Usefull

Effective. Gentle. Easy.
Enhancing Nasal High Flow Therapy
185048239 REV A 2014 Fisher & Paykel Healthcare Limited
www.fphcare.com
Introduction
The therapy and
Optiflow Junior
APPENDIX
The therapy and

Optiflow Junior
(CO N C I S E )
Beyond the ICU

Other evidence
Clinical
Definition
What it is
Mechanisms
How it works
Physiological
outcomes
What it does
Clinical outcomes
What it means
Tools
Usage
Pressure
Economics
Optiflow Junior
The R&D journey
Optiflow Junior
Unique features
Videos
Introduction
The therapy and

Optiflow Junior
Overview
Nasal High Flow (NHF) therapy

is being widely adopted in
neonatal and pediatric practice.
Its superceding some
traditional therapies.
Its effective, gentle and easy.
The economic and health
benefits are emerging.
Optiflow Junior enhances
the therapy benefits.
Improved patient care and outcomes
Avoid intubation
NEONATAL
Readmission
ACUITY
Fisher & Paykel Healthcare

customer research
demonstrates that
clinicians want to:
Treat in a noninterventionist manner
LENGTH OF STAY
Shorten length-of-stay
(to free up beds)
Reduce the burden

of educating staff
PEDIATRIC
Readmission
ACUITY
Control costs
Avoid readmission
LENGTH OF STAY
FPH International Medical Director Research 2013.
A therapy arrives...
THE RESPIRATORY CARE CONTINUUM
INVASIVE
VENTILATION
nCPAP
NASAL
HIGH FLOW
OXYGEN
THERAPY
Commercially
available
circa 2001
Momentum has been building
Growing research
Number of NHF papers published from 2000-2013
(Neonatal and Pediatric)
40
Manley et al.
N Engl J Med
2013
35
number of papers
3 Randomised
Controlled Trials
(RCTs)
30
Yoder et al.
Pediatrics
2013
25
20
15
Collins e
t al.
J. Pediat
r.
2013
10
5
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
n = 867
Whats
behind the
momentum?
The literature indicates that
the momentum stems from
these therapy attributes:
Effective
Gentle
Easy
NHF therapy benefits
Effective
Gentle
Easy
Similar efficacy
to CPAP
Clinical studies have shown
that nasal high flow has similar
efficacy to nCPAP.1,2,3
* Study populations weighted towards infants >26 weeks gestational age,
post extubation
1 Refs here

1 Manley et al. New Engl J Med. 2013.

2 Yoder et al. Pediatrics. 2013.

3 Collins et al. J Pediatr. 2013.

Effective
Gentle
Easy
Associated with
reduced escalation
and length of stay
ACUITY
Research in the pediatric population

indicates that NHF may reduce intubation
rates and shorten length of stay.1,2
LENGTH OF STAY
1 Refs here

1 McKiernan et al. J Pediatr. 2010.

2 Schibler et al. Int Care Med. 2011.

Effective
Gentle
Easy
Less nasal trauma

Three randomized controlled trials
have shown reduced rates of
nasal trauma associated with NHF
compared to nCPAP.1,2,3
1 Refs here




Effective
Gentle
Easy
No significant difference
in adverse events
Clinical studies have concluded that there
appears to be no significant difference in
other serious adverse events such as
pneumothorax when compared to nCPAP.1,2,3
1 Refs here




Effective
Gentle
Easy
Improved bonding
Surveys of practice describe
improved mother infant bonding
with NHF.1,2,3
1 Refs here

1 Hochwald et al. J Neonatal-Perinatal Med. 2010.

2 Hough et al. J Paediatr Child Health. 2011.

3 Ojha et al. Acta Paediatr. 2012.

10
Effective
Gentle
Easy
Comfortable and
well tolerated
Research and surveys of practice
indicate improved comfort,1 tolerance
and patient satisfaction with NHF.2,3,4
1 Refs here

