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

Transcription

1 Guidelines Best Practices for High Flow Nasal Cannula (HFNC) Pediatric Pocket Guide

2 Patient Selection Diagnoses Patient presents with one or more of the following signs or symptoms of respiratory distress: Hypoxemia Hypercapnia Tachypnea Accessory muscle use Grunting Nasal flaring 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 Disclaimer: Vapotherm does not practice medicine or provide medical services. These guidelines are based on Vapotherm s assessment of peer-reviewed published literature, physician interviews, physiological modeling. Providers should refer to the full indications for use, operating instructions, /or prescribing information of any products referenced before exercising their independent medical judgment to use or otherwise prescribe the products. 1 Vapotherm Pediatric Pocket Guide

3 Fitting the Cannula: Vapotherm Cannula & Flow Selection 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 infants. The single prong design ensures less than 50% nostril occlusion, is as effective as a dual prong cannula. The single prong also allows for placement of a NG tube. Cannula Sizes Cannula Flow Range Tip OD Premature 1-8 L/min 1.5 mm Neonatal 1-8 L/min 1.5 mm SOLO (single prong) 1-8 L/min 1.9 mm Infant 1-8 L/min 1.9 mm Intermediate Infant 1-8 L/min 1.9 mm Pediatric Small 1-20 L/min 1.9 mm Pediatric/Adult Small 5-40 L/min 2.7 mm Adult 5-40 L/min 4.8 mm Flow Selection: Age Weight Cannula(s) Minimum Flow Typical Starting Flow 1 mo <4kg 5 L/min 5-8 L/min 1 mo 1 year 4-10kg 5 L/min 8-12 L/min 1 6 years 10-20kg 5 L/min L/min 6 12 years 20-40kg 5 L/min L/min years >40kg 5 L/min 25+ L/min Cannula Application: Only Vapotherm cannulae should be used with the Vapotherm 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 Vapotherm Pediatric Pocket Guide 2

4 Therapy Implementation Maintenance Patient Assesment: SpO 2 <92% /or increased work of breathing (WOB)* 0 30 days Start flow at 5-8 L/min increase by 1 L/min, Start FiO 2 at 0.40 titrate, as needed to achieve target SpO 2 1 mo 1 year Start flow at 8-12 L/min increase by 1 L/min, SpO 2 >92% same as above except start FiO 2 at years Start flow at L/min increase by 1L/min, Set temperature to 37 C adjust to patient preference 6 12 years Start flow at L/min increase by 1-2 L/min, Start at 0.60 titrate, as needed to achieve target SpO 2 SpO 2 >92% same as above except start FiO 2 at years Start flow at 25 L/min increase by 2 L/min, 3 Vapotherm Pediatric Pocket Guide

5 Monitoring Therapy Patient Parameters: Documentation: Indices of work of breathing (WOB) SpO 2 PCO 2 FiO 2 Nasopharynx patency Feeding tolerance Patient Heart rate Respiratory rate Work of breathing (WOB) SpO 2 Device Flow rate FiO 2 Temperature Water level Cannula size Vapotherm Pediatric Pocket Guide 4

6 Vapotherm Weaning Wean flow by 1 L/min increments as patient tolerates Yes WEAN FiO 2 TO 25% FIRST Stable at 25% No Return O 2 to range acceptable for SpO 2 requirement If stable at lower flow for 4-6 hours, consider further wean Assess for further wean /or discontinuation Conventional cannula or room air Wean If stable FiOat 2 First, lower Flow flow Second for 24 hours, Vapotherm parameters consider (flow & O further 2 ) are independent of wean each other. Adjustment of flow will impact work of breathing while adjustment of O 2 maintains patient SpO 2. Monitoring of patients response to each change requires continuous assessment of breath sounds, respiratory rate, physical characteristics (e.g nasal flaring, grunting retractions). Patient assessment of HR, RR, SpO 2 Once stable for 4-6 hours, consider FiO 2 wean Once down to 25% FiO 2 stable for 24 hours wean flow 5 Vapotherm Pediatric Pocket Guide

7 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 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 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 extrathoracic airway obstruction. Precision Flow Heliox strategies follow the same general clinical guidelines for air-oxygen mixtures, except FiO 2 should be titrated between since higher oxygen concentrations ( 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 Vapotherm Pediatric Pocket Guide 6

8 Vapotherm, Inc. 100 Domain Dr, #102 Exeter, NH MKT-0018 Rev. C Last Modified 5/2017