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NOVEL, OFF-LABEL USE OF DUAL LUMEN NASAL CANNULA IN THE MANAGEMENT OF REFRACTORY HYPOXEMIA IN THE HOME CARE SETTING

HomeLife Oxygen, LLC, Memphis, TN

PURPOSE: When Oxygen (O2) requirements exceed the capabilities of home O2 equipment, dual lumen nasal cannula (DLNC) interfaced with two devices can double O2 availability to selected patients allowing management at home.

METHODS: DLNCs, developed for pneumatic O2 conserving devices (OCD) have two ports. They adapt to humidifiers on two separate O2 concentrators (CON) capable of 3 to 10 L/min. Available O2 could be 20 L/Min. For portability, lumens can be connected to a separate portable device. Either two O2 cylinders with single lumen OCD’s or perhaps two portable CON.

RESULTS: One patient (ILD) on two 8 L/min O2 concentrators(one to a nasal cannula and one to a Non-rebreathing Mask (NRM) had SpO2‘s in the low 90’s, but when the NRM was displaced SpO2 dropped to the low 80’s. Changing to a dual lumen cannula achieved 16 L/min nasally and maintained comparable Sp02’s. Eating and sleeping improved substantially. Another patient on 6 to 7 L/min has use this technique on portable CON and OCD especially on long car trips.

CONCLUSION: Certainly these situations are rare, but they do happen. One patient lived in relative comfort with his wife for 4 weeks on nasal O2 at 16 L/min. Another patient who uses an OCD at 6 at rest uses two portable CON (maximum setting of 5) that work off 12 volt adaptors for long trips. Each is set on 3 or 4 during long car trips.

CLINICAL IMPLICATIONS: Stable patients with refractory hypoxemia may be managed at home even if they exceed the capabilities of one CON or one portable system. Car trips may even be possible for some. This technique may also be useful in the acute care setting by simply being an economical way of providing high flow nasal O2 to acutely ill patients or by discharging stable patients home earlier than previously deemed feasible.

DISCLOSURE: Gregory Foust, Shareholder Owner of HomeLife Oxygen, LLC.