1 Spentzas et al. J Intensive Care Med. 2009.




11
Effective
Gentle
Easy
Simpler application
easier application and ongoing
care with NHF.1,2,3
1 Refs here




12
Effective
Gentle
Easy
Empowers parents
Parents have confidence to play a greater
role in their infants care. Parents reported
a preference for NHF in a randomised cross
over trial involving 20 infants.1 These findings
are mirrored in surveys of practice.2,3,4
1 Refs here

1 Klingenburg at al. Arch Dis Child Fetal Neonatal Ed. 2013.




13
Effective
Gentle
Easy
Loved by caregivers
improved caregiver satisfaction.1,2,3
1 Refs here




14
Summary
Effective
Gentle
Easy
15
ACUITY
Neonatal health economic benefits are emerging
$
LENGTH OF STAY
Avoiding intubation
Reduced risk of nasal trauma
Indication of reduced intubation rates

when used in combination with nCPAP.
Nasal trauma can sometimes result in costly

corrective surgery.
Manley et al (2013) indicated a 7.4 %

reduction (p = 0.12 NS*) in re-intubation
rates when nCPAP could be used as a
rescue therapy after NHF. This was
compared to nCPAP alone.
Clinical studies have shown a 7%2 to 15%1

reduction in nasal trauma compared to nCPAP.

4 Collins et al. Eur J Pediatr. 2013.
5
Yoder et al. Pediatrics. 2013.
Rnnestad et al. Pediatrics. 2005.
NHF reduces risk of nasal mucosa erosion4

which is a possible cause of nosocomial sepsis.5
Loftus et al. Laryngoscope. 1994.

* = Not Significant
16
ACUITY
Pediatric health economic benefits are emerging
LENGTH OF STAY
Avoiding intubation
Reduced length of stay
14 30% reduction in
intubation rate associated
with the introduction of NHF.1,2
2 day median reduction in

PICU length of stay associated
1 McKiernan et al. J Pediatr. 2010. 2

Schibler et al. Int Care Med. 2011.
17
Designed to enhance the inherent therapy benefits
Broader
range of
flows
In-built
safety
features
Effective
Enhancing
comfort
Gentle
Easy
Promoting
developmental
care
Simpler
for
caregivers
Further
empowers
parents
18
Where and why Optiflow Junior is being adopted
INVASIVE
VENTILATION
OXYGEN
THERAPY
nCPAP
Effective
Gentle
Easy
19
Improving patient care

and outcomes
Nasal High Flow therapy
20
Clinical
Definition
What is it?
Definition of Nasal High Flow
DEFINITION: Delivery of heated and humidified

blended oxygen at optimal flow rates directly
into the nares via a non-sealing nasal cannula.
Blended
gas
Optimal
flow
Heated
and
humidified
gas
Open
system
Context and definition
nCPAP
NHF/Optiflow Junior
Oxygen therapy
Sealed
Heated and humidified
Pressures prescribed
Flows typically
6-10 L/m
Non-sealed
Heated and humidified
Flow capabilities:
Neonatal up to 8 L/m,
Pediatric up to 25 L/m
Non-sealed
Cold, dry medical gas
Flows less than 2 L/m
Clinical
Mechanisms
How it works
Nasal High Flow with Optiflow
Respiratory
Support
Airway
Hydration
Comfort
Respiratory support
REDUCTION OF
DEAD SPACE
Clearance of expired air in
the upper airways1,2
Reduces rebreathing of gas with

high CO2 and depleted O21,2
Increases
alveolar ventilation1,2
1 Mundel T, et al. J Appl Physiol. 2013. 2

Frizzola et al. Pediatr Pulmonol. 2011.
Respiratory support
DYNAMIC POSITIVE
AIRWAY PRESSURE
Promotes slow and

deep breathing1,2,3
Increases
alveolar ventilation1
AIRWAY PRESSURE
Breath- and flow-dependent

airway pressure1,2,3
Respiratory
support with
Nasal High
Flow
Unassisted breathing
TIME
1 Mundel T, et al. J Appl Physiol. 2013. 2 Wilkinson et al. J Perinatol. 2008. 3 Arora et al. Pediatr Emerg Care. 2012.

