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).