Pediatric Guidelines and Best Practices2018-05-24T23:08:55-04:00

Pediatric Guidelines and Best Practices for High Flow Nasal Cannula (HFNC)

Asthma NIV

Patient Selection

Patient presents with one or more of the following symptoms:

  • Hypoxemia
  • Hypercapnia
  • Tachypnea
  • Accessory muscle use
  • Grunting
  • Nasal flaring

Diagnoses

These symptoms are indicative of but not solely attributed to:

  • Acute Respiratory Distress Syndrome (ARDS)
  • Viral bronchiolitis
  • Pneumonia
  • Acute Asthma
  • Congenital Heart Defects (CHD)
  • Persistent Pulmonary Hypertension
  • Bronchopulmonary Displasia (BPD)
  • Ventilator Weaning

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.
  • Cannula prongs should be wide enough not to “pinch” the nasal septum (erosion risk).
  • The SOLO cannula is a single prong cannula that can be used in neonates and infants. The single prong design ensures less than 50% nostril occlusion, and is as effective as a dual prong cannula. The single prong also allows for placement of a NG tube.
Nasal cannula size guide

Flow Selection:

Pediatric flow selection guide

Cannula Application:

  • 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
  • The Precision Flow’s operational flow range is locked depending on the disposable patient circuit (DPC) selected:
    • High Flow DPC (Blue packaging): 5-40 L/min
    • Low Flow DPC (Red packaging): 1-8 L/min

Therapy Implementation and Maintenance

Patient Assessment: SpO2 < 92% and/or increased work of breathing

Flow Icon

Flow

Temperature

FiO2

FiO2

0 – 30 days

Start at 5-8 L/min and increase by 1 L/min as work of breathing requires

Set temperature at 37°C and adjust to patient preference

Start at 0.40 and titrate as needed to achieve target SpO2

*If SpO2 > 92%, start at 0.21

1 month – 1 year

Start at 8-12 L/min and increase by 1 L/min as work of breathing requires

Set temperature at 37°C and adjust to patient preference

Start at 0.40 and titrate as needed to achieve target SpO2

*If SpO2 > 92%, start at 0.21

1 – 6 years

Start at 12-20 L/min and increase by 1 L/min as work of breathing requires

Set temperature at 37°C and adjust to patient preference

Start at 0.60 and titrate as needed to achieve target SpO2

*If SpO2 > 92%, start at 0.21

6 – 12 years

Start at 20-25 L/min and increase by 1-2 L/min as work of breathing requires

Set temperature at 37°C and adjust to patient preference

Start at 0.60 and titrate as needed to achieve target SpO2

*If SpO2 > 92%, start at 0.21

12 – 18 years

Start at 25 L/min and increase by 2 L/min as work of breathing requires

Set temperature at 37°C and adjust to patient preference

Start at 0.60 and titrate as needed to achieve target SpO2

*If SpO2 > 92%, start at 0.21

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.

Monitoring Therapy

Patient Parameters

  • Indices of work of breathing (WOB)
  • SpO2
  • PCO2
  • FiO2
  • Nasopharynx patency
  • Feeding tolerance

Documentation

Patient

  • Heart rate
  • Respiratory rate
  • Work of breathing (WOB)
  • SpO2

Device

  • Flow rate
  • FiO2
  • Temperature
  • Water level
  • Cannula size

Vapotherm Weaning

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

Accessories

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
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