Question

Case Studies 1. A patient with idiopathic pulmonary fibrosis is hypoxemic, breathing oxygen by nasal cannula at 6 L/min. The patient's respiratory rate is 25–30 breaths/min. Mask oxygen is attempted, but is not well tolerated by the patient despite an improvement in Spoz. What would you suggest?

Answer 1

Suggestions:

• Since idiopathic pulmonary fibrosis (IPF) is a type of progressive irreversible lung disease with a decline in lung function and resultant hypoxemia, which causes further complications, hypoxemia can be brought under control using supplemental oxygen therapy. There is no cure for IPF and only supportive treatment can be given. In this case, mask O2 is not well tolerated, so oxygen by nasal cannula should be given. In traditional low-flow nasal cannula, 6L per minute is the maximum with normal minute ventilation, which is the same as that of the patient's. High-flow nasal cannula (HFNC) oxygen therapy can be used, along with heated humidification systems for the prevention of drying up of the upper airway mucosa and to make the patient more comfortable. Adult therapeutic flows are usually in the 15–40 L/min range when HFNC is used.
• The patient should also enroll in pulmonary rehab to improve breathing.
• Immunizations for pneumonia and influenza should be given.
• The patient should stay active, but exertional activities should be avoided.
• Plenty of rest and a healthy diet is also important.
• Above all the patient should not smoke and should avoid passive smoking.