Hi everybody

I want to ask if there is an optimal or cutoff level of FiO2 after which I can remove nasal cpap to headbox or incubator O2 .

afaf korraa

prof of pediatrics and neonatology

We wean the ncpap pressure to 2 cm and the FiO2 to about 25% as a general guideline, before switching to lowflow nasal O2.

For many preterms, we wean to 2 cm and FiO2 21% (air), and then try without nasal O2.

According to our recent study published in Early Human Development this year. We do not recommend weaning from nCPAP until the baby is stable on room air. We no longer wean to Nasal Cannula as this increases O2 exposure and prolongs the duration of weaning. Also we avoid cycling the babies on CPAP a method of weaning.

...our recent study published in Early Human Development this year...

Interesting! Could you please give a link (Pubmed)?

thank you Dr. stefan and Dr. hesham. I never put my weaned patients on NC after cpap ,but I read many articles about this technique.

afaf korraa

Head of NICU

Al Azhar University

Edited August 6, 201114 yr by afaf
repitition

On VLBW/ELBW preemies with mild residual RDS, stable on NCPAP with FiO2<30% we wean by 1 LPM every 2-3 days until off.

Interesting! Could you please give a link (Pubmed)?

http://www.sciencedirect.com/science/article/pii/S0378378210007218

Hi Stefan,

I noted from one of your earlier posts that you take ncpap pressures down to 2cm, working on an functional residual capacity of about 4cm are your infants not already in a self supported state?

Regards

Alistair

...ncpap pressures down to 2cm, ...are your infants not already in a self supported state?

That's probably why it usually works to wean to 2 cm. The majority of patients with nCPAP in our unit is preterm and we have the impression that this strategy also helps to control apneas.

But of course, infants with stable breathing on 2 cm are with no or little oxygen need are usually - we generally take the cpap off, and only add supplemental oxygen IF needed.

@ali, to what pressure do you wean before trying without cpap?