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Volume 3 Supplement 1

ESICM LIVES 2015

New device to support patients with acute respiratory distress: high flow, nebulization and oxygen therapy with automated fi02 titration

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Introduction

Hyperoxia induced hypercapnia has been described more than 60 years ago [1] and first recommendations to avoid hyperoxia in COPD patients were provided more than 50 years ago [2]. Alarm bell was recently raised [3] after the demonstration that high oxygen flows could increase mortality in patients with respiratory distress [4].

Objectives

To develop a device continuously adjusting Fi02 with high flows of air/oxygen based on the Free02 system that titrates oxygen flow delivered to patients with the aim to maintain a constant oxygenation [5].

Methods

The Free02 system was modified to allow a mixture of oxygen and air administration with a constant gas flow. The proportion of oxygen is based on an advanced closed loop to maintain a constant Sp02. We compare this new prototype with Optiflow set with minimal Fi02 (35%). Both devices are set at 30L/min, and we plan to recruit 10 healthy subjects'. The experimental conditions are the following: healthy subjects will initially breath room air (5 minutes), followed by 5 minutes of induced hypoxemia (nitrogen administration), and return to initial conditions (breathing room air for 5 minutes). We record Sp02, respiratory rate, heart rate and Fi02 delivered.

Results

We will present results of this comparison in 10 healthy subjects. Initial data demonstrate the feasibility to deliver variable oxygen flows administered with air at high flows (from 20 to 60L/min). In this study, the flow is maintained constant at 30L/min. During nitrogen administration to the healthy subjects, with the new prototype controlling oxygen/air administration, the oxygen increases (leading to a Fi02 increase) to maintain constant the Sp02 level (set at 94% in this study), and the air flow decreases to maintain constant the total flow (30L/min). After cessation of nitrogen, the oxygen flow (and Fi02) are automatically reduced (Figure). In the first included subjects, with Optiflow. hyperoxia is present during the first and third condition (breathing room air) and hypoxemia occur during nitrogen administration.

Figure 1
figure1

Automatic adjustment of the Fi02.

Conclusions

This new device may help to optimize oxygenation avoiding hypoxemia and hyperoxia during high flow oxygen therapy.

Grant Acknowledgement

Fond de recherche en Santé du Québec, Canadian Fundation for Innovation

References

  1. 1.

    Davies CE, Mackinnon J: Neurological effects of oxygen in chronic cor pulmonale. Lancet. 1949

  2. 2.

    Campbell EJ: A method of controlled oxygen administration which reduces the risk of carbon-dioxide retention. Lancet. 1960

  3. 3.

    Beasley R, et al: High-concentration oxygen therapy in COPD. Lancet. 2011

  4. 4.

    Austin MA, et al: Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting: randomised controlled trial. BMJ. 2010

  5. 5.

    Lellouche F, L´her E: Automated oxygen flow titration to maintain constant oxygenation. Respir Care. 2012

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Author information

Correspondence to F Lellouche.

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Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0), which permits use, duplication, adaptation, distribution, and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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Lellouche, F., L'Her, E., Bouchard, P. et al. New device to support patients with acute respiratory distress: high flow, nebulization and oxygen therapy with automated fi02 titration. ICMx 3, A276 (2015) doi:10.1186/2197-425X-3-S1-A276

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Keywords

  • Healthy Subject
  • Respiratory Distress
  • High Flow
  • Oxygen Therapy
  • Oxygen Flow