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High Flow Ventilation in NICU

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MARIA garcia

on 9 December 2014

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Transcript of High Flow Ventilation in NICU

ADVANTAGES AND DISADVANTAGES
WHAT IS A HIGH FLOW VENTILATION?
HOW IT WORKS?
Delivers gases at flow rates 2-8l/m(neonates)
Generates 3xmore water than bubble systems and in molecular form (vapour).
Vapotherm's vapour transfer cartridges have pores 0.01 micrometers(bacteria 0.2-5m).
HFT Delivers through nasal cannula with medical grade vapour, precise temperature and oxygen.
OUTLINES
WHAT
IS A HIGH FLOW VENTILATION?

HOW
DOES IT WORK?

WHEN
IS IT USED?

ADVANTAGES AND DISADVANTAGES.

THE NURSING CARE
OF A NEONATE ON HIGH FLOW VENTILATION.

CONCLUSION.
High Flow Ventilation in NICU
VAPOTHERM
Sterile water
WHEN IS IT USED?
Non-Invasive Ventilation.
Delivers:
1. HEATED
2. HUMIDIFIED + BLENDED O2
3. VIA nasal canula > 2L/Kg/m
4.RESULT. High concentration O2 +
deliver continuous distending pressure.


% O2
l.p.m
humidified temperature
PATIENT SELECTION
SYMPTOMS
Mild to moderate respiratory distress.
Hypoxia.
Retractions.
Tachyapnoea.
Mild apnoea and bradycardia.
Grunting.
Nasal flaring.
Difficulty weaning from nasal CPAP.
Difficulty weaning from mechanical ventilation.
DIAGNOSES
Infant Respiratory Distress Syndrome (RDS).
Bronchopulmonary Displasia (BPD).
Prematurity.
Congenital heart defects.
Congenital diaphragmatic hernia (D-hernia).
Transient tachyapnoea of the newborn.
Meconium aspiration.
Persistent Pulmonary Hypertension.
CONTRAINDICATIONS
COMPARED TO CPAP
Reduced work of breathing through chest wall stabilisation, preservation of surfactant,reduction of atelectasis etc
Some babies seem to be more stable at high mean airway pressures (8-10cm H2O measured at the nose), although there is limited evidence that this is transmitted at alveolar level.
Stabilisation / opening at a larger airway level.
PEEP may improve gas exchange at alveolar level
Other mechanisms may involve e.g. stimulation of nasal mucosa.

Reduction in the number of ventilator days.
Reduction in nasal trauma.
Better tolerated than other forms of non-invasive respiratory therapy.
Baby's weight is improved on Vapotherm.
Oral feeding can be introduced earlier.

• Babies on
High Flow
will be more
settled
and
comfortable
than those on CPAP.

Less
abdominal gaseous distension than CPAP
• Babies do not require “time off” for nose breaks or changes between nasal prongs / masks,
reducing the amount of handling.
• Some evidence for
better weight gain
and improved feed tolerance.

Parents
have reported preferring being able to see more of their babies face.

Easier access
for cranial ultrasound scans and
head
circumference measurements.

ACCESSORIES AVALIABLES.

Aerogen
(nebulizer treatments).

Nitric Oxide.

Heliox gas .



• Upper airway abnormalities,
• Ventilatory failure.
• Severe cardiovascular instability.
• Frequent apnoea (despite caffeine in preterms).
NURSING CARE

Prongs: MUST be smaller than 50% of patient’s nose
(tight fit of nasal
cannula may generate pressure of 6-10cmH2O at flow as low as 1,5-2L/m).
• Vapotherm can give a flow of 4-8 L/min however in preterm infants flow of
5-6 L/min may be sufficient.
• Vapotherm can give up to 100% Oxygen.
• Operating temperature set at 34-35º C for flow rate <5 L/m and 36-38º C at >5 L/m (to prevent condensation).
• Use appropriate
sized
nasal cannula.
Monitoring
of heart rate, respiratory rate and SaO2 as a minimum
Transcutaneous
pCO2
monitoring is very usefu.l
Blood pressure monitoring intermittently unless UAC/arterial line in place.
Prone position, tilted head up to minimise work of breathing.
Orogastric tube preferred initially at least.
Maintaining comfort-monitor any sore areas around nose, heavy tubing.
Weaning(blood gases or clinical signs)

CONCLUSION
REFERENCES
THANK YOU!
ANY QUESTIONS?
Kelsey Barlow, Laura Joiner and María García
• GUIDLINES AND BEST PRACTICES FOR VAPOTHERM HIGH FLOW THERAPY. NICU POCKET GUIDE. 2 INDUSTRIAL
DRIVE, EXETER NH 03833 educationavtherm.com 603-658-00113100058 Rev,B.

• High flow nasal cannula (HFNC) for respiratory support(Vapotherm Precision Flow). Neonatal Intensive Care Unit Clinical Guideline. Ashford and St.Peter´s Hospitals NHS Trust. 11/05/2012
Guideline Details
Written by Dr. Peter Reynolds, Neonatal Consultant.Reviewed by Clinical Management Group March 2010.
Approved for use June 2010; Revised June 2011; Review June 2014.
He has cited:
1. Bhandari V et al. Synchronized nasal intermittent positive-pressure ventilation and neonatal
outcomes. Pediatrics. 2009 Aug;124(2):517-26.
2. Wilkinson D J. Pharyngeal pressure with high-flow nasal cannula Perinatol 2008;28(1):42-47
3. Saslow JG et al Work of breathing using high-flow nasal cannula in preterm infants. J.
Perinatol 2006;26(8):476-480
4. personal communication (Dr. K Ives, Neonatal Consultant, Oxford John Radcliffe)
5. Spence KL et al. High flow nasal cannula as a device to provide continuous positive airway
pressure in infants. J Perinatol 2007;27(12):772-775
6. Armfield M Use of Vapotherm for respiratory support with neonates
7. Woodhead et al (in press)

• Precision flow operating instruction manual. Vapotherm. 3001002 Rev. M 2014-2-11

• High Flow Therapy Clinical Review Thomas L Miller, PhD. Vapotherm 2012.

• Google images.

• Current methods of non-invasive ventilatory support for neonates. Ramadan A. Mahmoud, Charles Christoph Roehr,Gerd Schmalisch DOI: http://dx.doi.org/10.1016/j.prrv.2010.12.001

• Paediatric Respiratory Reviews. Volume 12, Issue 3, Pages 196–205, September 2011 Link http://www.prrjournal.com/article/S1526-0542(10)00126-0/abstract

Overall we feel that Vapotherm is a better form of non-invasive ventilation than others such as CPAP, as it is better tolerated by babies.

Parents also feel it is nicer as they can see the baby's face and it doesn't look as invasive.
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