Comparison of Standard High Humidity Oxygen Delivery Device Versus High Flow Integrated Flow Generated Oxygen Delivery Device in Minimizing Mechanical Ventilator Days Post Tracheostomy

Abstract

Background:

Many patients experiencing respiratory failure requiring mechanical ventilation (MV) undergo tracheostomy due to difficulty weaning from MV. Varying devices are used to deliver humidified oxygen to these patients. There is currently no accepted standard of practice for which device to use. This medical center sought to compare the impact of use of a standard oxygen delivery High Humidity Trach Collar (HHTC) to a High Flow (HF) Oxygen Integrated Flow Generated delivery device.

Methods:

This IRB approved cross over study was conducted in the medical and surgical Intensive Care Units (ICU). The primary study aim was to determine if there was a difference in the duration of MV with the use of a HF Integrated Flow Generated Oxygen delivery device rather than a standard HHTC Oxygen delivery device. ICU DAYS were also assessed. The Study was a cross over design. Patients in one ICU began using a standard HHTC while the other unit began with use of a HF integrated flow generator device. After a period of 6 months the device used “crossed over” to the alternate model for each ICU. The Mann-Whitney U test was used to analyze the continuous variables of MV and ICU days.

Results:

44 patients were placed on either device based on ICU location following placement of new tracheostomy. Mean Apache scores were 15.48 for the HHTC group and 16.09 for the HF group. 21 patients were placed on standard HHTC and 23 on HF type. Findings were: median days for HHTC patients was 15.0 and for HF device 8.95. Median ICU days were 23.0 for HHTC and 18.0 for HF. Mann-Whitney Test η1 = η2 vs η1 ≠ η2 was used for analysis of significance of difference for both MV and ICU days. Patients placed on HF device did show a statistically significant improvement value of .0483 (adjusted for ties) when comparing days of MV. ICU days comparison had a value of .0567 (adjusted for ties) which closely approached statistical significance.

Conclusions:

The statistically significantly difference in MV hours indicates that use of a HF Integrated Flow Generated Oxygen delivery device may decrease newly tracheostomized patients’ time on MV yielding improved patient safety and decreased cost of care. Decreased ICU Days although not statistically significant may yield the benefit of increased availability of ICU beds.