Respiratory support
SUPPLEMENTAL
OXYGEN
Accurate delivery of blended,
humidified oxygen1
Enhances confidence in
oxygen administration
Ritchie JE, et al. Anaesth Intensive Care. 2011.
Airway hydration
OPTIMAL
HUMIDITY
Enables comfortable delivery
of high flows1
Prevents desiccation of
the airway epithelium2,3
Improves
mucus clearance2
1 Roca O, et al. Respir Care. 2010. 2
Hasani A, et al. Chron Respir Dis. 2008. 3
Chidekel at al. Pulm Med. 2012
Comfort
EASE OF USE
OPEN SYSTEM
No seal required
Patient
comfort1,2
1 Roca O, et al. Respiratory Care. 2010.
2 Spentzas et al. J Intensive Care Med. 2009.
10
Physiological outcomes
In neonates:
In pediatrics:
NHF is associated
with:1,2
NHF is associated with:3,4

Improved breathing pattern.
Clinically similar
work of breathing
compared to
nCPAP.1,2
Rapid unloading of respiratory muscles.

Significant reduction in respiratory effort.
Rapid improvement in respiratory distress.
These effects tend to be more pronounced

with higher flows.
1 Saslow et al. J Perinatol. 2006. 2 deJongh et al. J Perinatol. 2013.

3 Milsi et al. Int Care Med. 2013. 4 Rubin et al. Pediatr Crit Care. 2013.
11
Clinical outcomes
In neonates:1,2,3
In pediatrics:4,5
NHF is similar to nCPAP

in terms of efficacy*

with less nasal trauma
and no significant difference

in other serious adverse
events (e.g. pneumothroax).
NHF is associated with:

Reduced intubation rates.
Reduced PICU
length of stay.
*Study populations weighted towards infants >26 weeks gestational age, post extubation
1 Collins et al. J. Pediatr. 2013. 2 Manley et al. New Engl J Med. 2013. 3
4
McKiernan et al. J Pediatr. 2010. 5
12
Tools
Neonatal usage
What flows should I use
for neonatal patients?
Current trends in practice
CURRENT USAGE THEORIES
FLOW
BASED
DOSE BY
WEIGHT
TITRATE
TO EFFECT
(OBSERVATIONAL)
There is direction in the literature to guide

how flow should be set and titrated.
COMBINE
2 AND 3
There are a number of possible approaches

based on current trends in practice.
Deliver a set flow
to all infants
Set flow according

The
following
to infants weight
Set flow and

approaches
have
titrate to effect
some supporting evidence:
1 Refs here

FLOW
BASED
Deliver a set flow

to all infants
DOSE BY
WEIGHT
Set flow according

to infants weight
TITRATE
TO EFFECT
(OBSERVATIONAL)
COMBINE
2 AND 3
Set flow and

titrate to effect
FLOW
BASED
Deliver a set flow

to all infants
1 Collins et al.

J. Pediatr. 2013.
DOSE BY
WEIGHT
Set flow according

to infants weight
2 Milsi et al.

Int Care Med. 2013.
TITRATE
TO EFFECT
(OBSERVATIONAL)
COMBINE
2 AND 3
Set flow and

titrate to effect
3 Manley et al.

N Engl J Med. 2013.
4 Yoder et al.

Pediatrics. 2013.
Supporting evidence
1 Collins et al.

J. Pediatr. 2013.
FIXED
FLOW
2 Milsi et al.

Int Care Med. 2013.
WEIGHT
BASED
3 Manley et al.

N Engl J Med. 2013.
AT THE
CLINICIANS
DISCRETION
All infants in the NHF

arm of the study
received initial flows
of 8 L/min.*
Infants receiving
flows 2 L/kg/min
demonstrated
rapid unloading of
respiratory muscles.*
Infants in the NHF

arm received either
5 or 6 L/min then flows
were titrated at the
clinicians discretion.*
* Once weaning of therapy

commenced, flows
could be reduced to a
minimum of 4 L/min.
* As of February 2014
there are currently no
RCTs that have evaluated
a l/kg/min approach in
the neonatal population.
* Flows could be titrated to

a minimum of 2 L/min
and a maximum of 6, 7
or 8 L/min based on max
flow of the cannula used.
4 Yoder et al.

