Change the adhesive tape weekly or more frequently as required, 4 LPM in infants/children under 2 years of age, Flow of 2 L/kg/min up to 12kg, plus 0.5 L/kg/min for each kg above 12kg (to a maximum of 50 LPM), Flow of 2L/kg/min up to 12kg, plus 0.5L/kg/min for each kg above 12kg (to a maximum of 50LPM), Flow of 2L/kg/min up to 12kg, plus 0.5L/kg/min for each kg above 12kg (to a maximum of 50 LPM), Any patient who does not exhibit signs of clinical stabilization, as described below, within 2 hours of commencement of HFNP therapy should be reviewed by PICU outreach service. Oxygen is a drug and should be prescribed with a target saturation range. 
Part I. European Society of Intensive Care Medicine, the ACCP and the SCCM, Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock, The incidence and effect on outcome of hypoxemia in hospitalized medical patients, Reliability of pulse oximetry in titrating supplemental oxygen therapy in ventilator-dependent patients, Relationship between supranormal oxygen tension and outcome after resuscitation from cardiac arrest, The effect of supplemental oxygen on hypercapnia in subjects with obesity-associated hypoventilation: a randomized, crossover, clinical study, Randomised controlled trial of high concentration, Randomized controlled trial of high concentration oxygen in suspected community-acquired pneumonia, A randomized controlled trial of oxygen therapy in acute myocardial infarction Air Verses Oxygen In myocarDial infarction study (AVOID Study), A clinicians review of the respiratory microbiome, www.nrls.npsa.nhs.uk/resources/?entryid45=62811. However, as compressed gas is drying and may damage the tracheal mucosa humidification might be indicated/appropriate for patients with increased/thickened secretions, secretion retention, or for generalized discomfort and compliance. 
June, Vol.97, Issue 9, pg827-830, Ricard, J. HFNP nursing clinical guideline for more information. Secretions can become thick & difficult to clear or cause airway obstruction. 
Note: In most low flow systems the flow is usually titrated (on the oxygen flow meter) and recorded in litres per minute (LPM). For nasal prong oxygen withhumidification a maximum flow of: Optiflow nasal prongs are compatible for use in humidified low or high flow oxygen delivery. Oxygen therapy and oxygen delivery principles (respiratory therapy). Maintain efficient and economical use of oxygen. However, if humidification is clinically indicated - set up as per the recommended guidelines for the specific equipment used. The target ranges specified in the 2008 guideline are likely to remain unchanged. In life-threatening emergencies, oxygen can be given without a prescription until the patient is stable. An orange traffic light confirms the AIRVO 2 has not been cleaned and disinfected since last use, and is not safe for use on a new patient. Junior Mode requires Junior Tube and Chamber Kit, Standard Mode requires standard Tube and Chamber Kit, 2 LPM in infants/children under 2 years of age. Oxygen (via intact upper airway) via a simple face mask at flow rates of 4LPM does not routinely require humidification. Follow the manufacturers Instructions for use for each device and setup. post anaesthetic or surgical procedure. The recommended oxygen target saturation range in patients not at risk of type II respiratory failure is 9498%. High-flow nasal cannula oxygen therapy for infants with bronchiolitis: Pilot study.Journal of Paediatrics. Level of consciousness (LOC) = alert, colour = pink, behaviour = normal. Follow instructions in the
All high flow systems require humidification. Start 24 or 28% oxygen via a Venturi mask, then check blood gases. (2013) High-Flow Nasal Prong Oxygen Therapy or Nasopharyngeal Continuous Positive Airway Pressure for Children With Moderate-to-Severe Respiratory Distress?www.pccmjounral.org September, Vol 14, No.3. Select the appropriate size nasal prong for the patient's age and size. Where considering the application of oxygen therapy it is essential to perform a thorough clinical assessment of the child.
