Guidelines and Best Practices for
Mask-Free NIV™ for Spontaneously
Breathing Patients
Pediatric Pocket Guide
Hi-VNI® Technology
Patient Selection Diagnoses
Patient presents with one or These symptoms are indicative
more of the following: of, but not solely attributed to:
• Respiratory distress • A
cute Respiratory
• Hypoxemia Distress Syndrome (ARDS)
• Hypercapnia • Viral bronchiolitis
• Tachypnea • Pneumonia
• Accessory muscle use • Acute Asthma
• Grunting • C
ongenital Heart Defects
(CHD)
• Nasal flaring
• P
ersistent Pulmonary
Hypertension
• B
ronchopulmonary Dysplasia
(BPD)
• Ventilator Weaning
1 Vapotherm Pediatric Pocket Guide
Hi-VNI Cannula Selection
Fitting the Hi-VNI Cannula:
• Make sure NOT to occlude greater than 50% of the nares.
• Hi-VNI cannula prongs should be wide enough not to pinch the nasal septum (erosion risk).
• T he SOLO is a single prong Hi-VNI cannula that can be used in neonates and infants. The single
prong design is as effective as a dual prong Hi-VNI cannula. The single prong simplifies NG
tube placement.
• The recommended flow rates for infants and toddlers under 20 kg is 2 L/min per kilogram of
weight.1
Note: If the patient’s weight is significantly above the 95th percentile for age, use CDC
50th percentile weight for age to start initial L/min rate, and titrate to clinical effect.
• Hi-VNI Technology is a de-escalation therapy. It is safe to start with highest flows based on
weight, and titrate down to clinical response (decreased WOB).
Hi-VNI Cannula Sizes 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
Hi-VNI Cannula Application:
• Only Vapotherm Hi-VNI cannulae should be used with the Vapotherm Precision Flow®
• Select the appropriate Hi-VNI cannula based on the above sizing chart
• Place the Hi-VNI cannula on the patient before attaching the delivery tube
• A
llow the system to reach the set point (temperature display will stop flashing) before connecting
delivery tube to the Hi-VNI cannula
• T he Precision Flow’s operational L/min range is locked depending on the disposable patient
circuit (DPC) selected:
– PF-DPC-HIGH (Blue packaging): 5-40 L/min
– PF-DPC-LOW (Red packaging): 1-8 L/min
1. Weiler et al, “The Relationship Between High Flow Nasal Cannula Rate and Effort of Breathing in Children”, The
Journal of Pediatrics. October 2017. Volume 189:66-71.
Vapotherm Pediatric Pocket Guide 2
Therapy Implementation and Maintenance
The recommended Set temperature to Start and titrate FiO2
starting L/min rate is 2 37°C and adjust to as needed to achieve
L/min per kilogram of patient preference. target SpO2.
weight.1 Titrate to
clinical effect.
Note: If the patient’s
weight is significantly
above the 95th
percentile for age, use
CDC 50th percentile
weight for age to start
initial flow rate.
1. Weiler et al, “The Relationship Between High Flow Nasal Cannula Rate and Effort of Breathing in Children”, The
Journal of Pediatrics. October 2017. Volume 189:66-71.
3 Vapotherm Pediatric Pocket Guide
Monitoring Therapy
Monitoring Therapy
Patient Parameters: Documentation:
• I ndices of work of breathing Patient
(WOB) • Heart rate
• SpO2 • Respiratory rate
• PCO2 • Work of breathing (WOB)
• FiO2 • SpO2
• Nasopharynx patency
Device
• Feeding tolerance
• Flow rate
• FiO2
• Temperature
• Water level
• Hi-VNI cannula prongs must
occlude no more than 50% of
the nares
Vapotherm Pediatric Pocket Guide 4
Weaning
Weaning
Weaning FiO2
L/min
Wean in Return FiO2 to
1 L/min range
WEAN BY L/MIN OR FiO2
increments acceptable for
as patient SpO2
tolerates requirement
Vapotherm Hi-VNI
Technology parameters
(L/min & FiO2) are
Consider Patient
independent of each
further wean assessment of
other. Adjustment of
titrated HR, RR, SpO2
L/min will impact work of
on clinical
breathing while
assessment
adjustment of FiO2
of work of
maintains patient SpO2.
breathing Continue
Monitoring patients’
FiO2 wean
response to each change
to maintain
requires continuous
If at less than SpO2 targets
assessment of breath
10 L/min you see sounds, respiratory rate,
rainout, consider physical characteristics
dropping (e.g nasal flaring,
temperature to grunting and retractions).
no lower than
34°C
Assess for
further wean
and/or
discontinuation
Conventional
cannula or
room air
5 Vapotherm Pediatric Pocket Guide
Aerosol Medication and Specialty Gases
Use with Aerosol Medication
Treating patients with respiratory disorders frequently requires combined use
of Hi-VNI Technology with aerosolized medication. For practice considerations
to do so, refer to the “Aerosol Delivery with HVNI Pocket Guide” and the
“Aerosol Medication Delivery with HVNI Therapy Practice Summary.”
Use with Nitric Oxide
• Vapotherm
Hi-VNI Technology is verified for use with
multiple nitric oxide delivery systems. To confirm your
system is compatible with Vapotherm, contact your local
representative.
• Vapotherm Nitric Oxide Disposable Patient Circuits (DPCs):
PF-NODPC-LOW 1-8 L/min
PF-NODPC-HIGH 5-40 L/min
• N
ote: Refer to the Instructions for Use provided with your
nitric oxide system and with the Nitric Oxide circuit.
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.
• T he lower gas density reduces the work of breathing by reducing the force
needed to move gas through the airways.
• H
eliox 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.
• P
recision Flow Heliox strategies follow the same general
clinical guidelines for air-oxygen mixtures, except FiO2
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.
• S
tandard Vapotherm Disposable Patient Circuits (DPCs)
may be used with the Precision Flow Heliox.
PF-DPC-LOW 1-8 L/min
PF-DPC-HIGH 5-40 L/min
Vapotherm Pediatric Pocket Guide 6
Vapotherm, Inc. • 100 Domain Drive • Exeter, NH 03833 • 603.658.0011 • www.vapotherm.com
MKT-0018 Rev E 11/18
