DO NOT USE FOR CLINICAL PRACTICE
Please use current guidelines available on the UHNM intranet for patient treatment
Please use current guidelines available on the UHNM intranet for patient treatment
DEFINITION
Delivery of humidified, heated and blended oxygen/air at flow rates between 1–8 L/min via nasal cannulae
INDICATIONS
- Treating or preventing apnoea of prematurity
- Respiratory support for babies with:
- respiratory distress syndrome – first line or post-extubation
- chronic lung disease
- meconium aspiration
- pulmonary oedema
- pulmonary hypoplasia
- pneumonia
- Babies slow to wean off nasal CPAP
- Babies with nasal trauma from nasal CPAP
SETTING AND FLOW RATE
- Set operating temperature at 36–38°C
- Start at flow rate of 4–6 L/min (flow rates <6 L/min in babies <2 kg)
- Use ≤8 L/min in babies ≥2 kg
- Ensure that air can exit freely around the prongs
MONITORING
Continuously
- Heart rate (including ECG)
- Respiratory rate
- SpO2
- Note: Monitor blood gases if on supplemental oxygen or clinically indicated
WAENING FLOW RATES
(This weaning mainly applies to babies born <34 weeks’ gestation, as some babies born ≥34 weeks may come off high flow without need for weaning)
FiO2 >0.3 | May not be possible to wean flow rate |
FiO2 <0.25 in baby ≥1.0 kg | Attempt to reduce by 1.0 L/min 24-hrly |
FiO2 <0.25 in baby <1.0 kg | Attempt to reduce by 1.0 L/min 48-hrly |
FiO2 0.25–0.3 | Attempt to reduce by 1.0 L/min 48-hrly |
Requiring <4.0 L/min |
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Escalate treatment Consider pneumothorax (rare) |
CONTRADINDICATIONS
- Upper airway abnormalities
- Ventilatory failure
- Severe cardiovascular instability
- Frequent apnoeas (despite caffeine in preterms)