epo + iNO policies, and ROXI/HFNC ppt (0/14)

epo dose is in what units of measure?

ng/kg/min based on IBW

pharmacy mixes veletri with what?

0.75mg veletri in a 50mL syringe of normal saline for a concentration of 15,000ng/mL to be use for initial dose titration

what is considered a response to treatment?

>20% increase in PaO2 or >20% reduction in PAP w/I 10min

how does the dripping work when dosing?

aeroneb runs dry b/w drops as it drips → aerosolizes → dries → repeats.

how often must you change the filter?

EVERY 48H

when to use HFNC w/ COVID?

normal compliance but severe symptomatic hypoxemia

considerations of HFNC and COVID (3)

1. use resting SpO2 over several measurements w any exertion causing dramatic hypoxemia

2. leave margin of safety (e.g., FiO2 <80%) in case needing to increase w/ intubating patient

3. SpO2 80-85% w/o symptoms is acceptable and 85-90% w/ dyspnea or evidence of minor tissue hypoxia is acceptable

HFNC + COVID indications

1. no response to 15L NRB, <85% SpO2

2. asymptomatic hypoxemia + evidence of end organ or tissue hypoxia

3. NOT for air hunger in pt on comfort care

HFNC + COVID infection control safety

1. airborne, droplet + contact

2. - P

3. not routinely in ED or acute care units unless limited ICU capacity

4. turn off HFNC for pt. movement through hospital

safety for HFNC and COVID

1. any flow acceptable if airborne PPE worn

2. keep HFNC off until simple surgical facemark in place over HFNC on pt + RT away from face (>2m/6ft)

3. turn off HFNC for any removal, adjustments r transport

4. correct size w/ snug fit of interface

ideal flow for HFNC

higher flows of 40-60L can better match high insp flow by pt. causing FiO2 to be closer to FDO2 by limiting entrained air, can provide minimal PEEP + reduce anatomic DS.

advantage of higher flow (3)

1. improve FiO2 delivery

2. reduce WoB

3. minor increase in PEEP

risks of higher flow

1. increase in droplet spread distance by 4cm (2in) at rest, 40cm (15in) w/ cough

2. delay in intubation

ROX index definition, predictors and math

ROXI is a predictor of HFNC failure based off of HFNC initiation (>4.88 being lower risk of intubation).

2h = ROXI <2.85
6h = ROXI <3.47
12h = ROXI <3.85

example: SpO2 90% on 50% w/ RR32 and 12h after initiation = (90/0.5)/32 = 5.63 ROXI score = lower risk intubation.