Question
How does nasal ventilation benefit airway management?
Answer
In many institutions, respiratory therapists provide intubation during emergency code situations and/or elective procedures. Current research in areas of non-invasive ventilation and airway management encourages best practice protocols and standardized care for optimal critical care patient outcomes.The importance of nasal ventilation is associated with advancements in the field of airway management.
High Flow Nasal Cannula (HFNC)
- Originally developed for neonates in respiratory distress and orofacial patients
- Control over FiO2 delivered and flow rate.
- Warm, humidified flows up to 70 LPM.
- Provides positive pressure to upper and lower airways, ranging 5-7 cmH20.
It is hypothesized that a high flow nasal cannula exceeds the inspiratory flow rate, reduces the negative pressure generated by inspiration, and impedes expiratory flow. Thus, reducing the tendency of the airways to collapse. It is pressure-dependent on mouth opening and leaks around the cannula. It may not generate pressures used therapeutically in continuous positive airway pressure (CPAP), but at an FiO2 of 21%, it has been shown to be sufficient, to keep airways open during sleep and improve obstructive sleep apnea (OSA) in children. Additional benefits of high flow nasal cannula, include maintenance of a constant FiO2, physiologic decrease in anatomical dead space, improved mucociliary clearance, and decreased work of breathing.
This Ask the Expert is an edited excerpt from the course, What’s Trending in Airway Management, presented by Dr. Christina Riccio, MD.
