AIRVO 2 High-Flow Standard Operating Procedure

Objectives

The objective of this SOP is to provide a consistent approach to delivering High-Flow therapy via the AIRVO 2 to prevent any complications and detriment to patients’ condition.

Scope

This guideline is intended for all healthcare professionals caring for patients requiring High-Flow via the AIRVO 2 within the Paediatric Intensive Care Unit (Ward 1D) Royal Hospital for Children, Glasgow, and as a guide for staff caring for these patients who are being nursed in other areas.

Introduction

The AIRVO 2 is a humidifier with an integrated flow generator that delivers high-flow warmed and humidified respiratory gases to spontaneously breathing patients through a variety of interfaces.  Much of the literature and research looking at ‘High-Flow’ therapy agree that therapy is well tolerated and with less associated nasal trauma than nasal CPAP (nCPAP).  The evidence indicates that the increase in Peek Expiratory End Pressure generated is similar to airway pressure achieved by nCPAP.  From a safety perspective no convincing adverse effects have been documented, although, similarly to nCPAP ‘abdominal distension remains a risk and requires careful monitoring.

The AIRVO 2 is for the treatment of spontaneously breathing patients who would benefit from receiving high flow warmed and humidified respiratory gases.  The device may be set from 2 – 60 L/minute, depending on the interface, and delivers a flow of gas that has high levels of humidity which aids patient comfort and can enhance mucociliary clearance of secretions.  The AIRVO is capable of delivering supplemental oxygen at any concentration between 21% and 95%.  The device can be used on infant to adult sized patients (if using on a patient greater than 10 years old, please refer to Appendix 4/5 – High Flow and the adult patient (p. 18)), including those who have had their upper airway bypassed.

With AIRVO 2, the aim is to meet or exceed the patient’s normal Peak Inspiratory Demand, which creates minimal air dilution, even when breathing orally.  AIRVO 2 can more accurately deliver prescribed oxygen concentrations at high flows, providing both versatility and continuity of care.  High Flow Nasal Cannula (HFNC) therapy has been shown in studies to reduce intubation rates in infants and children with acute respiratory failure.

The indications, initiation and weaning pathways are described in the appendixes.