Weaning from CPAP

They go to CPAP of 4 then to NC or RA. MD decides, RN can urge them in that direction.

We start to trial off when they've been kicking it on 21% for a while without issues. The MDs sometimes ask us to, sometimes we just give the kid a shot if we know them well and trust them. Or if a kid is an absolute maniac, after the fifth time they rip it off their own selves in two hours we might just leave it off and watch closely. If they're that frantic with it on, sometimes they do better without it.

For the most part, once they've been on +4 or +5 for awhile on CPAP we will then go to a 4L HFNC. We then wean on that as well. For some of our chronics, we will cycle between CPAP and HFNC until they are ready to be on HFNC full time.

When we have the term kids who are on CPAP for grunting, we can usually end up weaning right to room air once they've finished "transitioning" themselves...

For a kid who just had some TTN or RDS, we start on CPAP 5, wean to 4, and then either wean to 3 or go directly to 2L NC when they have no oxygen requirement.

For a chronic kid who has a long respiratory history, we start trialling three hours of NC per shift once they are stable on CPAP 4 with low oxygen requirements. Once they are doing well with that, we usually go to three hours of NC and six hours of CPAP, alternating, and we keep increasing the NC and decreasing the CPAP until the kid is on all NC.

Of course, there are exceptions to the rule, like the full term grunter who goes from CPAP 5 to RA because he figures things out. Or the really long-term chronic kid who ends up on HFNC. We have had only one kid go on HFNC since I have been in the NICU, and we ended up going home on 4L HFNC with a rather complicated set-up at the age of 9 months. We have another kid right now who we might try Vapotherm on (which we have not yet used since I have been there) before sending him for evaluation for a trach.