No difference was found between the two arms of the study in 30 day mortality or infarct size. See guide below for recommended patient sizing and flow rates. The recommended oxygen target saturation range in patients at risk of type II respiratory failure is 8892%. Intensive Care Med (2009) 35: 963-965. Hourly checks should be made for the following: Hourly checks should be made and recorded on the patient observation chart for the following (unless otherwise directed by the treating medical team): respiratory distress (descriptive assessment - i.e. On device start up, a green traffic light confirms the AIRVO 2 is safe for use on a new patient. As with the other delivery systems the inspired FiO2 depends on the flow rate of oxygen and varies according to the patient's minute ventilation. For all critically ill patients, high concentration oxygen should be administered immediately until the patient is stable. Oxygen is a treatment for hypoxaemia not breathlessness. Ralston, S.L., Lieberthal, A.S., Meissner, H.C., Alverston, B.K., Baley, J.E., Gadomski, A.M., Johnson, D.W., Light, M.J., Maraqa, n.F., Mendonca, E.A., Phelan, K.J., Zorc, J.J., Stanko-Lopp, D., Brown, M.A., Nathanson, I., Rosenblum, E., Sayles III, S. & Hernandez-Cancio, S. (2014) Pediatrics. Reduction or Cessation of oxygen therapy. Respiratory Distress (work of breathing) should be mild, or there should be no work of breathing. Appendix A for further information regarding appropriate junior range sizing: Fisher and Paykel Optiflow junior range sizing guide, Fisher and Paykel Optiflow nasal cannula standard range, ( In spontaneously breathing tracheostomy patients who require oxygen flow rates of less than 4 LPM there are two options available: Note: HME are used without a heated humidifier circuit. Which of the following statements are true? The type of humidification device selected will depend on the oxygen delivery system in use, and the patient's requirements. To ensure the patient is able to entrain room air around the nasal prongs and a complete seal is not created the prong size should be approximately half the diameter of the nares. We do not capture any email address. Monitoring of SpO, Many children in the recovery phase of acute respiratory illnesses are characterised by ventilation/perfusion mismatch (e.g. To ensure the highest concentration of oxygen is delivered to the patient the reservoir bag needs to be inflated prior to placing on the patients face. All vital signs should be with normal limits (ViCTOR white zone or modified zone) OXY-VENT with Tubing: The adaptor sits over the TRACH-VENT and the tubing attaches to the oxygen source (flow meter). This system is useful in accurately delivering concentrations of oxygen (21 95%).
The FiO2 inspired will vary depending on the patient's inspiratory flow, mask fit/size and patient's respiratory rate. Where oxygen weaning is successful, continuous pulse oximetry monitoring may be discontinued. Ensure the flow rate from the wall to the mask is adequate to maintain a fully inflated reservoir bag during the whole respiratory cycle (i.e. It allows the oxygen therapy to continue during feeding/eating and the re-breathing of CO2 isn't a potential complication. Commencement or Increase of Oxygen Therapy: 2. Where the Airvo2 is used as an oxygen delivery device the flow from this device is independent to the flow of oxygen. (2011) Reduced intubation rates for infants after introduction of high-flow nasal prong oxygen delivery. Note: Some flow meters may deliver greater than the maximum flow indicated on the flow meter if the ball is set above the highest amount. The AIRVO 2 Humidifier requires cleaning and disinfection between patients.
PICU High Flow Nasal Prong HFNP oxygen guideline. Journal of Pediatric Nursing, (30), 888-895. The non-rebreathing mask system may also have a valve on the side ports of the mask which prevents entrainment of room air into the mask. In some conditions e.g. early warning scores) will also be included. < 90% for infants with bronchiolitis, The child with cyanotic heart disease reaches their baseline Sp0, Mechanical ventilation (do not alter other ventilator settings), Mask-BiPaP or CPAP (do not alter pressure or volume settings. OXYGEN THERAPY STANDING MEDICAL ORDERS FOR NURSES. The treatment of an acute or emergency situation where hypoxaemia or hypoxia is suspected, and if the child is in respiratory distress manifested by: use of accessory muscles: nasal flaring, intercostal or sternal recession, tracheal tug, Short term therapy e.g. Tracheostomy HME - Heat Moisture Exchange (HME) with oxygen attachment The recommended target saturation range for patients not at risk of T2RF is 9294%. Therefore, humidification of nasal prong oxygen therapy is recommended. November, Vol.134, No.5, pge1474-e1502, Ramsey, K. (2012). Thank you for your interest in spreading the word on European Respiratory Society . ( Fisher and Paykel Optiflow (adult) nasal cannula standard range guide). If oxygen wean successful perform vital sign observation, intermittent SpO2 monitoring 30 minutes later, then hourly for 2 hours. Has two modes: Link to : Optiflow Nasal