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Fisher Paykel® Airvo2 - Junior Mode
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Pediatric Technical ReportTianna McCuaigRTT380 - Clinical Phase

Fisher Paykel® Airvo2 - Junior Mode

Advantages VS Disadvantages

Questions/Discussion

Potential Complications

Limitations

Summary

Alarms

Financial Complications

Safety Features

Principles of Operation

Index

01

How does the Airvo 2 work?

Principles of Operation

- The Fisher & Paykel Healthcare Airvo2 is specifically designed to meet the flow requirements and anatomical features for adults, neonates, infants & children on high flow nasal therapy.

Fisher Paykel® Airvo2

The basic set-up includes:

  • The AIRVO2 high flow system itself, including a humidifier that must be filled with sterile water
  • Oxygen tubing
  • Normal saline water bag
  • Airvo2 specific high flow heated single limbed circuit tubing
  • Multiple interfaces for both adult and pediatric applications, including nasal cannula, face mask and tracheostomy interface options (XS - XL options avaliable)

  • In order to begin ventilation, the operator must plug the Airvo2 into a wall outlet and oxygen DISS connection
  • The operator then turns the AIrvo2 on by holding the power button down until the screen lights up
  • In order to access Junior Mode, the operator must hold down the triangle button for approximately 5 seconds until colourful insects/birds pop-up on the screen
  • Settings (which include temperature, flow & O2 delivery) can be adjusted as per order using the up/down arrows, hitting the triangle button will confirm settings

Prinicipals of Operation

02

Is the Airvo2 effective in providing quality care to the pediatric population?

Advantages VS Disadvantages

Disadvantages

Advantages

vs

- If misused flow rates are used, there have been reports of pneumothorax & other barotraumatic related injuries in some pediatric patients (Kumar et al.)- Nasal patient interface for neonates/pediatrics at times might cause adherence issues as any liquid/bodily fluid can loosen the "wiggle pads" from a patients face and can be very easily accessed for a patient to remove themselves-Requires proper training and a lot of expertise to work properly (not a disadvantage to an RT)- If a larger pediatric child requires HHFNC treatment and an adult sized interface is used, Junior Mode cannot be enabled. This can pose risks and greater caution the operator must take to avoid barotrauma on a pediatric- Relatively more expensive than other types of CPAP devices

- Provides airway hydration and heated humidification (maintains mucocilary clearance and maintains healthy cilia transport) - Increase O2 saturation, prevent hypercarbia and decrease respiratory rate - Reduces deadspace and improves alveolar ventilation - Improves patient comfort compared to full face mask (especially for children) - Allows children to speak, drink, eat & sleep much more easier - Reduces skin breakdown and soreness associated with face mask - Reduces oxygen dilution compared to standard face mask oxygen therapy - Provides a range of flow rates (2-25LPM) for pediatrics

03

Does the Airvo2 have any major setbacks when providing care to pediatrics?

Limitations

Junior Mode

- Junior mode for the Airvo2 limits target settings to 34C & flow limitations 2-25LPM, increasing flow rates in increments of 1L/min. The device should be able to increase flow rates in lower increments, as the neonate/pediatric population responds to increases in flow rates/FiO2 levels more sensitive than the adult population (Kwon, 2020).

Patient Interfaces

The Junior Mode will only ventilate properly if used with the Airvo2 neonate or pediatric sized interfaces (OPT316/OPT318) This poses a limitation if the child is larger and may require an adult sized interface, which cannot be used in Junior Mode and must be used in the regular parameter settings.

No Battery Power Source

- Airvo 2 will not operate without being plugged in to a power source as it lacks internal battery power. For a transport of a patient on HHFNC on the Airvo2 unit, the battery will last 20 minutes before needing to be plugged into a outlet.

Limitations?

04

What protective stratagies does the Airvo2 have?

Safety Features

Safety Features

- It includes both visual and auditory alarms to warn you about any interruptions to treatment- If machine has been cleaned & recircuited, when powered on it will show a green traffic light signal, indicating it is cleaned & safe to use on another patient. If it has not been cleaned, a yellow traffic light will notify the operator before use.- The audio alarm when activated by an interruption, beeps 3 times and is repeated every 5 seconds until the interruption is fixed or the alarm signal is muted - An alarm will ring if the oxygen content is set too low (21%) and too high (90%) to ensure you are delivering your desired FiO2 (this can be adjusted in advanced settings)

The Airvo2 includes multiple alarms and signals for safety reasons that will be discussed on the next slide

05

Alarms

Cannot Reach Target Flow: check breathing tube or patient interface for blockage or target flow setting is too high (Note: O2 conc. can be affected by flow setting)Check Water: water chamber ran dry, replace chamber and water bag as dry chamber can damage floatCannot Reach Target Temp: unit may be operating at high flow rate in low ambient condition. Possibly decrease flow settingCheck Operating Conditions: unit is operating in unsuitable temperatures. DO NOT use if ambient temp. is less than 10C or greater than 30C.The Royal Children's Hospital, n.d.)

Check Tube: unit cannot detect breathing tube, check to ensure its not damaged & plugged into unit.Check for Leaks: leak in system, check water chamber, heated breathing tube & patient interface for leaksCheck for Blockages: blockage in system, check breathing tube & patient interface for noticeable blockages. Check air filter to ensure nothing is covering it & ensure if Junior mode is activated, proper patient interface is being used (OPT316/OPT318)O2 Too Low: measured O2 level fallen below allowed limit, ensure O2 source is connected properlyO2 Too High: measured O2 level has exceeded allowed limit. Double check & adjust O2 as necessary.

