Draft September 5, 2007 NASAL CANNULA USE IN THE NICU Nasal cannulas are use !n t"e NICU t# el!

!$er supplemental #%&'en t"erap&( In #ur smallest pat!ents )*27 +ee,s E-A at b!rt". +e rec#mmen +ean!n' t"ese pat!ents fr#m nC/A/ +"en t"e!r f!02 re1u!rement !s 0(22 !rectl& t# r##m a!r +!t"#ut us!n' a nasal cannula )see bubble nC/A/ 'u! el!nes.( 3urt"erm#re, nasal cannula #%&'en fl#+ rate s"#ul be +eane t# ma!nta!n Sp02 as per #ur un!t 'u! el!nes( 4e # n#t rec#mmen t"e r#ut!ne use #f blen e #%&'en +!t" nasal cannulas, alt"#u'" t"ere ma& be a rare pat!ent +"# benef!ts fr#m blen e #%&'en nasal cannula In 'eneral, nasal cannula #%&'en !s el!$ere at l#+ fl#+ rates c#mpare t# pe !atr!c an a ult un!ts( H#+e$er, ,eep !n m!n t"at t"e m!nute $ent!lat!#n !s +e!'"t epen ent an t"eref#re #ur pat!ents "a$e relat!$el& l#+ m!nute $ent!lat!#n( 3#r e%ample, a 2 ,!l#'ram bab& +!t" a t! al $#lume #f 20 ml5,' breat"!n' 60 t!mes a m!nute +#ul "a$e a m!nute $ent!lat!#n )20 ml 7 60 5m!n. #f 600 ml5m!n #r 0(6 lpm( Us!n' t"e "!'" fl#+ rates enc#untere !n pe !atr!cs an a ult me !c!ne lea t# nasal ama'e an !na $ertent C/A/ el!$er&( 8ecentl&, "!'"9fl#+ nasal cannulas "a$e been !ntr# uce !nt# t"e NICU +!t"#ut lar'e ran #m!:e c#ntr#l tr!als t# establ!s" eff!cac& an safet& )3!ner, 2005.( In a recent re$!e+ 3re& an S"ann )200;. s"#+e t"at nasal cannula fl#+s 'reater t"an 0(5 lpm resulte !n p#s!t!$e en 9 e%p!rat#r& pressure )/EE/. +"en cannulas +!t" a !ameter #f ; mm +ere ut!l!:e ( L#c,e et al( )2<<;. em#nstrate t"at nasal cannula fl#+s #f 2 lpm resulte !n es#p"a'eal pressures )n#n9 !n$as!$e measurement #f !ntrat"#rac!c pressure. #f <(= 2(0 cmH20 +"en ; mm cannula +ere ut!l!:e ( Sreenan et al( )2002. f#un t"at a C/A/ #f > cmH 20 c#ul be rel!able el!$ere t# ne#nates base #n t"e!r +e!'"t, an e$el#pe t"e f#ll#+!n' f#rmula t# eterm!ne t"e nasal cannula fl#+ nee e t# #bta!n a C/A/ #f > cmH20? 3l#+ rate @ 0(<2 A 0(>=)b# & +e!'"t !n ,!l#'rams. S# f#r a 2 ,!l#'ram pat!ent, a nasal cannula fl#+ rate #f 2(> lpm +!ll el!$er > cmH 20 pressure( H#+e$er t"e aut"#rs c#nclu e , BAs +e ! n#t perf#rm an& measurements #f pulm#nar& mec"an!cs !n 'eneral an +#r, #f breat"!n' !n part!cular, +e cann#t &et rec#mmen t"e use #f H3NC as a met"# #f resp!rat#r& supp#rt f#r lun' !sease !n t"e ne#nate(C 3urt"erm#re, D#pelman )200;. f#un t"at t"e !nc! ence #f nasal !nEur& +!t" nasal cannula +as s!m!lar t# t"at seen +!t" nC/A/ pr#n's( Sasl#+ et al( )200>. f#un t"at "!'" fl#+ nasal cannula el!$ere C/A/, "#+e$er t"e aut"#rs c#nclu e t"at +!t"#ut lar'e scale ran #m!:e tr!als e%am!n!n' safet& an eff!cac& t"at "!'" fl#+ nasal cannulas s"#ul be use +!t" caut!#n( 8ecentl&, S"#ema,er et al( )2007. publ!s"e t"e!r e%per!ence +!t" "!'" fl#+ nasal cannula, but c#nclu e t"at B#+!n' t# unres#l$e !nfect!#n c#ncerns an t"e pauc!t& #f publ!s"e #utc#mes t# ate, t"e safet& an ut!l!t& #f "!'" fl#+ nasal cannulas as c#mpare t# m#re tra !t!#nal resp!rat#r& supp#rt m# es rema!ns unpr#$en an nee s t# be furt"er !n$est!'ate (C T"us, !n l!'"t #f t"e c#ncerns #f unre'ulate C/A/ el!$er&, nasal !nEur& an lac, #f stu !es em#nstrat!n' eff!cac& an safet&, +e # n#t rec#mmen t"e use #f "!'" fl#+ nasal cannula at t"!s t!me( T"!s rec#mmen at!#n +!ll be re$!s!te as ne+ ata emer'es( -!$en t"e publ!s"e ata nasal cannula fl#+ rates s"#ul be less t"an #r e1ual t# 0(5 lpm, an fl#+ rates #f

