Page
6
of
13
© Copyright Diamedica (UK) Ltd 2018
SpO
2
>90% and
mild or no
respiratory distress
SpO
2
>90% but
moderate to severe
respiratory distress
SpO
2
<90%
Bubbles
No immediate
change needed,
may be able to
reduce CPAP level
to 5 cmH
2
0
Increase CPAP level
Increase CPAP level
Increase oxygen
flow
No bubbles
Check nasal
interface
Wean CPAP level
and check if child
still needs CPAP
Check nasal interface
Increase air flow,
check for bubbles
Increase CPAP level
Check nasal
interface
Increase oxygen
flow, check for
bubbles
Increase CPAP level
Trialling patients off CPAP and when to stop CPAP
At least once each day, children in the ward who are clinically stable (have no emergency signs and
SpO
2
>90%) should be disconnected from CPAP for 10–15 minutes, and carefully examined for
changes in clinical signs and SpO
2
, to assess whether supplemental oxygen and CPAP is still
required. Trials off CPAP are best done first thing in the morning, when there is likely to be
adequate staff to observe the child throughout the day. If trials off CPAP are started in the late
afternoon, low staff numbers overnight and the oxygen desaturation that sometimes occurs
during sleep mean that there is a risk of hypoxaemia developing unrecognized overnight.
Children who have an SpO
2
<90% while still on CPAP or who are unstable or very unwell should
not be given trials on room air.
Before a trial off CPAP, the SpO
2
should be checked to determine if the trial is safe
(i.e. SpO
2
>90%). The child should then be disconnected from the oxygen source and observed
carefully to avoid any adverse complications of hypoxaemia. If severe hypoxaemia (SpO
2
<80%),
apnoea or severe respiratory distress occurs, children should be immediately restarted on oxygen.
Some children will become hypoxaemic very rapidly when they are taken off oxygen, and this is a
marker of very severe disease and a high risk of death. Parents and nursing staff should be advised
to watch the child to see if he/she develops cyanosis or severe respiratory distress.