Pediatrics. 2013.
COMBINE
2 AND 3
The study recommended

that infants in the NHF
arm receive starting flows
based on weight:
1kg 1.9kg = 3 L/min
2kg - 2.9kg = 4 L/min
3kg = 5 L/min
Flows were then titrated
based on observation and
defined clinical criteria.
* Flows could be increased to
a max of 3 L/min above the
starting flow rate.
A consistent range of usage
Below is a visual summary of the flow ranges used in the 3 RCTs published in 2013.
The studies below use starting flows between 3 and 8 L/min.
NEONATAL
Flow
Guidance
source
Category
description
Collins et al
2013
Less than 32 weeks

gestational age
Manley et al
2013
Premature and
neonatal cannula
10
11
Infant, intermediate
infant cannula
Pediatric cannula
Yoder et al
2013
<2kg
2-3kg
>3kg
KEY:
= Minimum flow
= Starting flow
= Maximum flow
Conclusions
The literature provides a good source of guidance on how to set and titrate flow.
The study by Yoder et al, 2013 provides the most detailed guide to managing nasal high
flow in the context of an RCT. It may be a useful tool in developing your own protocol.
FLOW
BASED
Deliver a set flow

to all infants
DOSE BY
WEIGHT
Set flow according

to infants weight
TITRATE
TO EFFECT
(OBSERVATIONAL)
COMBINE
2 AND 3
Set flow and

titrate to effect
Tools
Pediatric usage
What flows should I use for bigger
babies and pediatric patients?
Pediatric usage
There are no large RCTs in the pediatric
population, however physiological

evidence suggests that flows equal
to or above 2 L/kg/min generate a
clinically relevant pharyngeal pressure,
with improved breathing pattern and
rapid unloading of respiratory muscles.1
It may be useful to think about
setting flow in terms of L/kg/min.

This may help to standardize therapy
across a broad population.
1 Milsi et al. Int Care Med. 2013.

Tools
Pressure
Ive got questions
about pressure
Ive got questions about pressure
Concern
Pressure
Considerations
Clinical data
Designed with in-built
safety features
Proactive monitoring/
management
11
Clinical data
Pressures are
typically low
Similar to nCPAP
The evidence from 3 RCTs, including over 800 babies,
suggests that nasal high flow is associated with a
similar risk of barotrauma compared to nCPAP.1,2,3
Pressures generated
with nasal high flow

are typically between
2 5 cm H20.1,4,5,6
Among infants 28 weeks gestational age HHHFNC [NHF]

appears to have similar efficacy and safety to nCPAP
when applied immediately post extubation or early as initial
non-invasive support for respiratory disfunction. YODER ET AL 2013
4 Saslow et al. J Perinatol. 2006.
5 Kubicka et al. Pediatrics. 2008.
6 Wilkinson et al. J Perinatol. 2008.
12
Designed with in-built safety features
Open
system
Patients vent flow and
pressure around the cannula.
In addition patients can
open their mouths.
Pressure
relief valve
Designed to allow flow and pressure
to vent from the circuit in case of the
unlikely scenario where the prongs
completely occlude the nares and
the mouth is held closed.
13
Proactive monitoring/management
Prong to
nare ratio
Sivieri et al. 20121 demonstrated
the importance of prong to nare
ratio as a key safety feature.

Sizing to approx half the nare limits

the possibility of harmful pressure.
Use of the pressure relief valve is
also mandated.
CHECKLIST
Ensure a clear gap

is visible around
each prong
No forced mouth

closure
Pressure relief valve

in place
Sivieri et al. Pediatr Pulmonol. 2012.
14
Summary
Considerations
Clinical data
Similar to nCPAP
Pressures are typically low
Designed with in-built safety features
Open system
Pressure relief valve
Proactive monitoring/management
Prong to nare ratio
No forced mouth closure
15
Tools
Economics
The emerging health
economic benefits
ACUITY
$
LENGTH OF STAY
Avoiding intubation


corrective surgery.



