High Flow Nasal Cannulas in NEWBORNS/// When to use them!!
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- Опубликовано: 5 сен 2024
- In the NICU: CPAP has long been the gold-standard of NON-INVASIVE ventilation- but now we're all realizing HIGH FLOW NASAL CANNULAs are pretty great too! Watch this review and learn: What is a HFNC? How does it differ from a regular NC? Why are HFNCs great? Why are they better or worse than CPAP? What flow do we start it on? How do they work? What situations has HFNC proven to be helpful???
This is NOT sponsored- but A MASSIVE thanks to Kelsey Shaylor and all the WONDERFUL people at Fisher and Paykel for allowing us to use their educational slides, and providing us with every article ever written about non-invasive ventilation. Your efforts towards education are so impressive!
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Dr. Tala is a board-certified neonatologist and has worked in busy level III and IV units for the past 15 years. She has won multiple teaching awards throughout her time as a neonatologist.
References:
www.otago.ac.n...
Yoder BA, Manley B, Collins C, Ives K, Kugelman A, Lavizzari A, McQueen M. Consensus approach to nasal high-flow therapy in neonates. J Perinatol. 2017 Jul;37(7):809-813. doi: 10.1038/jp.2017.24. Epub 2017 Mar 23. PMID: 28333157.
The evidence for high flow nasal cannula devices in infants
Iram Haq et al. Pediatric Respiratory Reviews 15 (2014) 124-134
Nasal High-Flow Therapy during Neonatal Endotracheal Intubation
Kate A. Hodgson, M.B., B.S., Louise S. Owen, M.D., C. Omar F. Kamlin, D.Med.Sci., Calum T. Roberts, Ph.D., Sophie E. Newman, M.B., B.S., Kate L. Francis, M.Biostat., Susan M. Donath, M.A., Peter G. Davis, M.D., and Brett J. Manley, Ph.D.
April 28, 2022 N Engl J Med 2022; 386:1627-1637
DOI: 10.1056/NEJMoa2116735
Hodgson KA, Wilkinson D, De Paoli AG, Manley BJ. Nasal high flow therapy for primary respiratory support in preterm infants. Cochrane Database of Systematic Reviews 2023, Issue 5. Art. No.: CD006405. DOI: 10.1002/14651858.CD006405.pub4. Accessed 19 June 2023.
Lavizzari A, Colnaghi M, Ciuffini F, Veneroni C, Musumeci S, Cortinovis I, Mosca F. Heated, humidified high-flow nasal cannula vs nasal continuous positive airway pressure for respiratory distress syndrome of prematurity: a randomized clinical noninferiority trial. JAMA Pediatr. 2016;99:F315-20.
International Journal of Clinical Pediatrics, ISSN 1927-1255 print, 1927-1263 online, Open Access
Article copyright, the authors; Journal compilation copyright, Int J Clin Pediatr and Elmer Press Inc
Journal website www.theijcp.org
biologylearner...
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**TIMESTAMPS**
02:19 What is a HFNC?
07:19 Why use a HFNC vs CPAP?
10:44 How does HFNC work?
19:41 In what situations do we use HFNC?
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*Disclaimer*: This video is intended for educational purposes only and while
we strive to give the most accurate information, errors may occur. Subsequently,
this video should not be a replacement for medical advice.
This is AMAZING ❤
Thank you so much!!!
Dr, I heard about your channel from the NICU team at the preemie party this year and this is amazing! I don’t know if you remember Bryston… he is about to be 5! He is still vent and trach and complex BUT such a hand full! Thank you for all your doing and thank you for everything you did with B!
Leslie!!!! HELLO!!! I’m so glad you found me! I cannot believe Bryston is 5!!!!! Is that possible??? What an amazing mama you are - I am in awe of the time and effort and love and fighting you must have done to get him here. I’d love some photos if you could send them to
Talatalksnicu@gmail.com
Yay!! Thank you for writing!!
I am new to the neonatal ward coming from adult nursing in England UK. I love your content which is really helping me become more knowledgeable. Thank you!
Hello Alison! I’m so happy for you you’ve seen the beautiful light of the NICU! Ha! Congratulations on your new role! We’re SOOOOO happy that these videos are helping! Thanks for taking the time to write to us :))
I am a pediatrician from Pakistan. Always learn something valuable from ur videos. Pure Brilliance.