Draft September 5, 2007 2 lpm #r 'reater s"#ul n#t be use ( If a pat!ent re1u!res "!'" fl#+ nasal cannula t"en t"at pat!ent s"#ul be treate +!t" nC/A/( T"e #ne e%cept!#n ma& be t"e pe !atr!c pat!ents F6 ,!l#'rams b# & +e!'"t t"at +e #ccas!#nall& care f#r, !n t"ese pat!ents fl#+ rates as "!'" as 2 lpm ma& be necessar&( H#+e$er, ,eep !n m!n t"at t"!s !s "alf #f t"e fl#+ rate necessar& t# '!$e a C/A/ #f > cmH20 acc#r !n' t# t"e e1uat!#n ab#$e )Sreenan, 200;.( Nasal Cannula Use !n t"e NICU at t"!s t!me? 0(2 t# 0(5 lpm #%&'en fl#+ rate t# start +ean #%&'en fl#+ rate as t#lerate t# ma!nta!n Sp02 acc#r !n' t# NICU 'u! el!nes !f fl#+s F0(5 lpm are necessar& c#ns! er nC/A/ !f fl#+s 2(0 lpm are necessar& place t"e pat!ent #n nC/A/ # n#t r#ut!nel& use blen e #%&'en

8E3E8ENCES 3!ner NN( Nasal cannula use !n t"e preterm !nfant? #%&'en #r pressureG /e !atr!cs( 2005 N#$H22>)5.?222>97( 3re& I, S"ann 3( 0%&'en a m!n!strat!#n !n !nfants( Arc" D!s C"!l 3etal Ne#natal E ( 200; JarH==)2.?3=69=( D#pelman AE, H#lbert D( Use #f #%&'en cannulas !n e%tremel& l#+ b!rt"+e!'"t !nfants !s ass#c!ate +!t" muc#sal trauma an blee !n', an p#ss!bl& +!t" c#a'ulase9ne'at!$e stap"&l#c#ccal seps!s( K /er!nat#l( 200; JarH2;)2.?<697( L#c,e 8-, 4#lfs#n J8, S"affer TH, 8ubenste!n SD, -reenspan KS( Ina $ertent A m!n!strat!#n #f /#s!t!$e En 9D!sten !n' /ressure Dur!n' Nasal Cannula 3l#+( /e !atr!cs 2<<; <2?2;592;=( Sasl#+ K-, A'"a! LH, Na,"la TA, Hart KK, La+r&s" 8, Sta"l -E, /&#n DH( 4#r, #f breat"!n' us!n' "!'"9fl#+ nasal cannula !n preterm !nfants( K /er!nat#l( 200> Au'H2>)=.?67>9=0( S"#ema,er JT, /!erce J8, M# er IA, D!-er#n!m# 8K( H!'" fl#+ nasal cannula $ersus nasal C/A/ f#r ne#natal resp!rat#r& !sease? a retr#spect!$e stu &( K /er!nat#l( 2007 3ebH27)2.?=59<2( Sreenan C, Lem,e 8/, Hu s#n9Jas#n A, 0s!#$!c" H( H!'"9fl#+ nasal cannulae !n t"e mana'ement #f apnea #f prematur!t&? a c#mpar!s#n +!t" c#n$ent!#nal nasal c#nt!nu#us p#s!t!$e a!r+a& pressure( /e !atr!cs( 2002 Ja&H207)5.?20=29;(

T"ese 'u! el!nes +ere rafte b& L#r! Ale%an er, 88T, 8C/H Iran #n Due"ne, 88T, 8C/, JIAH E +ar S"ep"er , JD an Le!f Nel!n, JD