Glad to hear about RAM CANNULA, some of our neonatologist are not convinced that RC can be used for NIPPV or if it is effective. I can report 2 premies less than 500g , where we were struggling with interface to extubate to. Ram Cannula worked perfectly both for Ventilation and oxygenation ( with a 5 to 10% more fio2 compared to when intubated). 2nd HFO is considered an escalation of ventilatory support ( it is true but once started, KEPP on HFO, till you extubate) but the oppsoite happens most of the time, and we as clinicians consider back to CV a weaning or improvement. this needs to be changed