5


* = Not Significant
17
ACUITY
LENGTH OF STAY
Avoiding intubation
14 30% reduction in


18
Tools
Economics
Optiflow Junior
v The BC Cannula
Economics: Optiflow v The BC Cannula
$
Product
The BC Cannula
$
Optiflow
Junior
20
$
Patient
outcomes
Product
The BC Cannula
Optiflow
Junior
Specifically
contoured for
Juniors delicate
anatomical
features.
-$?
21
$
Patient
outcomes
Product
Ease of use and

consumables
The BC Cannula
Optiflow
Junior
+
Specifically
contoured for
Juniors delicate
anatomical
features.
-$?
Reduced time
to fit.*
No additional
tape costs.
-$?
* Result found in internal Fisher & Paykel Healthcare testing compared to an F&P BC Cannula.
22
$
Patient
outcomes
Product
Ease of use and

consumables
Therapy
The BC Cannula
Optiflow
Junior
+
Specifically
contoured for
Juniors delicate
anatomical
features.
-$?
+
> Flow range =
broader scope
of therapy from
one device.
Reduced time
to fit.*
No additional
tape costs.
-$?
-$?
23
$
Patient
outcomes
Product
Ease of use and

consumables
Developmental care
and patient journey
Therapy
The BC Cannula
Optiflow
Junior
+
Specifically
contoured for
Juniors delicate
anatomical
features.
-$?
+
> Flow range =
broader scope
of therapy from
one device.
Reduced time
to fit.*
No additional
tape costs.
-$?
-$?
Easier developmental care

(e.g. longer circuit).
Softer and more

comfortable:
better patient and
parent experience.
-$?
24
$
Patient
outcomes
Product
Ease of use and

consumables
Developmental care
and patient journey
Therapy
Total
system cost
The BC Cannula
Optiflow
Junior
+
Specifically
contoured for
Juniors delicate
anatomical
features.
-$?
+
> Flow range =
broader scope
of therapy from
one device.
Reduced time
to fit.*
No additional
tape costs.
-$?
-$?
= $?
Easier developmental care
(e.g. longer circuit).
Softer and more

comfortable:
better patient and
parent experience.
-$?
= $?
25
Tools
Economics
Optiflow Junior
v nCPAP
Economics: Optiflow v nCPAP
$
Product
nCPAP
$
Optiflow
Junior
27
$
Patient
outcomes
Product
nCPAP
$
Optiflow
Junior
$
1
+
NHF
associated
with reduced
risk of nasal
trauma.1,2,3
+ -$?
Collins et al. J. Pediatr. 2013.
28
$
Patient
outcomes
Product
Ease of use and

consumables
nCPAP
$
Optiflow
Junior
$
1
+
NHF
associated
with reduced
risk of nasal
trauma.1,2,3
+ -$?
Faster to apply and

easier for cares.
Improved nursing
satisfaction.1,4,5,6
Easier to train staff
and maintain skill
level.
-$?

4 Hochwald et al. J Neonatal Perinatal Med. 2010. 5 Hough et al. J Paediatr Child Health. 2011. 6 Ojha et al. Acta Paediatr. 2012.

Collins et al. J Pediatr. 2013.
29
$
Patient
outcomes
Product
Ease of use and

consumables
Therapy
nCPAP
$
Optiflow
Junior
$
1
+
NHF
associated
with reduced
risk of nasal
trauma.1,2,3
+ -$?
+
Faster to apply and
easier for cares.
Improved nursing
Can also be
used to deliver
heated and
humidified
oxygen therapy
(range of flows).

and maintain skill
level.
-$?
-$?


