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
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
View CPAP FlexiTrunk Interface
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 capacity
1
Reduces the work of breathing
1
Promotes gas
exchange
2
Choose CPAP when you want to:
set and control pressure
stent open lungs and airway
reduce the need for mechanical ventilation
3
decrease the incidence of bronchopulmonary dysplasia.
4
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
View NHF Optiflow Junior 2 Interface
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 space
5
Reduces the work of breathing and improves oxygenation
5,6
Improves patient comfort and tolerance to therapy
7,8
Choose NHF when you want to:
set and control the flow rate
generate a low level of pressure
reduce nasal trauma
9
decrease re-breathed CO
2.
Compare CPAP and NHF therapies
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 capacity
1
Washes out anatomical dead space
5
Reduces the work of breathing
1
Reduces the work of breathing and improves oxygenation
5,6
Promotes gas exchange
2
Improves patient comfort and tolerance to therapy
7,8
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 ventilation
3
Reduce nasal trauma
9
Decrease the incidence of bronchopulmonary dysplasia
4
Decrease re-breathed CO
2
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.
.
Dysart KC. Physiologic Basis for Nasal Continuous Positive Airway Pressure, Heated and Humidified High-Flow Nasal Cannula, and Nasal Ventilation. Clinics in Perinatology. 2016 Dec;43(4):621–631.
View abstract
Lee KS, Dunn MS, Fenwick M, Shennan AT. A Comparison of Underwater Bubble Continuous Positive Airway Pressure with Ventilator-Derived Continuous Positive Airway Pressure in Premature Neonates Ready for Extubation. Neonatology. 1998;73(2):69–75.
View abstract
Tapia JL, Urzua S, Bancalari A, Meritano J, Torres G, Fabres J et al. Randomized Trial of Early Bubble Continuous Positive Airway Pressure for Very Low-Birth-Weight Infants. The Journal of Pediatrics. 2012 Jul;161(1):75–80.e1.
View abstract
Subramaniam P, Ho JJ, Davis PG. Prophylactic nasal continuous positive airway pressure for preventing morbidity and mortality in very preterm infants. Cochrane Database of Systematic Reviews. 2016 Jun 14;(6).
View abstract
Dysart K, Miller TL, Wolfson MR, Shaffer TH. Research in high-flow therapy: Mechanisms of action. Respiratory Medicine. 2009 Oct;103(10):1400–1405.
View abstract
Bressan S, Balzani M, Krauss B, Pettenazzo A, Zanconato S, Baraldi E. High-flow nasal cannula oxygen for bronchiolitis in a pediatric ward: a pilot study. European Journal of Pediatrics. 2013 Dec 31;172(12):1649–1656.
View abstract
Osman M, Elsharkawy A, Abdel-Hady H. Assessment of pain during application of nasal-continuous positive airway pressure and heated, humidified high-flow nasal cannulae in preterm infants. Journal of Perinatology. 2015 Apr 27;35(4):263–267.
View abstract
Spentzas T, Minarik M, Patters AB, Vinson B, Stidham G. Children With Respiratory Distress Treated With High-Flow Nasal Cannula. Journal of Intensive Care Medicine. 2009 Sep 23;24(5):323–328.
View abstract
Yoder BA, Stoddard RA, Li M, King J, Dirnberger DR, Abbasi S. Heated, Humidified High-Flow Nasal Cannula Versus Nasal CPAP for Respiratory Support in Neonates. Pediatrics. 2013 May 1;131(5):e1482–1490.
View abstract
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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Infant Respiratory
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Neonatal Resuscitation Therapy Overview
Neonatal Invasive Ventilation Therapy Overview
Neonatal CPAP Therapy Overview
Neonatal NHF Therapy Overview
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Pediatric Invasive Therapy Overview
Infant CPAP Therapy Overview
Pediatric NHF Therapy Overview
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