OptiflowTM via AirvoTM
High/Low Flow
Oxygen Delivery System
Devika Cook
Charge Nurse
Adult and Emergency PACU
Auckland City Hospital
What is the definition of a double
blind study?
Two Orthopaedic Surgeons
trying to read an ECG!
Objectives
OptiflowTM
• Nasal High/Low Flow Oxygen Therapy
• Designed to meet inspiratory demand
• Provides natural balance of temperature
and humidity
• Low level positive airway pressure
• Used in conjunction with the AirvoTM
AIRVOTM
• High-performance humidifier and
integrated flow generator
Consistent temperature & humidity level
Accurate FiO2 with a constant flow rate
Ability to alter flow rate (15-45 lpm and
oxygen percentage 21-60%)
Indications for Use
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Increased respiratory demand
Intolerance of conventional face mask
Hypoxia/Emergence Agitation
Major surgery – abdominal, head and neck
High BMI
Obesity
Smoker
Benefits
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Easy to implement
Comfort → patient compliance
Not affected by NGT
Can prevent less invasive ventilation
Direct Delivery to Naso/Oro-Pharynx
Less dilution effect
Benefits - cont
• Warm humidified oxygen
Less damage to mucosa
• Improved gas exchange and O2 saturation
• Decreased LOS in PACU
• Transferable system for ward use
Reduced care costs
Disadvantage
• No battery pack, dependent on AC power
Case Study
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34 year old male caucasian
Post-Op Lap Appendicectomy
ASA 1 – training for Auckland Marathon
? Aspirated on induction
CXR – “slight” Pulmonary Oedema
Decreased saturations in PACU
Clinical Presentation
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Patient not distressed
Breathing not laboured
Hudson Mask on 15 litres
Persistent low sats 88-90%
Nil complaints of Pain or PONV
Circulation stable
Medical request for CPAP circuit
CPAP Circuit
“Dolly Parton”
OptiflowTM/AirvoTM Circuit
Treatment
• 1400 - OptiflowTM via AirvoTM commenced
• Initially set for high oxygenation
 15 lpm of oxygen (piped via flow meter)
 15 lpm flow rate (generated by AirvoTM)
 Approximate oxygen concentration 63%
• Arterial line inserted
• ABG’s at 30 minute intervals
Treatment - cont
• 1500 – sats slight improvement to 92%
• 1600 – sats up to 94%
• 1630 – commenced weaning of O2
↓Oxygen flow 7 lpm(50%)
↑Flow rate to 30 lpm
Saturations constant in mid 90’s
• Constant monitoring of ABG’s & pulse ox
• OptiflowTM/AirvoTM titrated for effect
AIRVOTM Table
Outcome
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Referred to HDU → “wait & see”
Oxygen flow decreased incrementally
Steady improvement in saturations
Re-routing of ward
Six hours later stable
Oxygen flow ↓ 5 lpm
Flow rate maintained at 35 lpm approx 32%
Maintaining saturations at 97-98%
2000-transferred to Gen Surg ward with
OptiflowTM/AirvoTM
Resolution
• 24 hours later
 CXR Pulmonary Oedema resolved
completely
• Maintaining adequate saturations on air
• 48 hours – discharged home
• Unable to complete the Marathon 
Conclusion
• Early intervention with OptiflowTM/AirvoTM
O2 delivery and humidification does have
an impact on patient outcomes
• Works relatively quickly – sustained effect
• Suitable for patients when conventional
masks are not feasible
• Can decrease LOS in PACU
“Simply Better Oxygen Therapy”
Acknowledgements
• Product Specialist F & P
 Annelise La Roche
• Materials Management ACH
• Nurse Educators PACU
 Liz Boucher & Penny Jones
• Level 8 PACU RN’s
 For embracing the technique and
ongoing support of the system
The A, B, C of Anaesthesia
• Airway
• Bagel
• Coffee