Noninvasive therapies in the
NICU


View: CPAP, NHF, clinical literature
What is the difference between continuous positive airway pressure (CPAP) and nasal high flow (NHF)?
Compare therapies
Optiflow Junior 2 Nasal interface

Continuous positive airway pressure

CPAP is a mode of noninvasive respiratory support that provides continuous distending pressure throughout the respiratory cycle to spontaneously breathing patients.

CPAP requires a closed system and is typically delivered using a nasal interface, circuit and a pressure generator (either a bubble generator or ventilator).

Learn more about CPAP
 

CPAP interface –
FlexiTrunk™

Intended to deliver prescribed pressure
Interface designed to seal and maintain prescribed pressure
Larger breathing tubes (compared to a standard oxygen cannula) lower resistance to flow

Primary mechanisms

Establishes functional residual capacity1
Reduces the work of breathing1
Promotes gas
exchange2

Choose CPAP when you want to:

  • set and control pressure
 
  • stent open lungs and airway
 
  • reduce the need for mechanical ventilation3
 
  • decrease the incidence of bronchopulmonary dysplasia.4
Optiflow Junior 2 Nasal interface

Nasal high flow

NHF is a mode of noninvasive respiratory support that provides high flows of heated and humidified blended air and oxygen through an unsealed interface.

NHF requires an open system and is typically delivered using an unsealed nasal high flow interface and a single-limb circuit. The flow range is dependent on the flow driver/platform used.

Learn more about NHF
 

NHF interface –
Optiflow™ Junior 2

Delivers prescribed flow
Interface designed to be unsealed
Narrower breathing tubes (compared with CPAP) increase resistance to flow

Primary mechanisms

Washes out anatomical dead space5
Reduces the work of breathing and improves oxygenation5,6
Improves patient comfort and tolerance to therapy7,8

Choose NHF when you want to:

  • set and control the flow rate
 
  • generate a low level of pressure
 
  • reduce nasal trauma9
 
  • decrease re-breathed CO2.
Continuous positive airway pressure Nasal high flow
Provides continuous distending pressure throughout the respiratory cycle to spontaneously breathing patients. Provides high flows of heated and humidified blended air and oxygen through an unsealed interface.
Requires a closed system and is typically delivered using a nasal interface, circuit and a pressure generator (either a bubble generator or ventilator). Requires an open system and is typically delivered using an unsealed nasal high flow interface and a single-limb circuit. The flow range is dependent on the flow driver/platform used.
Interface
Uses the FlexiTrunk interface Uses the Optiflow Junior 2 interface
Intended to deliver prescribed pressure Delivers prescribed flow
Interface designed to seal and maintain prescribed pressure Interface designed to be unsealed
Larger breathing tubes, compared to a standard oxygen cannula, lowers resistance to flow Narrower breathing tubes (compared with CPAP) increase resistance to flow
Primary mechanisms
Establishes functional residual capacity1 Washes out anatomical dead space5
Reduces the work of breathing1 Reduces the work of breathing and improves oxygenation5,6
Promotes gas exchange2 Improves patient comfort and tolerance to therapy7,8
Choose when you want to:
Set and control pressure Set and control the flow rate
Stent open lungs and airway Generate a low level of pressure
Reduce the need for mechanical ventilation3 Reduce nasal trauma9
Decrease the incidence of bronchopulmonary dysplasia4 Decrease re-breathed CO2
 

An overview of the clinical literature: CPAP and NHF for the neonatal population

CPAP continues to be the standard of care in neonates < 28 weeks' gestational age (GA). However, there are several pathways of care in which CPAP and NHF may be used.
Postextubation
support
 
CPAP or NHF
Wilkinson et al. 2016
Cochrane Review​
Primary respiratory support
 
CPAP or NHF
Bruet et al. 2021
Systematic Review
Alternative to prolonged CPAP
 
CPAP or NHF
Roehr et al. 2016, Yoder et al. 2017 Consensus
< 28 weeks' GA

CPAP first
For neonates with compromised lung development and a higher need for respiratory support.

 
From 28 weeks' GA

NHF first with rescue CPAP
This approach may be considered for neonates who are stable or require lower acuity of care because it provides two noninvasive options before mechanical ventilation needs to be taken into consideration.


Optiflow Junior 2
Blender Transition Kit

NHF therapy without changing the circuit.

This kit allows patients to receive NHF therapy as an alternative to prolonged CPAP therapy without changing the circuit. It comes with an Optiflow Junior 2 nasal cannula, pressure manifold and an adapter that connects to the inspiratory limb of the CPAP circuit. Available in five sizes.

View Optiflow Junior 2 Blender Transition Kit

The Rosie Maternity Hospital Documentary Series

The reason, the rollout and the results: The Rosie, a Cambridge University Hospital, shares its successful implementation of noninvasive therapies for neonatal patients.
The implementation of a new therapy at the Rosie

The journey to implement noninvasive therapies at the Rosie

This video explores research behind the decision to deliver CPAP and NHF at the hospital.

A new therapy in practice at the Rosie

NHF and CPAP in practice at the Rosie

Learn how the hospital is providing noninvasive therapies for its young patients.
 
The impact of a new therapy at the Rosie

The Rosie reveals how noninvasive therapies have impacted on the hospital

Hear how the successful implementation of NHF and CPAP therapies on to its wards is being experienced by staff and families.

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View references
F&P, FlexiTrunk and Optiflow are trademarks of Fisher & Paykel Healthcare Limited. For patent information, see www.fphcare.com/ip
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