Authors

• Marina Deucht — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0002-1290-7369
• Ivana Vujeva — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0003-3593-5351

Keywords

heart surgery, chronic obstructive pulmonary disease, high flow oxygen therapy, nasal cannula, respiratory physiotherapy

DOI

Full Text

**Introduction:** Chronic obstructive pulmonary disease (COPD) develops and progresses over the years. Disease characterized by productive cough, dyspnea, hypoxemia and hypercapnia presents a high risk of development of postoperative pulmonary complications in patients after cardiac surgery. (1, 2) Repeated endotracheal intubation is neither good nor desirable option therefore physiotherapy respiratory treatment and non-invasive ventilation (NIV) in any form is strongly recommended. (3) Objective: To show effectiveness of high flow oxygen therapy using physiotherapy respiratory treatment and AIRVOTM 2 device with nasal cannula in patient with poorly managed COPD who developed postoperative pulmonary complications after cardiac surgery. **Case report:** This case report presents an example of twenty days treating a patient who had clinically documented acute exacerbation of COPD following cardiac surgery. Respiratory distress, hypoxemia and moderate to severe hypercapnia were developed. In similar patients, along with early respiratory physiotherapy, NIV has become preferred modality of respiratory support because it increases tidal volume, maintains adequate alveolar ventilation, washes out carbon dioxide, reduces the work of breathing and eliminates majority of anatomical dead space. Chosen form of NIV is relatively new method of respiratory support using AIRVOTM 2 device. SPO2 and gasses O2 and CO2 from arterial blood parameter were compared before starting therapy and after few hours. High flows of heated and humidified mixture of air and oxygen delivered through nasal cannula resulted in significantly better and faster recovery of above mentioned patient. **Conclusion:** After several days of treatment with this method, patient was discharged home in stable cardiorespiratory condition with significant improvements in pulmonary and hemodynamic parameters. Implementation of adequately titrated high flow oxygen therapy with early respiratory physiotherapy treatment played an important role in successful recovery.

Literature

1. Girou E, Brun-Buisson C, Taillé S, Lemaire F, Brochard L. Secular trends in nosocomial infections and mortality associated with noninvasive ventilation in patients with exacerbation of COPD and pulmonary edema. JAMA. 2003;290(22):2985–91. https://doi.org/10.1001/jama.290.22.2985
2. Campbell EJ, Baker MD, Crites-Silver P. Subjective effects of humidification of oxygen for delivery by nasal cannula. A prospective study. Chest. 1988;93:289–93. https://doi.org/10.1378/chest.93.2.289
3. Chanques G, Contantin JM, Sauter M, Jung B, Sebbane M, Verzilli D. Discomfort associated with underhumidified high-flow oxygen therapy in critically ill patients. Intensive Care Med. 2009;35(6):996–1003. https://doi.org/10.1007/s00134-009-1456-x