​​​Caution: HFNPO2 has the potential to generate aerosolised droplets. It may increase
the risk of transmission of respiratory viruses to healthcare workers​​​​​​​​​​​​ and other patients.

Please remember the points below when HFNPO2 is the most appropriate treatment for your patient and 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.
  • When starting HFNPO2, please document a detailed management plan for review, escalation of care and cessation of HFNPO2 – including end of life planning when appropriate.
  • When HFNPO2 is the only appropriate therapy and a respiratory viral infection is suspected or confirmed, 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. For more information, see 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, NSW MInistry of Health​.

Reviewed by

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

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​​.​​​​​​​​​​​
Current as at: Monday 21 December 2020
Contact page owner: Health Protection NSW