Hello doctor! Thanks so much for your lovely words and for taking the time to write in!!! Is there anything in particular you would like to see?
I'm so glad that I've found this channel as a new neonatology resident, you made a lot of things so easy to understand so thank you and keep up with the great work ❤
We’re so glad the channel is helpful! Congratulations on your new role- hope you enjoy your residency doctor!
As a NICU RRT, you did a phenomenal job, Doc. Thank you for your explanation. Especially, the intrinsic vs extrensic flow rate.
Oh yay! Thank you so much! What a lovely compliment by someone who deals with the device all day long!
As a nursing student, thank you so much for your videos! You explain things so well.
So glad that you’re finding them helpful Sarah! Also impressed that you’re looking for other ways to add to your education! That’s fantastic!!! Good luck in your studies
I just wanted to say thank you for all of your informative videos. I'm a mom of triplets born at 25+6 last July. My 2 girls spent 3 months in the NICU and my boy was there 4 months. I found your channel sometime during that time while they were in the hospital to try to learn about their medical conditions and now, almost a year later, I still watch to further understand their diagnoses/conditions and what all they went through. I learned so much during my 3-4 month "internship" at the hospital, but your lectures really make things clear. BTW, my babies are doing really well now considering how early they were born and being multiples. I owe it in part to the excellent care they received while in the NICU. Thank you for doing what you do!
MW- wow! Congratulations on getting your babies home after such long NICU stays (combined 10 months!!). That they are doing so well now is much more of a testament to you than anything else. I agree- it really is an “internship” for intelligent parents- it’s crazy the understanding everyone has by the end! If you have any interest in discussing your stay or giving advice to other parents/ we’d love to have you on a video?!!
Hi , my name is Stuart and i am from San Diego, but reside north of Dallas in TX. I enjoy watching your videos, because you explain the topics in an easy to understand way! Where you from Dr. Tala?
Thank you dr Tala , for what you are doing 🎉
Your efforts emprower our knowledge at distance of 13000 km from US.
Best wishes ❤
I love that!!! Great time to live in where we information can just be shared like this!!! Thanks so much for commenting!!
Wonderful as always , i really appreciate your effort in making neonatology smooth
Thank you so much Imad- what a lovely comment!! Thanks for being here!
I appreciate the references to recent studies & research! Thank your for a much needed topic! What is your experience with Ramcannulas and CPAP and NIMV?
Hello! Thank you for your kind words! Lots experience with all! And those lectures are coming :)
Ok, great! Looking forward to that! Thank you!
I love all your videos! I’d love to watch one on NIPPV
Hello! Thank you so much! Would love to do one on NIPPV (we haven’t gotten around to Cpap yet though!) will be coming though!!!
Great video! This was really helpful. RN and NRP instructor from Wyoming USA
Oh so happy you liked it! Also Wyoming was a big hole on our map so thank you so much for letting us know where you’re from! Ha!
😂😂
The wall
The bike example was good
Hahahaha!!! Not a great example but I tried!!!
Thank you Dr Tala and the team! Extremely helpful channel for my residency journey!
SO happy this is helpful for you!!! Thanks so much for watching, commenting and subscribing!
Thank U, Dr. Tala
Thank you for watching!
Another GREAT Tala Talk, thank you Dr. Tala!
Thank you so much Sarah! Really appreciate your support and positive comments!
So competent and energetic. Keep creating stuff like this. Kudos 😊
Thank you so much for your lovely comment. Had a week where I didn’t feel very energetic so this was timely!!!!
Excellent! I am a resident in NICU. Could you please record a lecture about adrenal insufficiency in premies.
Thanks so much Dr. Narmin! Yes we really need to get that out!!! Thanks so much for watching and for your suggestion :)
Hi really appreciate your excellent talks.
Can you talk about transposition of great arteries.
Diagnosis, X-ray reading and management etc.
Thank you
Yes! This is a great suggestion and we really need to get back to our heart series!!! Thank you for being here :)
Great effort doc !!!
Thanks so much :)
Very use! Thank you so much!
Thank you so much for letting us know! We'll be putting out CPAP relatively soon :)
As every time, a fruitful presentation ❤ thank you
Would you like to make hypotension and it’s actual management
Hello! Thank you for your amazing comment. We definitely need to make a video on hypotension- a way that will actually make sense- since we all do stuff so differently! Thank you!!
