Pediatric High Flow Nasal Cannula VAPOTHERM POCKET GUIDE

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1 Pediatric High Flow Nasal Cannula VAPOTHERM POCKET GUIDE

2 Patient Selection Diagnoses Signs and Symptoms: Patient presents with one or more of the following: Mild to moderate respiratory distress Hypoxemia Hypercapnia Tachypnea Accessory muscle use Grunting Nasal flaring Mild apnea and bradycardia (neonate) These conditions may benefit from Vapotherm: Acute Respiratory Distress Syndrome (ARDS) Viral bronchiolitis Pneumonia Severe Acute Asthma Congenital Heart Defects (CHD) Persistent Pulmonary Hypertension Bronchopulmonary Displasia (BPD) Separation from mechanical ventilation Separation from non-invasive ventilation 1 Vapotherm PICU Pocket Guide

3 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). The 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 FLOW SELECTION: Age Weight Cannula(s) Typical Starting Flow 0 30 days <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 L/min years >40kg L/min Disclaimer: Suggested flow rates and FiO 2 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 The 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 2

4 Therapy Implementation and Maintenance PATIENT ASSESMENT: SpO 2 <92% and/or increased work of breathing (WOB)* 0 30 days 1 mo 1 year Start flow at 5 L/min and increase by 1 L/min, Start flow at 6 L/min and increase by 1 L/min, Set temperature to C Start FiO 2 at 0.40 and titrate, as needed to achieve target SpO 2 SpO 2 >92% same as above except start FiO 2 at years Start flow at 8 L/min and increase by 1L/min, 6 12 years Start flow at 10 L/min and increase by 1-2 L/min, Set temperature to 37 C and decrease per patient preference Start at 0.60 and titrate, as needed to achieve target SpO 2 SpO 2 >92% same as above except start FiO 2 at years Start flow at 12 L/min and increase by 2 L/min, * Management of patients with cyanotic congenital heart disease should target disease-specific SpO 2 targets. Suggested starting FiO 2 guidelines do not apply to patients with single ventricle physiology undergoing palliation, or patients adversely affected by oxygen-mediated decreases in pulmonary vascular resistance. 3 Vapotherm PICU Pocket Guide

5 Monitoring Therapy Patient Parameters: Documentation: Indices of work of breathing (WOB) SpO 2 PCO 2 FiO 2 Nasopharynx patency Feeding tolerance Patient Heart rate Respiratory rate Work of breathing (WOB) SpO 2 Device Flow rate FiO 2 Temperature Water level Cannula size Vapotherm PICU Pocket Guide 4

6 Vapotherm Weaning PATIENT ASSESMENT: SpO 2 >93% or within desired range and unlabored respirations 0 30 days 1 mo 1 year weaned by 1-2 weaned by 1-2 Wean FiO 2 by decreasing 2-5% every minutes 1 6 years weaned by 1-2 Set temperature to C or to patient preference 6 12 years weaned by 1-2 Wean FiO 2 by decreasing 5-10% every hour years weaned by Vapotherm PICU Pocket Guide

7 Accessories USE WITH AEROGEN An 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). The 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 Vapotherm 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 Vapotherm 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. The lower gas density reduces the work of breathing by reducing the force needed to move gas through the airways. Heliox 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. Precision Flow Heliox strategies follow the same general clinical guidelines for air-oxygen mixtures, except FiO 2 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. Vapotherm Heliox Disposable Patient Circuits (DPC) PFH-DPC-LOW 1-8 L/min PFH-DPC-HIGH 5-40 L/min Vapotherm PICU Pocket Guide 6

8 Vapotherm, Inc. 22 Industrial Drive Exeter, NH MKT-0018 Rev. A

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