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 |
|
|
Escalate treatment Consider pneumothorax (rare) |
CONTRADINDICATIONS
- Upper airway abnormalities
- Ventilatory failure
- Severe cardiovascular instability
- Frequent apnoeas (despite caffeine in preterms)
Date updated: 2024-01-22