Hello dr tala,thank you for your informative videos,can you please make a video about approach to feeding increments
Thank you so much for your lovely comment! We can definitely cover this! Actually this is a great idea for a nugget- we’ve been looking for more of those videos! Thank you for being here :)
Great information, thank you. ❤️
So glad you liked it- thanks so much for being here :)
Thanks alot Dr Tala 🌹🌹
You’re so welcome! So glad you’re here :)
thanks.. 🎉
Thank you for all your support!!!
Another great video.
You’re the best! Always so motivating! Bet you’re like this at work too :)
@TalaTalksNICU I am mostly, our work is hard we have to hold each other up!! I am sure to sprinkle in a bit a sarcasm just to keep it spicy.
I mean - what is a work day without some sarcasm!? Ha!!!!
@@TalaTalksNICU I honestly wouldn't know it is my preferred language. Lol
Thanks a lot!
Thank you Felipe!!! Love your comments!
"From the wall" NC doesn't use humidified air? But the thingamajig (I'm sorry i don't really know what it's called) has water in it, and above is the gauge where we set the liters with the ball thing floating. So i always assumed the water was humidifying it. 4:02
Ah yes, the flowmeter*
Ha! Yes!!!! You’re right! Some “from the wall” NC can have humidification- often they don’t though!!
Dr. What if patients in high flow 60l/95% fio2 with spo2 in monitor 98 percent but tachypnea do I need to change to cpap? My patients is 83 years old
This is all for neonatal education!!!! I haven’t taken care of adults for nearly 25 years! Good luck!
Hello Tala.....Nice job
Thanks so much for watching and for taking the time to comment :)
Can you nipple feed an infant on HFNC? Just concerned with air blowing high on your nose while struggling to nipple, is it safe to nipple feed them while on it?
Great question. Different units have different protocols- generally where I’ve worked we use 2L as the cut off (ie can feed on 2L or less). Obviously it all depends on work of breathing etc. If they’re breathing 90 times a minute and needing 40% fio2 on 2L we still wouldn’t feed!
How many spells and dsats is allowed for baby to switch from cpap to high flow ? Are any spells right after switching cosidered 'normal'? How low dsats after switching are 'acceptable' ?
Urgh- these are all great questions! And we don’t really know the answers to any of them!!!!! Sometimes babies take a short period getting used to HFNC (ie they may need higher Oxygen for a bit- or continuously!) So the answer is really what are you willing to have as an fio2 on HFNC to avoid desats. If you were on cpap 5 21% and now you’re on 4 LPM HFNC at 60% and your sats are in the high 80s then for me this would be an unacceptable rise in fi02 need. So I don’t really have an answer!!! How desperate are you to get the baby off CPAP / how old is the baby/ etc etc.
Hi, Dr. TALA. Should we remove th cannula during bottle feed? Luke for example baby is on 2-4LPM. Pls explain further. Thank you.
If a baby needs a cannula it should stay on! Different units feed babies at different levels- generally 2LPM or less is pretty common. Hope that helps?
Hi Tala. A baby was born 23weeks and 3 days and now 42weeks. Care team placed her on HFNC 15L FI02 21-25%. Is that safe for babies lungs for that high O2 liters? Thanks
Hello- it's really interesting what's happening in the non-invasive vent world. A few years ago, I would have said- that's really high. Now- if the baby is comfortable and it's doing the job then I'd try it. There's still a lot more potential that I don't think we've tapped into with this support!
But if someone on HFNP therapy is needing 100% FiO2 surely that means they need more support?
Absolutely! Great point. If your baby is on like 4L and needing 100% for a long time and barely hanging on then they’re probably telling you they need something else!! Cpap/ NIPPV/ intubation!
But a baby may have had a bad event or a brief deterioration- the concentration can go up that much if needed.
Thanks for making this point!
Bu
How much time we can use HFNC
Great question! The answer is as long as the baby needs it! here, we don't normally send babies home on HFNC so eventually they need to be weaned off, but generally they're pretty comfortable on HFNC so we're not in a rush to push them off it.
What are your textbooks for your specialty
I think we should do a video on this!!!! Great question!