Emergency Medicine Book

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High Flow Oxygen

Aka: High Flow Oxygen, High Oxygen Delivery, Non-Rebreathing Mask, Non-Rebreather Mask, Oxygen Hood
  1. See Also
    1. Oxygen Delivery
    2. Non-Invasive Positive Pressure Ventilation
  2. Indications
    1. Preoxygenation in Rapid Sequence Intubation
    2. Carbon Monoxide Poisoning
    3. Severe Hypoxia temporizing measure (Oxygen Saturation <88% on FIO2 50%)
  3. Precautions
    1. Non-Rebreather Mask will transiently improve Hypoxia despite severe lung injury or inflammation
      1. Severe Hypoxia is often due to physiologic shunt through diseased alveoli
      2. Increasing alveolar recruitment will improve both ventilation and oxygenation
        1. Positive Pressure Ventilation (e.g. NIPPV, Mechanical Ventilation) increases alveolar recruitment
        2. Contrast with Supplemental Oxygen which does NOT improve ventilation
    2. Hypoxia due to apnea also improves with Supplemental Oxygen
      1. Apneic Oxygenation may sustain Oxygen Saturation for 30-60 minutes
        1. Useful in Rapid Sequence Intubation
      2. However, carbon dioxide will continue to rise, and pH will continue to fall without respiration
      3. Positive Pressure Ventilation (e.g. NIPPV, Mechanical Ventilation) is the correct treatment for apnea
    3. References
      1. Weingart and Swaminathan in Herbert (2021) EM:Rap 21(1): 8-9
  4. Preparations: Non-Rebreathing Mask with reservoir
    1. Delivers only 60-70% Oxygen at 15 L/min
      1. Previously described as delivering 95% FIO2 (leakage around mask prevents this)
      2. Standard Anesthesia masks have tighter seal and achieve closer to 95% FIO2
      3. Increasing flow above 15 L/min if regulator allows can achieve closer to 90% FIO2
        1. Alternatively concurrently apply Nasal Cannula at 15 lpm with Non-Rebreather Mask
    2. Two valves added to rebreathing mask prevents:
      1. Entrainment of room air during inspiration
      2. Retention of exhaled gases during expiration
  5. Preparations: Oxygen Hood
    1. Clear plastic shell encompasses the baby's head
    2. Well tolerated by infants
    3. Size of hood limits use to younger than age 1 year
    4. Allows easy access to chest, trunk, and extremities
    5. Allows control of Oxygen Delivery
      1. Oxygen concentration
      2. Inspired oxygen Temperature and humidity
    6. Delivers 80-90% oxygen at 10-15 liter per minute
  6. References
    1. (1997) Pediatric Advanced Life Support, AHA, p. 4-5 to 4-7
    2. (2016) Fundamental Critical Care Support, SCCM, p. 45-60

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