30
$
Patient
outcomes
Product
Ease of use and

consumables
Developmental care
and patient journey
Therapy
nCPAP
$
Optiflow
Junior
$
1
+
NHF
associated
with reduced
risk of nasal
trauma.1,2,3
+ -$?
+
Faster to apply and
easier for cares.
Improved nursing
-$?
Easier developmental
care, less visually
intrusive. Empowers
parents.
Can also be
used to deliver
heated and
humidified
oxygen therapy
(range of flows).

and maintain skill
level.
-$?
Softer and more comfortable: better patient

and parent experience.
-$?


31
$
Patient
outcomes
Product
Ease of use and

consumables
Developmental care
and patient journey
Therapy
Total
system cost
nCPAP
$
Optiflow
Junior
$
1
+
NHF
associated
with reduced
risk of nasal
trauma.1,2,3
+ -$?
+
Faster to apply and
easier for cares.
Improved nursing
-$?
-$?
= $?
Easier developmental
care, less visually
intrusive. Empowers
parents.
Can also be
used to deliver
heated and
humidified
oxygen therapy
(range of flows).

and maintain skill
level.
Softer and more comfortable: better patient

and parent experience.
-$?
= $?


32
Tools
Economics
Summary
Economics summary
$
Patient
outcomes
Product
Ease of use and

consumables
Developmental care
and patient journey
Therapy
Total
system cost
nCPAP
Optiflow Junior
Generic NHF cannula
34
Tools
The research &

development journey
Project background
In 2009 existing
cannula designs
left room for
improvement.
Opportunity to improve:
Flow range
Condensate control
Prong design
Retention mechanism
Tubing design
Speed and ease of application
1 Refs here

36
A patient-focussed R&D journey
Observation
Interacting with customers
Embedded our engineers in 50
hospitals around the world to look,
listen and learn
Design
Engineering concepts
Patient studies, research &
concept development
Customer needs
Clinical trials
Refining project objectives
1.5 years of field testing
Production
Manufacture
chosen concept
Distilling customer desires
37
Customer needs
Higher performance must

deliver a wider range of flows
Customer feedback
CLINICIAN: I want to be able to

deliver higher flows
NURSE:

No rain out in tubes

Give me pre-cut tape
PARENT:

I want to be able to
see my babys face
BABY:

Make me better
Let me sleep
Effective
Gentle
Easy
Increased safety
Enhanced facilitation
of developmental
care
Improved
comfort
Improved ease
of use for parent
and clinician
38
39
Tools
Unique features
Optiflow delivers:
Enhanced therapy
Effective
Gentle
Easy
Wide
flow range =
broad scope
of therapy from
one device
*
*
*
*
41
Optiflow delivers:
Enhanced protection and assurance
Effective
Gentle
Easy
Breathable
FlexiTube
designed to
minimise
condensate
Soft
ergonomic
prong design
to minimise
risk of septal
damage
Kink-proof
FlexiTube
Easy-click
connector swivels
to untangle
tubing without
disconnecting
flow
42
Optiflow delivers:
Enhanced protection and assurance
Effective
Gentle
Easy
Insulating
sleeve to
minimize
condensate
43
Optiflow delivers:
Enhanced developmental care
Effective
Gentle
Easy
Long
circuit for easy
kangaroo
care
Soft
unobtrusive
design facilitates
developmental
care
44
Optiflow delivers:
Enhanced comfort and toleration
Effective
Gentle
Easy
Wigglepad
attachment
for optimal
comfort
Soft prong
design to
minimise risk
of nasal
trauma
Anatomicallyshaped prongs
to fit developing
airway
45
Optiflow delivers:
Enhanced ease of use for caregivers
Effective
Gentle
Easy
Wigglepad
velcro allows
easy re-application,
adjustment and
maintenance
Long circuit
for flexiblity
in cares and
placement
46
Optiflow delivers:
Enhanced ease of use for parents
Effective
Gentle
Easy
Clothing
clip to assist
feeding
Long
circuit
for easy
feeding
47
Optiflow Junior
A nasal cannula designed

specifically for infants
and children
Enhancing the
established benefits of
nasal high flow therapy
Effective
Gentle
Easy
48
Award-winning
Optiflow Junior
Optiflow Junior has been recognised

the world over for its excellence in
design, winning many prestigious
product design awards.
49
Tools
Videos
Videos
Optiflow
Junior wins
Best Design
Award
Optiflow
Junior
fitting guide
51
Appendix
Introduction
The therapy
and Optiflow Junior
(CONCISE)
Overview
Nasal High Flow (NHF) therapy

