Converting high flow over to the flight environment does have its challenges. In the air ambulance world, there is a limited supply of oxygen-carrying capabilities. This affects the amount of time that a patient can be transported while receiving high flow therapy. There are definite considerations in transporting a patient with high flow oxygen needs; the total patient transport time, the amount of oxygen needed during flight, as well as the amount of oxygen needed during ground ambulance transfers to and from the aircraft. By using an oxygen tank duration formula (Cylinder PSI x Cylinder Factor x FiO2 / Flow Rate) it allows the medical team to know, in minutes, how long the oxygen will last at the set rate for the patient.
AirCARE1 was asked to transport a 70-year-old male from Arizona to California. He was diagnosed with Progressive Acute Systolic Congestive Heart Failure with an ejection fraction of 35 per cent. He was being transported for further treatment, intervention and a second opinion at a facility in California.
From the sending of facility reports, the AirCARE1 medical crew was made aware of the fact the patient would need increased oxygen during transport. The patient was currently on oxygen at 10 litres per minute (LMP) via oxy mask. To properly prepare for this, the team ensured all oxygen tanks onboard the aircraft were filled. Our dispatch team confirmed with both receiving and sending ground ambulance crews that their oxygen tanks were also at capacity. The AirCARE1 crew decided the patient might be most comfortable on high flow via nasal canula. The aircraft was prepared with all the necessary equipment required to initiate high flow oxygen if needed. The team would make their final decision once bedside.
At bedside, the patient was found to be on multiple intravenous infusions including, vasopressin, Bumex and dobutamine to aid in stimulating the heart muscle to improve blood flow. He was still on oxygen at 10 LMP via oxy mask. It was decided the patient would in fact benefit from high flow oxygen therapy. The team would begin therapy onboard the aircraft. Since the patient’s medical condition was stable at this point, the crew decided it was safer to initiate high flow once on the aircraft versus initiating therapy at bedside. The patient was moved to the AirCARE1 stretcher system, hooked up to the IV infusion pumps and cardiac monitor.
Once onboard the aircraft, the crew transferred the patient to high flow oxygen utilising the Hamilton T1 ICU transport ventilator and Hamilton-H900 humidifier. Once connected, this proprietary system provides the same functionality as the high flow devices used in the hospital setting. The patient’s initial settings were a set flow of 40 liters with an FiO2 of 70 per cent. During flight, the medical team was able to decrease the patient’s FiO2 to 60 per cent, which aided in decreasing the onboard oxygen consumption. The high flow therapy provided a notable improvement in SpO2 from where the patient was while on just the oxy mask. The infusing medications had to be adjusted to maintain blood pressure within the parameters set for this patient. Many patients report an increase in anxiety while on high flow and sedation medications are often required. This patient was not a candidate for such medications due to his hypotension. Fortunately, the patient was able to rest comfortably without sedation throughout the flight.
During the patient’s transport with AirCARE1, the patient experienced improved results from high flow oxygen therapy. The heat and humidification along with elevating peak inspiratory flow demands allowed the patient’s lower airways to open and increase the functional residual capacity of his lungs. There was a noticeable decrease in work of breathing because of added treatments allowing the patient to be more comfortable during flight.
Utilizing High Flow Oxygen Therapy has advanced AirCARE1’s critical care capabilities by allowing them to transport patients previously ineligible for transport due to high oxygen demands.