Respiratory Support During Surgery with Nasal High Flow in Type II Respiratory Failure
The study presented in the image discusses the use of Nasal High Flow (NHF) therapy during surgery in a patient with end-stage Chronic Obstructive Pulmonary Disease (COPD) and Type II Respiratory Failure. NHF is typically used in Intensive Care Units (ICUs) to support patients with acute respiratory failure and post-extubation, particularly helping to manage hypercapnia (elevated carbon dioxide levels).
In this case report, the patient, a 63-year-old male with a BMI of 28, FEV₁ of 1.21 liters (36% predicted), and SpO₂ of 86%, underwent two elective surgeries. The first surgery, an umbilical hernia repair, required intubation as the patient refused spinal anesthesia. For the second surgery, a transurethral bladder tumor resection, Non-Invasive Ventilation (NIV) was initially offered, but the patient refused. Instead, NHF was used at a rate of 40L/min, avoiding the need for intubation, while providing continuous respiratory support.
The outcome was positive: NHF maintained stable gas exchange during surgery, and the patient’s recovery in the ICU was uneventful in both surgeries. The case demonstrates NHF as a potential alternative to traditional invasive ventilation during surgery for high-risk patients with respiratory failure.
Key Takeaways:
- Nasal High Flow (NHF) Therapy: Effective in managing respiratory support during surgery for patients with COPD and Type II Respiratory Failure.
- Benefits: NHF helps avoid re-inhalation of CO₂ and may prevent the need for invasive ventilation.
- Clinical Application: While NHF is typically used in ICUs, this case shows its potential in the surgical setting for patients unable to tolerate other forms of respiratory support.
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