Prong Flow Rate Guide. While a specific FiO2 is delivered to the patient the FiO2 that is actually inspired by the patient (ie what the patient actually receives) varies depending on: At the RCH, oxygen therapy via an isolette is usually only for use in the Butterfly neonatal intensive care unit. Humidification can be provided using either the MR850 Humidifier or the AIRVO 2 Humidifier. Normal values and SpO 2 targets, Appendix A - Paediatric sizing guides for nasal prongs. A quasi-randomized controlled trial, Arterial hyperoxia and in-hospital mortality after resuscitation from cardiac arrest, Arterial oxygen tension and mortality in mechanically ventilated patients, Association between arterial hyperoxia following resuscitation from cardiac arrest and in-hospital mortality, Association between administered oxygen, arterial partial oxygen pressure and mortality in mechanically ventilated intensive care unit patients, Has oxygen administration delayed appropriate respiratory care? A non-rebreathing face mask has an oxygen reservoir bag and one-way valve system which prevents exhaled gases mixing with fresh gas flow. A patient with COPD and a history of hypercapnic respiratory failure becomes very breathless on the ward. Two sizes of Optiflow Junior nasal prongs suitable for use with AIRVO 2 Humidifier: FiO2 21-95% - Note, the oxygen flow rate from the wall or portable sources should not exceed the flow rate of the Airvo2 Medical gases, including air and oxygen, have a drying effect on mucous membranes resulting in airway damage. Why is a guideline for emergency oxygen necessary? Any patient who does not exhibit signs of clinical stabilization with 4 hours of commencement of HFNP should be considered for transfer to the PICU. The new children's guideline will provide comprehensive guidance on the emergency use of oxygen in paediatric healthcare and the adult guideline has been extended to include first responders and palliative care settings. Check nasal prong and tubing for patency, kinks or twists at any point in the tubing and clear or change prongs if necessary. B.R. RT203 Circuit and O2 stem - click here for instructions for use), Low Flow - Suitable for patients using the Optiflow Junior Nasal Prongs. Archives of Disease in Childhood - Fetal and Neonatal Edition, 88, F84 - F88. Humidification during oxygen therapy and non-invasive ventilation: do we need some and how much? Continuous pulse oximetry for 30 minutes post cessation of oxygen therapy inspiration and expiration). 20 (6), 39-45. British Journal of Nursing, 23(7), 382-386. Oxygen is not a flammable gas but it does support combustion (rapid burning). Only patients with COPD are at risk of T2RF.
Online ISSN: 2073-4735, Copyright 2022 by the European Respiratory Society. ), Appendix A - Pediatric sizing guides for nasal prongs, Fisher and Paykel Optiflow junior range sizing guide. Patients who require an FiO2 greater than 50% require PICU medical review. asthma, bronchiolitis, and pneumonia) and can be managed with SpO, Oxygen therapy should be closely monitored & assessed at regular intervals, Children with cyanotic congenital heart disease normally have SpO. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. RT330 circuit - click here for instructions for use). 4 503 504, Clinical Practice Guidelines: The Diagnosis, Management & Prevention of Bronchiolitis. High Flow Nasal Prong Therapy (HFNP), See the A nebuliser mask, tracheostomy mask with a mask interface adaptor (Fisher&Paykel RT013), or Tracheostomy Direct Connection (Fisher&Paykel OPT870) are intended for use with the AIRVO 2 Humidifier. Clinical observations: (2014). Nasal prong flow rates of greater than 2 LPM (under 2 years of age) or 4 LPM (over 2 years of age), Nasal prong flow rates of greater than 1 LPM in neonates, Facial mask flow rates of greater than 5 LPM. Supplemental oxygen relieves hypoxaemia but does not improve ventilation or treat the underlying cause of the hypoxaemia. Care and considerations of child with simple nasal prongs: If the required flow rate exceeds those as recommended above this may result in nasal discomfort and irritation of the mucous membranes. Oxygen should be given to all patients having an acute stroke regardless of oxygen saturation.
Therefore, the results only apply to the short period of time between admission to hospital and primary PCI.
Check on the individual flow meter for where to read the ball (i.e. Mosby's Skills. use of accessory muscles/nasal flaring - see Respiratory Distress on EMR), Ensure the individual MET criteria are observed regardless of oxygen requirements, Cease oxygen therapy entirely and maintain line of sight for approximately 5 minutes, LOC = alert, note lethargy or irritability, Non re-breather face mask (mask with oxygen reservoir bag and one-way valves which aims to prevent/reduce room air entrainment), Isolette - neonates (usually for use in the Neonatal Intensive Care Unit only), Face mask or tracheostomy mask used in conjunction with an, NB: There is separate CPG for HFNP use in the NICU (see, Cold, dry air increases heat and fluid loss.
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