Improved patient care and outcomes
Avoid intubation
NEONATAL
Readmission
ACUITY
Fisher & Paykel Healthcare

customer research
demonstrates that
clinicians want to:
Treat in a noninterventionist manner
LENGTH OF STAY
Shorten length-of-stay
(to free up beds)
Reduce the burden

of educating staff
PEDIATRIC
Readmission
ACUITY
Control costs
Avoid readmission
LENGTH OF STAY
FPH International Medical Director Research 2013.
A therapy arrives...
THE RESPIRATORY CARE CONTINUUM
INVASIVE
VENTILATION
nCPAP
NASAL
HIGH FLOW
OXYGEN
THERAPY
Commercially
available
circa 2001
Momentum has been building
Growing research
Number of NHF papers published from 2000-2013
(Neonatal and Pediatric)
40
Manley et al.
N Engl J Med
2013
35
number of papers
3 Randomised
Controlled Trials
(RCTs)
30
Yoder et al.
Pediatrics
2013
25
20
15
Collins e
t al.
J. Pediat
r.
2013
10
5
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
n = 867
Whats
behind the
momentum?
The literature indicates that
the momentum stems from
these therapy attributes:
Effective
Gentle
Easy
The literature suggests

these therapy benefits
vs nCPAP
Similar efficacy
to nCPAP1,2,3
Associated with
Effective
1,2,3
Less nasal trauma
reduced escalation
and length of stay4,5
No significant
difference in
adverse events1,2,3
Improved
bonding6,7,8
Simpler
Gentle
application6,7,8
Easy
Comfortable and
well tolerated
6,7,8
Empowers
parents9
Caregiver
satisfaction6,7,8
1 Collins et al. J Pediatr. 2013. 2 Manley et al. New Engl J Med. 2013. 3 Yoder et al. Pediatrics. 2013. 4 McKiernan et al. J Pediatr. 2010.
5 Schibler et al. Int Care Med. 2011. 6 Hochwald et al. J Neonatal Perinatal Med. 2010. 7 Hough et al. J Paediatr Child Health. 2011.
8
1 Ojha
al. Acta Paediatr. 2012. 9 Klingenburg at al. Arch Dis Child Fetal Neonatal Ed. 2013.
here
Refs et
ACUITY
$
LENGTH OF STAY
Avoiding intubation


corrective surgery.



5


* = Not Significant
ACUITY
LENGTH OF STAY
Avoiding intubation
14 30% reduction in


10
Designed to enhance the inherent therapy benefits
Broader
range of
flows
In-built
safety
features
Effective
Enhancing
comfort
Gentle
Easy
Promoting
developmental
care
Simpler
for
caregivers
Further
empowers
parents
11
Where and why Optiflow Junior is being adopted
INVASIVE
VENTILATION
OXYGEN
THERAPY
nCPAP
Effective
Gentle
Easy
12
Improving patient care

and outcomes
Nasal High Flow therapy
13
Introduction
Beyond the ICU
The patient journey: neonatal care
ACUITY
Readmission
LENGTH OF STAY
L&D
NICU
WARD
HOME
Early use
Better management of symptoms
AIMS TO:
AIMS TO:
Keep kids out of the ICU

Reduce intubations
Reduce transfers
Shorten durations of intubation
Reduce need for nCPAP
Better manage symptoms with humidity

Shorten length of stay
Promote ease of use
Reduce re-admissions/admissions
15
The patient journey: pediatric care
ACUITY
Readmission
LENGTH OF STAY
ED
PICU
WARD
HOME
Early use
Better management of symptoms
AIMS TO:
AIMS TO:
Keep infants out of the ICU

