Nasal HFO Experience

[ali]

Hello everyone,

We have recently taken delivery of SLE6000s and with them the ability to deliver nasal HFO. I would be extremely grateful to hear from anyone who has experiences of its use, any issues, the type of respiratory physiology it suits, size of infants etc. 

Many thanks 

Al 😊😊

[piatkat]

Hi Ali, I'm pretty sure you've seen that, but for anybody not familiar with HFOV- maybe this RCT will shed some light: https://pubmed.ncbi.nlm.nih.gov/33890156/

[selja]

We use it extensively. Starting from 28 weeks and up. Our babies and nurses love it.

[tveralopez]

Starting in the end of 2020 we use nasal HFO especially in VLBW preterms after or to reach first extubation and continue it untill they reach 21% and 7cmH2O MAP.

We've also had good - but not controlled  - experience using it for deteriorated apnoe-bradycardia in 2-3 week old premies.

Equipment is Dräger Babylog® VN800 /VN500.

[Guest Bj_budijuwono]

Dear colleague, how to setting nasal HFO, its same with invasive HFO depending on blood gas... 

[Urs Zimmermann]

Dear Ali

Nasal HFO is a wonderful thing. We use it for almost a decade now and we have particular experience in treating late preterm infants with nHFO.

The most important (and practical relevant) points in a nutshell:

·         nHFO is not a minor form of invasive HFO, but an empowered form of CPAP

·         as in invasive HFO, oxygenation und ventilation can managed almost separately

·         in nHFO oxygenation is provided by CPAP and PEEP (oxygenation hardly ever gets much better by nHFO)

·         But there is an important improvement of ventilation in nHFO (please measure pCO2 carefully while using nHFO to prevent hyperventilation)

·         In nHFO amplitude is not that important to steer ventilation as it is in invasive HFO (the transmission of pressure to the airways is limited). In contrast frequency has a relevant impact on ventilation (lowering the frequency improves CO2 washout)

So whenever you have a newborn on CPAP that has respiratory acidosis with high levels of CO2 while oxygenation is more or less ok (e.g. sepsis, post extubation, post INSURE, etc.), nHFO will be very helpful and may prevent the Baby from getting intubated.

We use the medinCNO® since this is basically a perfect CPAP-device, which also provides nHFO (and synchronised NIPPV).