Neonatal Guidelines and Best Practices for High Flow Nasal Cannula (HFNC)
Patient presents with one or more of the following symptoms:
- Mild apnea and bradycardia
- Nasal flaring
- Difficulty weaning from Nasal CPAP
- Difficulty weaning from mechanical ventilation
These symptoms are indicative of but not solely attributed to:
- Infant Respiratory Distress Syndrome (RDS)
- Bronchopulmonary Displasia (BPD)
- Congenital Heart Defects
- Congenital diaphragmatic hernia (CDH)
- Transient Tachypnea of the Newborn (TTN)
- Meconium aspiration
- Persistent Pulmonary Hypertension (PPHN)
Vapotherm Cannula and Flow Selection
Fitting the Cannula:
- Make sure not to occlude greater than 50% of the internal diameter of each of the nares.
- Weights and recommended cannula size will vary depending on the inner diameter of the
nares and the outer diameter of the cannula prongs in use.
- Only Vapotherm cannulae should be used with the Precision Flow
- Select the appropriate cannula based on the above sizing chart
- Place the cannula on the patient before attaching the delivery tube
- Allow the system to reach the set point (temperature display will stop flashing) before connecting delivery tube to the cannula
- Vapotherm Low Flow Disposable Patient Circuits (red packaging) should always be used when treating neonatal patients
Therapy Implementation and Maintenance
SpO2 > 88% with moderate increase in work of breathing
Start at 4 L/min and increase by 0.5 L/min as work of breathing requires
36°C – 37°C
Start at 21% and increase conservatively to maintain target SpO2
SpO2 < 88% with moderate increase in work of breathing
Start at 5 L/min and increase by 0.5 L/min as work of breathing requires
36°C – 37°C
Start at 25% and increase conservatively if needed to maintain target SpO2
SpO2 < 88% with severe respiratory distress
Start at 6 L/min and increase by 0.5 L/min as work of breathing requires
36°C – 37°C
Start at 30% and increase conservatively if needed to maintain target SpO2
Note: When using Vapotherm therapy with a radiant warmer or incubator set the Precision Flow within one degree of the radiant warmer or incubator.
Vapotherm does not practice medicine or provide medical services. Providers should refer to the full indications for use, operating instructions, and/or prescribing information of any products referenced before exercising their independent medical judgment to use or otherwise prescribe the products.
- Indices of work of breathing (WOB)
- Nasopharynx patency
- Feeding tolerance
- Heart rate
- Respiratory rate
- Work of breathing (WOB)
- Flow rate
- FiO2Respiratory rate
- Water level
- Cannula size
Wean FiO2 to 25% first
Not Stable at 25%
Return O2 to range acceptable for SpO2 requirement
Patient assessment of HR, RR, SpO2
Once stable for 4-6 hours, consider FiO2 wean
Once down to 25% FiO2 and stable for 24 hours wean flow
￼Wean FiO2 First, Flow Second
Vapotherm parameters (flow & O2) are independent of each other. Adjustment of flow will impact work of breathing while adjustment of O2 maintains patient SpO2. Monitoring of patients’ response to each change requires continuous assessment of breath sounds, respiratory rate, physical characteristics (e.g nasal flaring, grunting and retractions).
Stable at 25%
Wean flow by 1 L/min increments as patient tolerates
If stable at lower flow for 4-6 hours, consider further wean
Assess for further wean and/or discontinuation
Conventional cannula or room air
Use With Aerogen®
- An adapter is available for the Precision Flow to enable nebulizer treatments. The inline adapter is designed to be used specifically with the Aerogen® Aeroneb® solo (AAA-1).
- The adapter is not for continuous use and should be removed after each treatment.
- It is important to maintain proper upright orientation of the inline adapter during the drug administration process. Vapotherm recommends the AAA-1 be at an upright 45º angle to minimize condensation.
Use With Nitric Oxide
- Vapotherm technology is verified for use with INOmax® DS and DSIR (PF-NODPC-LOW 1-8 L/min, PF-NODPC-HIGH 5-40 L/min).
- Note: See Ikaria® for instructions for use.
Use With Precision Flow Heliox®
- Vapotherm offers an ideal solution for convenient delivery of conditioned helium-oxygen gas mixtures (Heliox).
- Heliox has a significantly lower density than typical air/oxygen mixtures.
- The lower gas density reduces the work of breathing by reducing the force needed to move gas through the airways.
- Heliox is commonly used on patients with diseases of increased airway resistance, such as bronchiolitis, asthma, post-extubation stridor, airway compression, intra and extrathoracic airway obstruction.
- Precision Flow Heliox strategies follow the same general clinical guidelines for air-oxygen mixtures, except FiO2 should be titrated between 0.21 and 0.4 since higher oxygen concentrations (and lower helium concentrations) would result in a less significant clinical effect.
- Vapotherm Heliox Disposable Patient Circuits (DPC)
PF-DPC-LOW 1-8 L/min
PF-DPC-HIGH 5-40 L/min