Low flow oxygen delivery via nasal cannula to neonates

Finer, Neil N.; Bates, Rosanne; Tomat, Paula

doi:10.1002/(sici)1099-0496(199601)21:1<48::aid-ppul8>3.0.co;2-m

Cited by 54 publications

(39 citation statements)

References 5 publications

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“…3,4 In addition, using the lowest flow possible minimizes irritation from drying of the nasal passage. 5 The literature also guided the development of a chart to calculate the O 2 level delivered to the hypopharynx (FHO 2 ) from patient weight, NC flow, and FIO 2 . 3,4,6,8 Using a number of assumptions, the mathematical calculation can be simplified to (0.21 ϩ [flow/ weight] ϫ [FNCO 2 Ϫ 0.21]), where FNCO 2 is the FIO 2 set to be delivered via the NC (Appendix 1).…”

Section: Resultsmentioning

confidence: 99%

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Standardizing Nasal Cannula Oxygen Administration in the Neonatal Intensive Care Unit

et al. 2006

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OBJECTIVE.A multicycle, quality improvement method was used to standardize nasal cannula O 2 administration and weaning in the NICU. METHODS.A 2-armed nasal cannula standardized order form (nasal cannula for stable O 2 arm and nasal cannula for stable flow arm) was developed after review of the literature, surveying of the practice of NICU physicians and nurse practitioners, and development of consensus among these providers. Outcomes were measured by tracking the distribution of protocol arm chosen, days on O 2 , weeks on nasal cannula, and disposition of infants who were supported by nasal cannula. Data were collected in an SPSS statistical data set.RESULTS. Of the 90 infants evaluated, 12 were supported on the stable O 2 arm and 53 on the stable flow arm for their entire nasal cannula course. Twenty-five infants switched between arms of support. Patients who were on the stable flow arm of the standard order set for their entire nasal cannula course experienced fewer O 2 days but more days on nasal cannula. A subpopulation of infants were supported on nasal cannula flow 0.5 to 1.0 L, with fraction of inspired O 2 of 21%. When data from the first 10 weeks of observation were compared with that of the second 10 weeks, the rate of discharge on O 2 had decreased from 13 (30%) of 44 to 3 (7%) of 39.CONCLUSIONS. The multiple steps of literature review, practice surveys, and consensus-building resulted in enthusiastic reception of the nasal cannula standardized order form. The 2-armed nasal cannula protocol forced caregivers to consider which method of support was most beneficial for each infant who was on nasal cannula and allowed a subpopulation of NICU patients to be supported with a lower fraction of inspired O 2 than previously used in the NICU. saturation levels. Initially, the hospital-based committee developed a unit-based O 2 saturation protocol to avoid hyperoxia. 1 However, the focus on O 2 saturation targeting revealed difficulty in maintaining infants who were on nasal cannula (NC) within their goal saturation ranges. This objective finding, along with the long-standing frustration of nurses and doctors concerning varied "methods of weaning" NC O 2 , directed the committee's attention toward development of NC weaning guidelines and standard orders.The literature provided evidence for the clinical practice of NC use 2-10 ; however, obstacles still remained when introducing this practice into the clinical service. The process of developing and introducing standard NC orders was approached using a quality improvement (QI) model. 11 When any new practice is implemented, close monitoring is required to ensure that the proposed changes take place. Involvement of many disciplines and distribution of information throughout the process allow for modifications and ultimately facilitate acceptance of the new process. The purpose of rigorous QI monitoring is to document the evolution of practice and outcomes in relation to proposed changes. METHODSThis QI project was reviewed by the Children's Mercy Pediatr...

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Section: Resultsmentioning

confidence: 99%

“…The literature provided evidence for the clinical practice of NC use [2][3][4][5][6][7][8][9][10] ; however, obstacles still remained when introducing this practice into the clinical service. The process of developing and introducing standard NC orders was approached using a quality improvement (QI) model.…”

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confidence: 99%

Standardizing Nasal Cannula Oxygen Administration in the Neonatal Intensive Care Unit

et al. 2006

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“…30,31 In clinical studies, hypopharyngeal oxygen concentrations have been shown to be reliable measures of the actual inspired oxygen concentrations. [32][33][34][35][36][37][38] If hypopharyngeal oxygen concentrations need to be decreased from those achieved with the 100% oxygen source, an entrainment device would be useful in those situations.…”

Section: Figurementioning

confidence: 99%

Accuracy of a Novel System for Oxygen Delivery to Small Children

2011

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT:Oxygen is an effective treatment, but its availability is limited in some settings, particularly in developing countries. Entrainment devices offer promise for simplifying oxygen delivery, decreasing the cost of oxygen therapy, and increasing its availability. WHAT THIS STUDY ADDS:Entrainment devices can be used to deliver specific oxygen concentrations to infants and small children. With appropriate delivery systems, these devices can deliver blended gas with accuracy and precision at the low flows required by infants and small children. abstract OBJECTIVE: Oxygen therapy for infants and small children in developing countries is often not available. Entrainment devices may provide an accurate and precise concentration of oxygen when used at the flow rates appropriate for infants and small children. METHODS:A continuously adjustable entrainment device was tested to determine the concentrations and flows of oxygen delivered by using low inlet flow rates suitable for therapy for infants and small children and 3 distinct oxygen delivery systems that varied in their resistive load. RESULTS:The use of long and large bore, low resistance tubing (similar to a mask) resulted in the delivery of oxygen concentrations that tracked closely (accurate and precise) to values indicated by the entrainment device. The directly connected system with lower resistance (similar to a hood) produced a similar profile of concentrations and flow rates to the large bore tubing but with even greater accuracy. The use of a long and narrow tubing with higher resistance (similar to a cannula) did not deliver accurate oxygen concentrations. In fact, this high-resistance system failed to work as intended, and instead of entraining air, a large proportion (sometimes Ͼ50%) of the oxygen delivered to the entrainment device was ejected through its vents. CONCLUSIONS:Entrainment devices can deliver accurate oxygen concentrations at low flow rates if used with low resistance delivery systems; however, entrainment devices are not suitable for use with high resistance delivery systems such as a standard nasal cannula.

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“…Standard or low-flow NC therapy has been limited by inadequate humidification and the drying effect on upper airway mucosa, and for infants has a variably defined upperlimit of 0.5-2 l/min (l.p.m.). 7,8 Nasal mucosal injury and bleeding have also been associated with unheated NC flow (1 l.p.m. ), although overly aggressive suctioning of the nares may contribute as well.…”

Section: 2mentioning

confidence: 99%

Preterm VLBW infants: post-extubation respiratory support

Gilmore

2006

J Perinatol

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Low flow oxygen delivery via nasal cannula to neonates

Cited by 54 publications

References 5 publications

Standardizing Nasal Cannula Oxygen Administration in the Neonatal Intensive Care Unit

Standardizing Nasal Cannula Oxygen Administration in the Neonatal Intensive Care Unit

Accuracy of a Novel System for Oxygen Delivery to Small Children

Preterm VLBW infants: post-extubation respiratory support

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