Reduce intubations
Reduce transfers
Shorten durations of intubation
Reduce need for CPAP/
Non invasive ventilation
Better manage symptoms with humidity

Shorten length of stay
Promote ease of use
Reduce re-admissions/admissions
16
Introduction
Other evidence
Guidance on implementation is emerging

KEY:
NEONATAL
Guidance
source
Category
description
Collins et al
2013
Less than 32 weeks

gestational age
Manley et al
2013
Premature and
neonatal cannula
= Minimum flow
= Starting flow
= Maximum flow
Flow
1
10
11
Infant, intermediate
infant cannula
Pediatric cannula
Yoder et al
2013
<2kg
2-3kg
>3kg
PEDIATRIC
Milsi et al
2013
Collins et al. J. Pediatr. 2013.
Weight range
2.6 7.3kg
2 litres per kg per minute

3
Milsi et al. Int Care Med. 2013.
18
The evidence of the momentum
Growing
usage
Published
surveys
of practice
Australia/NZ USA
UK
Users:
Evidence of increasing use in clinical practice (ANZNN Report)
Findings:
Approximately 70% of respondents reported using nasal

high flow in some capacity in their neonatal practice
Hochwald et al. J Neonatal-Perinatal Med. 2010.
Hough et al. J Paediatr Child Health. 2011.
Ojha et al. Acta Paediatrica. 2012.
19

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Effective. Gentle. Easy.

Enhancing Nasal High Flow Therapy

185048239 REV A 2014 Fisher & Paykel Healthcare Limited

Beyond the ICU

The therapy and

Nasal High Flow (NHF) therapy

Improved patient care and outcomes

Fisher & Paykel Healthcare

Treat in a noninterventionist manner

Reduce the burden

FPH International Medical Director Research 2013.

Momentum has been building

NHF therapy benefits

1 Manley et al. New Engl J Med. 2013.

NHF therapy benefits

Research in the pediatric population

1 McKiernan et al. J Pediatr. 2010.

NHF therapy benefits

Less nasal trauma

1 Manley et al. New Engl J Med. 2013.

NHF therapy benefits

1 Manley et al. New Engl J Med. 2013.

NHF therapy benefits

1 Hochwald et al. J Neonatal-Perinatal Med. 2010.

NHF therapy benefits

1 Spentzas et al. J Intensive Care Med. 2009.

NHF therapy benefits

1 Hochwald et al. J Neonatal-Perinatal Med. 2010.

NHF therapy benefits

1 Klingenburg at al. Arch Dis Child Fetal Neonatal Ed. 2013.

NHF therapy benefits

1 Hochwald et al. J Neonatal-Perinatal Med. 2010.

Neonatal health economic benefits are emerging

Reduced risk of nasal trauma

Indication of reduced intubation rates

Nasal trauma can sometimes result in costly

Manley et al (2013) indicated a 7.4 %

Clinical studies have shown a 7%2 to 15%1

1 Manley et al. New Engl J Med. 2013.

Yoder et al. Pediatrics. 2013.

Rnnestad et al. Pediatrics. 2005.

NHF reduces risk of nasal mucosa erosion4

Loftus et al. Laryngoscope. 1994.

Pediatric health economic benefits are emerging

Reduced length of stay

2 day median reduction in

1 McKiernan et al. J Pediatr. 2010. 2

Schibler et al. Int Care Med. 2011.

Designed to enhance the inherent therapy benefits

Where and why Optiflow Junior is being adopted

Improving patient care

Definition of Nasal High Flow

DEFINITION: Delivery of heated and humidified

Context and definition

Nasal High Flow with Optiflow

Reduces rebreathing of gas with

Frizzola et al. Pediatr Pulmonol. 2011.

Promotes slow and

Breath- and flow-dependent

Ritchie JE, et al. Anaesth Intensive Care. 2011.

Hasani A, et al. Chron Respir Dis. 2008. 3

Chidekel at al. Pulm Med. 2012

1 Roca O, et al. Respiratory Care. 2010.