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Pediatric High Flow Nasal Cannula
VAPOTHERM POCKET GUIDE
Patient Selection
Signs and Symptoms:
Patient presents with one or
more of the following:
• M
ild to moderate respiratory
distress
• Hypoxemia
• Hypercapnia
• Tachypnea
• Accessory muscle use
• Grunting
• Nasal flaring
• Mild
apnea and bradycardia
(neonate)
Diagnoses
These conditions may
benefit from Vapotherm:
cute Respiratory
• A
Distress Syndrome (ARDS)
• Viral bronchiolitis
• Pneumonia
• Severe Acute Asthma
• Congenital Heart Defects (CHD)
• P
ersistent Pulmonary
Hypertension
• B
ronchopulmonary Displasia
(BPD)
• S
eparation from mechanical
ventilation
eparation from non-invasive
• S
ventilation
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Vapotherm PICU Pocket Guide
Vapotherm Cannula & Flow Selection
FITTING THE CANNULA:
• Make sure not to occlude greater than 50% of the internal diameter of each of the nares.
• Cannula prongs should be wide enough not to “pinch” the nasal septum (erosion risk).
• T
he SOLO cannula is a single prong cannula that can be used in neonates and infants.
The single prong design ensures less than 50% nostril occlusion, and is as effective as a
dual prong cannula. The single prong also allows for placement of a NG tube.
Cannula Sizes
Cannula Flow Range
Tip OD
Premature
1-8 L/min
1.5 mm
Neonatal
1-8 L/min
1.5 mm
SOLO (single prong)
1-8 L/min
1.9 mm
Infant
1-8 L/min
1.9 mm
Intermediate Infant
1-8 L/min
1.9 mm
Pediatric Small
1-20 L/min
1.9 mm
Pediatric/Adult Small
5-40 L/min
2.7 mm
Adult
5-40 L/min
4.8 mm
Cannula(s)
Typical Starting Flow
FLOW SELECTION:
Age
0 – 30 days
Weight
<4kg
4-5 L/min
1 mo – 1 year
4-10kg
5-8 L/min
1 – 6 years
10-20kg
5-10 L/min
6 – 12 years
20-40kg
10-14 L/min
12 – 18 years
>40kg
12-16 L/min
Disclaimer: Suggested flow rates and FiO2 settings are guidelines. Actual settings should be determined according to
specific patient requirements and physician discretion.
CANNULA APPLICATION:
• Only Vapotherm cannulae should be used with the Vapotherm Precision Flow
• Select the appropriate cannula based on the above sizing chart
• Place the cannula on the patient before attaching the delivery tube
• Allow the system to reach the set point before connecting delivery tube to the cannula
• T
he Precision Flow’s operational flow range is locked depending on the disposable patient
circuit (DPC) selected:
– High Flow DPC (Blue packaging): 5-40 L/min
– Low Flow DPC (Red packaging): 1-8 L/min
Vapotherm PICU Pocket Guide
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Therapy Implementation and Maintenance
0 – 30 days
Start flow at 5 L/min
and
increase by 1 L/min,
as WOB requires
1 mo – 1 year
Start flow at 6 L/min and
increase by 1 L/min,
as WOB requires
1 – 6 years
Start flow at 8 L/min
and
increase by 1L/min,
as WOB requires
6 – 12 years
Start flow at 10 L/min
and
increase by 1-2 L/min,
as WOB requires
12 – 18 years
PATIENT ASSESMENT: SpO2<92% and/or increased work of breathing (WOB)*
Start flow at 12 L/min
and
increase by 2 L/min,
as WOB requires
Set temperature
to 36-37°C
Set temperature
to 37°C
and decrease per
patient preference
Start FiO2 at 0.40 and titrate,
as needed to achieve
target SpO2
SpO2 >92% same as above
except start FiO2 at 0.21
Start at 0.60 and titrate,
as needed to achieve
target SpO2
SpO2 >92% same as above
except start FiO2 at 0.21
*Management of patients with cyanotic congenital heart disease should target disease-specific SpO2 targets. Suggested starting
FiO2 guidelines do not apply to patients with single ventricle physiology undergoing palliation, or patients adversely affected by
oxygen-mediated decreases in pulmonary vascular resistance.
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Vapotherm PICU Pocket Guide
Monitoring Therapy
Patient Parameters:
Documentation:
• Indices of work of breathing
(WOB)
Patient
• SpO2
• Respiratory rate
• PCO2
• FiO2
• Nasopharynx patency
• Feeding tolerance
• Heart rate
• Work of breathing (WOB)
• SpO2
Device
• Flow rate
• FiO2
• Temperature
• Water level
• Cannula size
Vapotherm PICU Pocket Guide
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Vapotherm Weaning
0 – 30 days
If FiO2 ≤ .60, flow
rate may be
weaned by 1-2
L/min every hour
1 mo – 1 year
If FiO2 ≤ .60, flow
rate may be
weaned by 1-2
L/min every hour
1 – 6 years
If FiO2 ≤ .60, flow
rate may be
weaned by 1-2
L/min every hour
6 – 12 years
If FiO2 ≤ .60, flow
rate may be
weaned by 1-2
L/min every hour
12 – 18 years
PATIENT ASSESMENT: SpO2 >93% or within desired range and unlabored respirations
If FiO2 ≤ .60, flow
rate may be
weaned by 1-4
L/min every hour
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Vapotherm PICU Pocket Guide
Wean FiO2 by
decreasing 2-5%
every 30-60 minutes
Set temperature
to 36- 37°C or to
patient preference
Wean FiO2 by
decreasing 5-10%
every hour
Accessories
USE WITH AEROGEN®
• A
n adapter is available for the Precision Flow to enable nebulizer
treatments. The inline adapter is designed to be used specifically with
the Aerogen® Aeroneb® solo (AAA-1).
• T
he adapter is not for continuous use and should be removed after
each treatment.
• It is important to maintain proper upright orientation of the inline adapter
during the drug administration process. Vapotherm recommends the
AAA-1 be at an upright 45º angle to minimize condensation.
USE WITH NITRIC OXIDE
• V
apotherm technology is verified for use with INOmax® DS and
DSIR (PF-NODPC-LOW 1-8 L/min, PF-NODPC-HIGH 5-40 L/min).
• Note: See Ikaria® for instructions for use.
USE WITH PRECISION FLOW HELIOX®
• V
apotherm offers an ideal solution for convenient delivery of
conditioned helium-oxygen gas mixtures (Heliox).
• Heliox has a significantly lower density than typical air/oxygen mixtures.
• T
he lower gas density reduces the work of breathing by reducing
the force needed to move gas through the airways.
• H
eliox is commonly used on patients with diseases of increased
airway resistance, such as bronchiolitis, asthma, post-extubation
stridor, airway compression, intra and extrathoracic airway obstruction.
• P
recision Flow Heliox strategies follow the same general clinical
guidelines for air-oxygen mixtures, except FiO2 should be titrated
between 0.21 and 0.4 since higher oxygen concentrations (and lower
helium concentrations) would result in a less significant clinical effect.
• V
apotherm Heliox Disposable Patient Circuits (DPC)
PFH-DPC-LOW 1-8 L/min
PFH-DPC-HIGH 5-40 L/min
Vapotherm PICU Pocket Guide
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Vapotherm, Inc. • 22 Industrial Drive • Exeter, NH 03833 • 603.658.0011 • www.vtherm.com
MKT-0018 Rev. A