Alarm Settings

06

What risks might the Airvo2 device have that can restrict proper ventilation?

Potential Complications

The Airvo2 creates potential complications as a safety issue for pediatrics in terms of barotrauma. Reports of pneumothorax, atelectasis, pneumomediastinum were associated with high flows from the high flow nasal cannula in neonate and infant populations (Kwon, 2020). Recommendations provided in the Airvo2 user manual to avoid this issue is 2L/kg/min for the pediatric popluation.Contraindications can also cause complications to the patient if placed on HHFNC. Contraindications to any HHFNC ventilation includes:- critically ill with immediate need for NIV or intubation- apneas requiring NIV/intubation- blocked nasal passages or choanal atresia- any facial malformations- any trauma or surgeries to the nasopharynx- any congenital heart disease- decrease LOC- suspected or confirmed foreign body aspiration (Queensland Children's Hospital, 2020)

Potential Complications

07

How expensive is the Airvo2 itself & its additional parts?

Financial Complications

Airvo2 Cost Breakdown:As Canada did not have any pricing lists for the Airvo2 unit and accessories, the US had a study completed which listed the pricing breakdown for the Airvo unit & its seperate accesories- The Airvo2 unit itself (with in‐built humidifier) with a 1‐year warranty costs around $4330 USD when sold to a medical establishment (such as a hospital, doctors building, sleep lab etc.) - Another $150 USD is the cost for the specified disposable circuit (heated humidity tubing with a standard nasal cannula interface)- Different sizes of the disposable nasal cannula interface come at a cost of around $50 USD each (Gupta et al., 2021).Total average cost for complete set-up of one Airvo2 unit + accessories = Approximately $4530 USD or $6191 CAD

Financial Complications

08: Summary

There are many contraindications to using the Airvo2 which the operator must be aware of. The overall cost for the unit itself is relatively high in the US (compared to CPAP options)

The Airvo2 has few limitations which include no internal battery, limitations to flow for pediatrics & although it has plenty of alarm alerts it has limited alarm adjustment options that can be set for specific patients

It includes many safety features in Junior Mode to provide the safest recommended flow rates for the neonate/pediatric population (recommended 2L/kg/min) and informing the operator of any possible leakages/blockages

The Airvo2 is compact, relatively easy to set-up and used as a trained RRT & can provide adequate humidified non-inasive ventilation to neonates & pediatrics to improve saturations, reduce deadspace, improve mucus clearance & prevent hypercarbia

In Summary...

After completing my research on the Airvo2 unit itself, I would highly recommend it to healthcare professionals that can afford the units & looking for a type of heated non-invasive ventilation. The Airvo2 unit itself is very compact and relatively easy for trained respiratory therapists to use and provide adequate ventilation to pediatrics to improve oxygen saturations, improve mucus clearance & reduce hypercarbia.From my little experience I have currently within my clinical placement, I’ve had the chance to see one pediatric with RSV that needed to be set-up on the Airvo2 Junior Mode in order to maintain their saturations (as oxygen therapy wasn’t enough to maintain them). The unit was useful in raising the pediatrics saturations and he could tolerate the nasal interface much easier then a full face mask. It allowed the pediatric freedom to speak, drink, eat and sleep with ease, which overall allowed the unit to ventilate him properly as he wasn’t removing the mask.I do however find some disadvantages as it lacks a large internal battery, making transport much more difficult. As mentioned before, it is more expensive for hospitals to purchase compared to other units so that could pose a problem in acquiring them, depending on the medical facility. Overall, the Airvo2 unit in my opinion is a useful non-invasive ventilation device that should be used by healthcare professionals on pediatrics to reduce the chance of requiring invasive ventilation.

My Opinion on the Airvo2: Junior Mode

Airvo 2 User Manual - The Royal Children's Hospital. (n.d.). Retrieved December 12, 2022, from https://www.rch.org.au/uploadedFiles/Main/Content/rchcpg/AIRVO%202%20Humidifier%20user%20manual.pdf Airvo treatment: Effectiveness on Covid 19 Patients. Medgate Today. (2020, July 28). Retrieved December 11, 2022, from https://medgatetoday.com/airvo-treatment-effectiveness-on-covid-19-patients/ Gupta, N., Sachdev, A., Gupta, S., & Gupta, D. (2021, June). High-flow oxygen therapy in COVID times: Where affordability meets utility. Pediatric pulmonology. Retrieved December 11, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014044/ Kumar, A., Hemantlal, P. M., & Mehta, Y. (2016). Airway management: High flow nasal oxygenation. Annals of cardiac anaesthesia. Retrieved November 30, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5070348/Kwon, J.-W. (2020, January). High-flow nasal cannula oxygen therapy in children: A clinical review. Clinical and experimental pediatrics. Retrieved December 10, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7027347/High Flow Nasal Therapy - Queensland Children's Hospital. (2020, June 25). Retrieved December 10, 2022, from https://www.childrens.health.qld.gov.au/wp-content/uploads/PDF/guidelines/gdl-70025.pdf

References

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