​​​Caution: HFNPO2 generates aerosolised droplets that spread widely, and it may increase
the risk of transmission of respiratory viruses to healthcare workers

Please remember the points below when HFNPO2 is the most appropriate treatment for your patient when they are unwell with an acute respiratory viral illness (including COVID-19)

  • Low flow conventional oxygen therapy is sufficient for most adult patients with SpO2<92%. Lower thresholds should be used in patients at risk of hypercapnic respiratory failure (SpO2 88–92% – see TSANZ Oxygen guidelines for acute oxygen use in adults).
  • Its use in the treatment and management of patients with COVID-19 can be reviewed in the Australian guidelines for the clinical care of people with COVID-19.
  • HFNPO2 still remains an appropriate therapy for some people with respiratory failure from causes other than COVID-19.
  • When starting HFNPO2, please document a detailed management plan for review and cessation of HFNPO2 – including end of life planning when appropriate.
  • When HFNPO2 is the only appropriate therapy, administer in a negative pressure or single room using contact, droplet and airborne precautions. If this is not possible then efforts should be made to move the patient to a negative pressure or single room as soon as possible.
  • Any room which has had an aerosol generating procedure in it requires airborne precautions for a minimum of 30 minutes after. The exact time depends on air changes per hour. See page 4 of  Infection Prevention and Control Novel Coronavirus 2019 (2019-nCoV) – Hospital setting from the Clinical Excellence Commission.
  • Local sites should also consider local COVID-19 screening questions and processes in the context of local prevalence data when using HFNPO2.

Document information

Developed by

  • Professor Peter Wark
  • Dr Matthew Peters
  • Dr Paul Hamor
  • Nick Yates (NP)
  • John Harrington (CNC)
  • Helen Kulas (ACI Respiratory Network Manager).​


  • ACI Respiratory Network
  • ACI Evidence Generation and Dissemination Team
  • Ministry of Health (Ron Manning)
  • ICU (Nhi Nguyen, Mark Nicholls)
  • ED (Michael Golding, Clare Skinner)
  • Infection Control (Kathy Dempsey, James Mackie)
  • Paediatrics (Matthew O’Meara)
  • Anaesthetics (David D’Silva).

Endorsed by

Dr Nigel Lyons, Deputy Secretary, Health System Strategy and Planning​.

For use by

All NSW Health staff coming in to contact with patients receiving these therapies and all NSW Health COVID-19 Communities of Practice​​.​​
Page Updated: Wednesday 3 June 2020
Contact page owner: Health Protection NSW