In this section
Note: This guideline is currently under review.
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 and Continuous Bi-level Positive Airway Pressure (BPAP).
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, BPAP or NPV, but 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 Medicine and other relevant heads of department.
This 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 PICU environment.
CPAP can be initiated on the inpatient units, or in outpatients. NIV can be initiated on inpatient units only.
In established/long-term CPAP/NIV patients, temporary, and minor changes to settings, or an increase in FiO2,may be required for episodes of minor illness or palliation.
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, or where CPAP/NIV settings are adjusted.
Monitor patient for and document hourly on EMR, in the Ventilator Pressures row, under Observations:
At the commencement of each nursing shift the ventilator settings should be checked against the medical orders and documented on EMR, in the Ventilator Pressures row, under 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 the patient has an NGT, a nasojenunal tube (NJT) or a nasopharyngeal airway (NPA) insitu there is an increased risk of pressure area formation and leak.
If documented or correlating medical orders are not present, seek medical input.
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 one to 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.
RCH Nursing Competency documents
Nursing Guidelines and Clinical Practice Guidelines (CPG)
The evidence table for this guideline can be found here.
Please remember to
read the disclaimer
The development of this nursing guideline was coordinated by John Kemp, Clinical Nurse Facilitator, Sugar Glider, and approved by the Nursing Clinical Effectiveness Committee. Updated October 2018.