP masks and consistently remove them during treatment. As a consequence of the constant mask removal (as well as the fact that until now there has been a lack of a reliable alternative), atelectasis and a compromised pulmonary status usually then result. Thanks to Optiflow Junior we were able to offer the alternative in a time of need. 2. Optiflow™ treatment for respiratory distress secondary to atelectasis CASE STUDY SUBMITTED BY Optiflow Junior™ Nasal High Flow Amy Dore, RRT-NPS Dell Children’s Medical Center of Central Texas Austin, Texas, USA further to 6 L/min. The patient could not tolerate being BACKGROUND weaned to 6 L/min, therefore the flow was increased to 7 An 11 month old male patient with end-stage renal L/min and maintained for 24 hours. His condition disease secondary to prune belly was admitted to PICU progressively improved and he received hemi-dialysis post bilateral nephrectomy and bladder augmentation. relieving more fluid retention post-surgery. On the third The patient was extubated in the operating room post day, the patient was weaned further to 2 L/min and stayed procedure and transferred on nasal cannulae at 2 L/min. on 2 L/min for two days. By post-operative day 5 he was He was admitted to the PICU at 1710 hours. During the weaned to room air. Due to the patient’s complicated first 24 hours, the patient began to exhibit signs of history with end-stage renal insufficiency he is still being respiratory compromise and increased work of breathing. monitored by our pediatric ICU physicians. He had no In addition, he was having difficulty with fluid retention and respiratory compromise. hemo-dialysis was instituted soon after surgery. DISCUSSION CLINICAL COURSE In this case study Optiflow Junior was seen to be capable On day 2 the patient was hypoxic and demonstrating a of relieving acute respiratory distress and atelectasis and further increased work of breathing. The chest x-ray then avoiding escalation of any invasive or non-invasive confirmed a complete white-out of the left chest ventilation. This patient had acute post-operative needs secondary to atelectasis. Optiflow Junior was commenced with a very complex medical condition including fluid at a flow of 10 L/min and 100% FiO2. The patient retention secondary to renal insufficiency. The continued to have increased work of breathing and hyperinflation of the right lung was quickly resolved by hypoxia so the flow was increased to 15 L/min. The increasing pulmonary toilet and weaning the flow rates patient was maintained on 15 L/min for six hours relieving according to patient tolerance. There were no negative his hypoxia and work of breathing. After six hours the flow outcomes associated with the application of Optiflow was able to be weaned to 10 L/min. He was maintained Junior. on 10 L/min throughout the night. The patient was consistently slightly tachypneic; it was thought that this tachycardia was secondary to medications being administered. The morning chest x-ray revealed hyperinflation on the right side of the chest with an upward herniation of the lung across the mediastinum to the left chest. This prompted a wean of Optiflow Junior down to 8 L/min for only a couple of hours before weaning Case Study submitted to Fisher & Paykel Healthcare Ltd 185048058 Rev A For more information please contact your local Fisher & Paykel Healthcare representative Manufacturer Fisher & Paykel Healthcare Ltd 15 Maurice Paykel Place East Tamaki, Auckland 2013 PO Box 14 348 Panmure Auckland 1741 New Zealand Tel: +64 9 574 0100 Fax: +64 9 574 0158 Email:[email protected] Web:www.fphcare.com Australia Tel: +61 3 9879 5022 Fax: +61 3 9879 5232 Austria Tel: 0800 29 31 23 Fax: 0800 29 31 22 Benelux Tel:+31 40 216 3555 Fax: +31 40 216 3554 China Tel: +86 20 3205 3486 Fax: +86 20 3205 2132 France Tel: +33 1 6446 5201 Fax: +33 1 6446 5221 Germany Tel: +49 7181 98599 0 Fax: +49 7181 98599 66 185048058 Rev_A © 2013 Fisher & Paykel Healthcare Limited India Tel: +91 80 4284 4000 Fax: +91 80 4123 6044 Irish Republic Tel: 1800 409 011 Italy Tel: +39 06 7839 2939 Fax: +39 06 7814 7709 Japan Tel: +81 3 3661 7205 Fax: +81 3 3661 7206 www.fphcare.com Northern Ireland Tel: 0800 132 189 Spain Tel: +34 902 013 346 Fax: +34 902 013 379 Sweden Tel: +46 8 564 76 680 Fax: +46 8 36 63 10 Switzerland Tel: 0800 83 47 63 Fax: 0800 83 47 54 Taiwan Tel: +886 2 8751 1739 Fax: +886 2 8751 5625 Turkey Tel: +90 312 354 34 12 Fax: +90 312 354 31 01 (EU Authorised Representative) UK Fisher & Paykel Healthcare Ltd Unit 16, Cordwallis Park Clivemont Road, Maidenhead Berkshire SL6 7BU, UK Tel: +44 1628 626 136 Fax: +44 1628 626 146 USA/Canada Tel: +1 800 446 3908 or +1 949 453 4000 Fax: +1 949 453 4001
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