=Heated humidified oxygen.
Turn machine on at least 15 minutes before use (else high flow COLD air, which is not good).
No battery pack, so can’t move for intubation!
Flow rate depends on size of baby – basically 2l/kg/min, or 12l/min from 6kg. Maximum flow is 20 if over 6kg, no scope for increase below that.
Cannulae should not occlude airways else excessive pressure – no more than 50%
Start at 40% FiO2. Increase if saturations below 94%, increase flow if persistent/worsening work of breathing or resp/heart rate.
Response usually within first few hours – if none then likely intubation required.
Contraindications (for UHW/DGH)
- Congenital cardiac disease
- Asthma or chronic respiratory disease
- Reduced conscious level
- Acute neuromuscular disease
- Neurorespiratory with no agreed ceiling of care
- Pneumothorax
- Maxillofacial/choanal abnormalities
Review
Hourly for first 4 hours. Blood gas at 2 hours.
Weaning
Wean FiO2 in steps of 5% every hour.
Once under 30%, wean flow by 2l/min every 2 hours.
Reintroduce feeds if FiO2 below 40%.
Discontinue treatment once flow down to 4.