Optiflow™+ Tracheostomy Interface

Improving care for tracheostomy patients

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Optiflow + Tracheostomy interface features

1.
Evaqua™ technology is designed to reduce formation of mobile condensate

2.
Connects to our AirSpiral breathing tube for 93% less condensate*

Re-designed sputum guard, also available as a spare part

*compared with F&P AIRVO^TM900PT501 breathing tube in internal Fisher & Paykel Healthcare testing.

Why use Humidifed High Flow therapy for
Tracheostomy patients?

What is physiological humidity?

Under normal circumstances the upper airway functions to ensure that inhaled air reaches the lungs at body temperature (37 °C) and close to 100 % relative humidity¹.
Bypassing these warming and humidifying functions in tracheostomised patients allows cooler, dryer gases to be delivered to the carina than would normally occur.
Within the literature, values for absolute humidity in tracheostomised patients vary between 17 and 44 mgh2O/L and tracheal temperature values range from 32 to 37 °C.² However, the level of acceptable humidity remains the subject of some debate.³

Humidified high flow for tracheostomies?

Humidified high flow therapy has been shown to:

Improve work of breathing (WOB) in acute care and decrease adverse clinical events in chronic care in a study of children with tracheostomies compared to a passive HME⁷
Assist ventilation in a study of patients with chronic respiratory failure carrying a trans-tracheal catheter for long-term oxygen therapy compared to low-flow oxygen therapy⁸
Provide higher humidification levels in a bench study compared to both active and passive HMEs, leading to the recommendation of using humidified high flow in patients who require supplemental oxygen or those with high tidal volumes⁹

What are the effects of sub-optimal humidity on tracheostomy patients?

Heat and moisture loss from mucociliary epithelium, which can lead to permanent loss of ciliated epithelium⁴
Reduced mucociliary clearance leading to retention of secretions⁵
Drying or thickening of secretions⁵
Pulmonary infection⁶
Obstruction or occlusion of the airway or tracheostomy tube⁶
Tracheitis⁶
Atelectasis^{2, 6}
Death⁶

Optiflow High Flow airway hydration mechanism overview

Airway Hydration improves mucociliary clearance

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.

Watch how mucociliary clearance works

Product Codes

Part No.	Description	Quantity
OPT970	Optiflow+ Tracheostomy interface	20 pack
OPT970E	Optiflow+ Tracheostomy interface	1 pack
OPT971	Sputum guard spare part	20 pack

References

Why use Humidifed High Flow therapy for Tracheostomy patients?

Williams R, Rankin N, Smith T, Galler D, Seakins P. Relationship between the humidity and temperature of inspired gas and the function of the airway mucosa. Crit Care Med 1996; 24(11): 1920-9.
Thomachot L, Viviand X, Arnaud S, Vialet R, Albanese J, Martin C. Preservation of humidity and heat of respiratory gases in spontaneously breathing, tracheostomized patients. Acta anaesthesiologica Scandinavica 1998; 42(7): 841-4.
Gross JL, Park GR. Humidification of inspired gases during mechanical ventilation. Minerva anestesiologica 2012; 78(4): 496-502.
Billau C. Humidification. In: Russell C, Matta S, eds. Tracheostomy: A Multi-Professional Handbook. Cambridge: Cambridge University Press; 2004: 143-56.
Griggs A. Tracheostomy: suctioning and humidification. Nursing standard (Royal College of Nursing (Great Britain) : 1987) 1998; 13(2): 49-53; quiz 5-6.
Buglass E. Tracheostomycare: tracheal suctioning and humidification. British journal of nursing (Mark Allen Publishing) 1999; 8(8): 500-4.
McNamara DG, Asher MI, Rubin BK, Stewart A, Byrnes CA. Heated humidification improves clinical outcomes, compared to a heat and moisture exchanger in children with tracheostomies. Respiratory care 2014; 59(1): 46-53.
Brack T, Senn O, Russi EW, Bloch KE. Transtracheal high-flow insufflation supports spontaneous respiration in chronic respiratory failure. Chest 2005; 127(1): 98-104.
Schneider H, O’Hearn DJ, Leblanc K, et al. High-flow transtracheal insufflation treats obstructive sleep apnea. A pilot study. Am J Respir Crit Care Med 2000; 161(6): 1869-76.
Chikata Y, Oto J, Onodera M, Nishimura M. Humidification performance of humidifying devices for tracheostomized patients with spontaneous breathing: a bench study. Respiratory care 2013; 58(9): 1442-8
Takigawa K, Fujita J, Negayama k, Yamagishi Y, Yamaji Y, Ouchi K. Nosocomial Outbreak of Pseudomonas cepacia Respiratory Infection in Immunocompromised Patients Associated with Contaminated Nebulizer Devices. Jpn J Infect Dis. 1993; 67(11):1115-1125

Water vapor vs. water droplets

Takigawa K, Fujita J, Negayama k, Yamagishi Y, Yamaji Y, Ouchi K. Nosocomial Outbreak of Pseudomonas cepacia Respiratory Infection in Immunocompromised Patients Associated with Contaminated Nebulizer Devices. Jpn J Infect Dis. 1993; 67(11):1115-1125

Airway hydration improves mucociliary clearance

Reduced respiratory rate

Hasani A, Chapman TH, McCool D, Smith RE, Dilworth JP, Agnew JE. Domiciliary humidification improves lung mucociliary clearance in patients with bronchiectasis. Chron Respir Dis 2008;5(2):81–86.

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