HFNC (heated humidified high-flow nasal cannula) has several advantages over low flow nasal cannula and nasal CPAP for neonatal respiratory support. HFNC provides better humidification, delivers a fixed level of oxygen, uses higher gas flow that generates positive pressure, and can be used immediately post-extubation or as initial support with similar efficacy and safety as other non-invasive options. Evidence supports its use as post-extubation support in preterm infants, where it has less nasal trauma and reduced risk of pneumothorax compared to nasal CPAP. Delivery room CPAP can also reduce the need for intubation, ventilation and surfactant in preterm infants with RDS when initiated within 6 hours.

1. Pediatric and neonatal mechanical ventilation 2
NIV
Tageldin Aly

3. Objectives
Low flow nasal cannula
HFNC ( HHH- NC )
Bubble NCPAP
BIPAP

5. Low flow nasal cannula
VS.
HFNC ( HHH- NC )
1.Humidification system
HFNC was more humid than NC and CPAP
O2 ToxicityFIO2 controllable ))2.Fixed oxygen concentration system
Fio2 24%- 65 %))To avoid O2 Toxicity
3.High-flow system
at least 2 L/min and usually 2–8 L/min. A high-flow system can
generate nasopharyngeal pressure that reduces airway
resistance and work of breath
4. PEEP system
If you give 6 l/m flow it will deliver 4 cmH2o PEEP

6. CONCLUSIONS: Among infants ≥28 weeks’ gestational age,
HHHFNC appears to have similar efficacy and safety to nCPAP
when applied immediately postextubation or early as initial
noninvasive support for respiratory dysfunction.

7. Conclusions:
. HFNC use has similar rates of efficacy to other forms of non-
invasive respiratory support in preterm infants for preventing
ttt. failure, death and CLD.
.Most evidence is available for the use of HFNC as post-
extubation support.
.Safety HFNC is less nasal trauma, and reduced pneumothorax
compared with nasal CPAP

8. NCPAP

10. Delivery room CPAP
.Reduces the need for intubation, M .ventilation and
surfactant in preterm neonates with RDS.
.Inclusion criteria (28-32 wks ,mild to moderate RDS
,within 6 hours )exclude( asphyxia, anomalies ,CHD )
•. RF required intubation( fio2 60%, pco2
60,pao2 60)

11. HHHNC IN DELIVERY ROOM

12. HHHNC VS NCPAP

13. HHHNC & AOP

14. Vapotherm Cannula

17. BIPAP

18. BIPAP
Provide two levels of positive airway pressure
during the respiratory cycle
• Higher level (IPAP): “10 -20” cm H2O
• Lower level(EPAP): “ “5 to 7” cm H2O
• Leak compensation
• Hypercapnic respiratory failure
• Comes in 3 types:
1. PS: pt. trigger
2. PC: set RR
18/5/3. BiPAP: IPAP (PSV )+EPAP ( PEEP ).

19. BIPAP
.SYN. better than ASYN. Decrease WOB .
.Back up rate (apnea )
.Decrease need for MV. & intubation
.Tight mask nasal injury, aspiration
. NIV present in dragger ventilator

20. THANK YOU