Optiflow™ High Flow Mechanisms of Action


 

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The mechanisms of action differ from those of conventional therapies, as do the resulting physiological effects and clinical outcomes.

The Optiflow Nasal High Flow therapy mechanisms of action are:

  • Respiratory support (through the reduction of dead space and delivery of a dynamic positive airway pressure)
  • Airway hydration/humidification
  • Patient comfort
  • Supplemental oxygen (if required)
Note: the above mechanisms of action for high flow apply to delivery through an Optiflow nasal cannula interface. The mechanisms of action differ when high flow is delivered through a tracheostomy or mask interface adapter.
 
Optiflow Mechanisms

Reduction of deadspace explained



Clearance of expired air in the upper airways, reduces rebreathing of gas high in CO2 and depleted of O2, resulting in an increase in alveolar ventilation.

Nasal High Flow Dead Space
Optiflow High Flow deadspace mechanism overview

Reduction of Deadspace


Watch the effect in action (45 seconds)

This video depicts clearance of a radioactive tracer from upper airway model using a Gamma camera imaging superimposed on a CT scan. Flow rates were 15, 30 and 45 L/min. In this experiment you can see that as flow rate increases so does clearance.

Dynamic positive airway pressure explained



Nasal high flow creates breath and flow-dependent pressure, making inspiration
easier and promoting slow, deep breathing on expiration,
thereby increasing alveolar ventilation.


Dynamic Positive Airway Pressure
Optiflow High Flow pressure mechanism overview

Dynamic positive airway pressure



Watch the effect in action (33 seconds)

Corley et al. 2011 showed once Optiflow is commenced in patients post-cardiac, there is a significant increase in areas of lung aeration. This change reflects enhanced lung volume and tidal volume. The researchers determined a strong correlation between airway pressure (Paw) and end-expiratory lung impedance (EELI). Paw increased by 3.0 cmH20 and EELI increased by 25.6%. EELI is a surrogate for end expiratory lung volume.

~ Corley et al. Br J Anaesth. 2011.

 

Airway hydration explained



Humidity enables the comfortable delivery of high flows. Optimized humidity emulates the natural balance of heat and moisture that occurs normally in healthy lungs and may help to maintain physiological stability in compromised airways.

Airway hydration explained
Optiflow High Flow airway hydration mechanism overview

Airway hydration


Watch the effect in action (45 seconds)

The experiment portrayed in the video was conducted on two ovine tracheal samples exposed at 100% relative humidity (left panel) and the other at 90% relative humidity (right panel) for 15 minutes.

As the clip starts, tiny beating cilia are flickering in the background. Then, debris in the mucus of the right image becomes stationary. The dark spots moving quickly across the left image showed debris being cleared by effective mucociliary transport. After just an hour at the lower humidity, the mucosa has completely dried out.

Patient comfort explained


Respiratory support delivered via a mask poses challenges for clinicians and patients. Nasal High Flow is delivered via a cannula. Better patient comfort may promote improved compliance.

Patient Comfort Explained
Medical staff with Optiflow patient

Patient comfort



Clinical evidence suggests that use of Optiflow provides improved comfort compared to conventional oxygen delivery devices1,2. A study in JAMA3 found significantly reduced skin breakdown and noted a lower nurse workload with Optiflow than with BPAP. Patients are able to eat, drink and sleep with the Optiflow cannula and can talk with their caregivers and families.

  1. Roca et al. Respir Care. 2010.
  2. Lenglet et al. Respir Care. 2012.
  3. Stéphan et al. JAMA. 2015.

Supplemental oxygen (if required) explained



Providing oxygen via Nasal High Flow can give you some confidence in the accurate delivery of blended, humidified oxygen.

Supplemental Oxygen
Oxygen capacity of Optiflow comparison graph

Supplemental Oxygen



In the example illustrated, the maximum oxygen flow from the face mask (in the left pane) is limited to approximately 10 L/min which is not sufficient to meet the patient’s peak inspiratory demand of 50 L/min. To compensate for this deficit, 40 L/min of room air will be entrained for every breath, which will dilute the oxygen and deliver a variable (sometimes unknown) FiO2.

In our example (in the right pane), Optiflow is able to meet the patient’s entire inspiratory demand of 50 L/min, without the need for dilution of oxygen - this gives confidence in the delivery of a specified FiO2.

 

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Interactive Online
Learning

Gain a deeper understanding of the
mechanism of action of nasal high flow by
completing this course on the F&P Education Hub.

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