In this section
Definition of Terms
Non-invasive respiratory support is a means of providing ventilatory support to children with either upper airway obstruction or respiratory failure. Respiratory failure constitutes either failure of ventilation or failure of lung function.
Non-invasive respiratory support encompasses CPAP, APAP, Bi-level Positive Airway Pressure (BiPAP). APAP should be considered synonymous with CPAP for the remainder of this document.
Positive pressure respiratory support is delivered via a mechanical ventilation driver utilizing an external interface such as a nasal mask, nasal pillow, full-face, or total-face mask.
Medical conditions treatable with CPAP or NIV support include but are not limited to:
Contraindications include but are not limited to:
This Clinical Guideline is intended to assist in the management of infants and children who require medium to long term respiratory support in the form of non-invasive CPAP or BiPAP, and who are otherwise medically stable, as inpatients within The Royal Children’s Hospital
Where an individual patient’s clinical requirements fall outside these guidelines, consensus on patient management must be agreed to by the PICU, Respiratory and Sleep Medicine Consultant, and other relevant heads of department
guideline does not refer to the management of CPAP or NIV in the neonatal
patient. Please refer to the Newborn Intensive Care Unit.
A patient who requires CPAP/NIV for the management of acute respiratory failure will require transfer to the Paediatric Intensive Care Unit. Initiation of this therapy may occur in the Emergency Department or PICU environment. Stabilization and ongoing management of this therapy should occur in the
CPAP can be safely initiated on the inpatient units, or as an outpatient.
NIV can only be safely initiated on inpatient units due to additional complexity and monitoring requirements.
In established/long-term CPAP/NIV patients, temporary and/or minor changes to settings, or an increase in FiO2, may be required for episodes of minor illness, or for palliation.
These patients may continue to be safely cared for on their current inpatient unit.
nursing assessment guideline for additional information.
When a patient requires CPAP/NIV support and management, consultation with, and referral to the
Department of Respiratory and Sleep Medicine is required.
The condition of the patient should be stable, without an anticipated requirement for frequent adjustments to mechanical ventilation. However, adjustments may be required in:
Patients should receive a complete nursing respiratory assessment at least once at the commencement of each shift, where the patient’s respiratory status changes, where CPAP/NIV settings are adjusted, and/or oxygen requirements change.
Monitor patient for and document hourly on EMR Flowsheets under Observations:
Monitor device and document hourly on EMR Flowsheets under Respiratory Support Observations:
Additional device observations may include:
In established/long-term CPAP/NIV patients who are clinically stable, and where ventilation settings do not require adjustment, the frequency of physical assessment may be reduced.
Reduction in the frequency of patient physical assessment should be approved and documented by the treating medical team.
At the commencement of each nursing shift the ventilator settings should be checked against the medical orders and documented on EMR Flowsheets under Respiratory Support Observations.
Monitor device each shift or when resuming treatment
The Respiratory and Sleep Medicine Consultant, or their delegate, is responsible for arranging assessment and documentation of ongoing CPAP/NIV requirements.
If documented or correlating medical orders are not present, seek medical review and documentation of same prior to commencing CPAP/NIV.
Unless otherwise indicated, patients who are managed on CPAP/NIV in the home environment will use reusable ventilation circuits.
If patients are to be discharged home on CPAP/NIV they should use the home (reusable) circuit for at least two nights prior to discharge in order that compliance and efficacy can be assessed.
When managed as inpatients, unless otherwise indicated, patients receiving CPAP/NIV should be managed on disposable circuits.
Where patients who
are established on long-term NIV are readmitted they should use their home driver and equipment, unless otherwise clinically indicated.
Nursing Competency documents available on the below topics. Sugar Glider staff contact the education team to access the content.
• Ventilation - Mechanical (Basic Principles) • Ventilation (Non Invasive) • Conventional Ventilation (Basic Principles in Neonates)• CPAP (Neonates)• CPAP (Nasopharyngeal)• Blood Gas Analysis
RCH Staff only - Tracheostomy Learning Package on learning hero.
The evidence table for this guideline can be viewed here.
Please remember to
read the disclaimer
The development of this nursing guideline was coordinated by John Kemp, Clinical Support Nurse/Respiratory Nurse Consultant, Sugar Glider, and approved by the Nursing Clinical Effectiveness Committee. Updated January 2022.