Allman, Robert, RRT

Cornman, Linda, BS, RRT-NPS

Ebert, Barbara A., CRNP

Miller, Kenneth, MEd, RRT-NPS

Misselbeck, Tim S, MD

English

Misselbeck, Timothy S

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksPatient Care Services / NursingThe Utilization of High Flow Oxygen toAdminister Inhaled Pulmonary Vasodilators inPost-Operative Left Ventricular Assist PatientPopulation to Facilitate ExtubationKenneth Miller MEd, RRT-ACCS, AE-C;Lehigh Valley Health Network, Kenneth.Miller@lvhn.orgTim S. Misselbeck MDLehigh Valley Health Network, Timothy_S.Misselbeck@lvhn.orgBarbara A. Ebert CRNPLehigh Valley Health Network, Barbara_A.Ebert@lvhn.orgRobert Allman RRTLehigh Valley Health Network, Robert.Allman_Jr@lvhn.orgLinda Cornman BS, RRT-NPS, RRT-ACCS, AE-CLehigh Valley Health Network, Linda.Cornman@lvhn.orgFollow this and additional works at: http://scholarlyworks.lvhn.org/patient-care-services-nursingPart of the Medical Education Commons, Nursing Commons, and the Surgery CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtMiller, K., Misselbeck, T., Ebert, B., Allman, R., Cornman, L. (2015, November 7). The Utilization of High Flow Oxygen to AdministerInhaled Pulmonary Vasodilators in Post-Operative Left Ventricular Assist Patient Population to Facilitate Extubation. Poster presented at:AARC International Congress, Tampa, FL.Miller, K., Misselbeck, T., Ebert, B., Allman, R., Cornman, L. (2016, October 28). The Utilization of High Flow Oxygen to AdministerInhaled Pulmonary Vasodilators in Post-Operative Left Ventricular Assist Patient Population to Facilitate Extubation. Poster presented at:Research Day 2016,Lehigh Valley Health Network, Allentown, PA.Lehigh Valley Health Network, Allentown, PennsylvaniaThe Utilization of High Flow Oxygen to Administer Inhaled Pulmonary Vasodilators in            Post-Operative Left Ventricular Assist Patient Population to Facilitate ExtubationKenneth Miller, MEd, RRT-ACCS, AE-C; Timothy Misselbeck, MD; Barbara Ebert, CRNP; Robert Allman, RRT; Linda Cornman, BS, RRT-NPS, RRT-ACCS, AE-CTable 1 Ventricular DurationMeanRe-intubation Age Range Epoprostenol HoursHigh Flow Oxygen HoursPre-HFO (n=10) 16.6 hours 1/10 72-75 years 24 hours 0Post-HFO (n=9) 6.9 hours* 0/9 67-73 years 24 hours 28 hours  © 2015 Lehigh Valley Health NetworkReferences:1.	 	Groves	DS,	Blum	FE,	Huffmyer	JL,	Kennedy	JL,	Ahmad	HB,	Durieux	ME,	Kern	JA.	Effects	of	early	inhaled	epoprostenol	therapy	on	pulmonary	artery	pressure	and	blood	loss	during	LVAD	placement	.	J Cardiothorac Vasc Anesth.	2014	Jun;28(3):652-60.	2.	 	Bhashyam	AR,	Wolf	MT,	Marcinkowski	AL,	Saville	A,	Thomas	K,Carcillo	JA,	Corcoran	TE.	Aerosol	delivery	through	nasal	cannulas:	an	in	vitro	study.	J Aerosol Med Pulm Drug Deliv	2008;21(2):181-188.3.	 	Arzu	Ari,	Hasan	Areabi,	James	B	Fink	Evaluation	of	Aerosol	Generator	Devices	at	3	Locations	in	Humidified	and	Non-humidified	Circuits	During	Adult	Mechanical	Ventilation.	Respir Care,	July	2010	55:7	837-844.•		Left	ventricular	assist	device	(LVAD)	is	an	implanted	mechanical	circulatory	support	device	utilized	in	patients	with	heart	failure	to	enhance	left	ventricular	function.•		Epoprostenol	is	a	potent	pulmonary	vasodilator	when	delivered	in	inhaled	form.•		High	Flow	Nasal	Cannula	can	provide	effective	delivery	of	Epoprostenol.DiscussionHigh Flow Nasal CannulaEpoprostenol Administration  •		With	successful	implantation	of	the	LVAD,	the	right	ventricle	must	increase	work	to	match	the	left	ventricular	function.•		The	utilization	of	Epoprostenol	in	the	post	LVAD	patient	has	been	beneficial	in	reducing	right	ventricular	afterload	by	dilating	the	pulmonary	vasculature.1	•		Historically,	LVAD	patients	required	mechanical	ventilation	in	order	to	administer	nebulized	Epoprostenol	for	twelve	to	twenty	hours	post	surgery.•		Often	patients	required	unnecessary	sedation	and	other	interventions	to	maintain	ventilation	despite	stable	gas	exchange	and	pulmonary	mechanics.	•		To	address	the	issue	of	prolonged	ventilation,	patients	who	have	stable	gas	exchange,	hemodynamic	status,	and	pulmonary	mechanics	were	extubated	and	placed	on	high	flow	oxygen	(HFO)*		to	complete	the	remaining	administration	of	nebulized	Epoprostenol.	•		Nebulization	was	provided	by	the	Aeroneb**	placed	prior	to	the	humidifier	(FP	850)	via	the	Optiflow.2,3Compared	to	historical	data	the	ventilatory	duration	of	the	LVAD	patients	was	reduced	by	9.7	hours	without	any	noted	complications.	(Table	1)•		Epoprostenol	is	utilized	as	a	prophylactic	therapy	post	LVAD	procedure.•		High	Flow	Oxygen	appears	to	provide	a	safe	alternative	delivery	method	for	Epoprostenol	administration	and	facilitates	ventilatory	liberation.•		More	research	needs	to	be	conducted	to	determine	true	cause	and	effect	of	this	intervention.Conclusion•		Based	on	our	clinical	data	high	flow	oxygen	is	a	feasible	option	for	providing	the	administration	of	an	inhaled	pulmonary	vasodilator	in	order	to	facilitate	ventilatory	liberation.•		It	is	a	safe	and	effective	means	for	providing	administration	of	nebulized	pulmonary	vasodilators.•		More	research	needs	to	be	conducted	in	this	method	of	aerosol	therapy	delivery.	ResultsIntroductionMethodsCardiac Function and LVAD*OptiflowFisher-PaykelAuckland, NewZealand**Aerogen AeronebGalway, Ireland* p<.05

The Utilization of High Flow Oxygen to Administer Inhaled Pulmonary Vasodilators in Post-Operative Left Ventricular Assist Patient Population to Facilitate Extubation

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The Utilization of High Flow Oxygen to Administer Inhaled Pulmonary Vasodilators in Post-Operative Left Ventricular Assist Patient Population to Facilitate Extubation

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