Effects of nasal CPAP on supraglottic and total pulmonary resistance in preterm infants

1990 ◽  
Vol 68 (1) ◽  
pp. 141-146 ◽  
Author(s):  
M. J. Miller ◽  
J. M. DiFiore ◽  
K. P. Strohl ◽  
R. J. Martin
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Preterm Infants ◽  
Premature Infants ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Nasal Airflow ◽  
Pulmonary Resistance ◽  
Nasal Cpap ◽  
Primary Mechanism ◽  
Postconceptional Age

The effects of continuous positive airway pressure (CPAP) on supraglottic and total pulmonary resistance were determined in 10 healthy premature infants (postconceptional age 34 +/- 2 wk, weight at study 1,628 +/- 250 g). Nasal airflow was measured with a mask pneumotachograph, and pressures in the esophagus and oropharynx were measured with a 5-Fr Millar or fluid-filled catheter. Nasal CPAP between 0 and 5 cmH2O correlated well with oropharyngeal pressure (r = 0.94). Total supraglottic resistance, total pulmonary resistance, and supraglottic resistance in inspiration and expiration were measured on increasing CPAP. Total supraglottic resistance decreased from 46 +/- 29 to 17 +/- 16 cmH2O.l-1.s (P less than 0.005) between 0 and 5 cmH2O CPAP, and a delay in return of resistance to control values was seen as CPAP was reciprocally decreased to 0. CPAP produced a decrease in supraglottic resistance in both inspiration and expiration, from 41 +/- 26 to 14 +/- 9 and from 33 +/- 17 to 10 +/- 6 cmH2O.l-1.s, respectively (P less than 0.01). Total pulmonary resistance also decreased from 161 +/- 40 to 95 +/- 24 cmH2O.l-1.s (P less than 0.01) between 0 and 5 cmH2O CPAP. The decrease in total supraglottic resistance in these infants accounted for 60% of the change in total pulmonary resistance, which occurred on CPAP of 5 cmH2O. We speculate that CPAP may decrease supraglottic resistance directly through mechanical splinting of the airway. This effect of CPAP may be the primary mechanism by which this form of therapy reduces apnea with an obstructive component in premature infants.

scholarly journals Predictor Factors of Continuous Positive Airway Pressure Failure in Preterm Infants with Respiratory Distress

2021 ◽  
Vol 8 ◽  
pp. 2333794X2110074
Author(s):  
Winda Intan Permatahati ◽  
Amalia Setyati ◽  
Ekawaty Lutfia Haksari
Keyword(s):  
Birth Weight ◽  
Continuous Positive Airway Pressure ◽  
Respiratory Distress ◽  
Preterm Infants ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Multivariate Logistic Regression Analysis ◽  
Mortality And Morbidity ◽  
Nasal Cpap ◽  
Cpap Failure

Respiratory distress contributes significantly to mortality, and morbidity in preterm infants. The incidence of nasal continuous positive airway pressure (CPAP) failure is remarkably high. There are limited data available regarding nasal CPAP failure in Indonesia, and this study is expected to be a reference in taking preventive measures to reduce mortality and morbidity in preterm infants. To determine predictive factors of nasal CPAP failure in preterm infants with respiratory distress. A retrospective cohort study was conducted in preterm infants with respiratory distress at the Neonatology ward of Dr. Sardjito Hospital during January 2017-July 2019. Chi-square or Fisher’s exact tests, followed by multivariate logistic regression analysis with backward method, was used to identify factors contributing to nasal CPAP failure. A total of 150 infants were included in this study. Fifty-three (37.8%) infants had nasal CPAP failure. Bivariate analysis showed birth weight <1000 g, singleton, APGAR score 4-7, premature rupture of membrane (PROM), Downes score, and initiation of fractional concentration of inspired (FiO2) requirement were all risk factors of nasal CPAP failure. However, only birth weight <1000 g ( P = .022; OR 2.69; CI 95% 1.34-5.44), initial Downes score ( P = .035; OR 2.68; CI 95% 3.10-24.11), and initiation of FiO2 requirement ≥30% ( P = .0001; OR 3.03; CI 95% 2.04-4.50) were significant predictors for nasal CPAP failure by multivariate analysis. Birth weight <1000 g, singleton, initial Downes score, and initiation of FiO2 requirement >30% were significant predictors of nasal CPAP failure in preterm infants with respiratory distress.

scholarly journals Effect of Nursing Protocol Regarding Nasal Skin Breakdown for Preterm Infants Receiving Continuous Positive Airway Pressure

2020 ◽  
Vol 1 (3) ◽  
pp. 16
Author(s):  
Khadiga M. Said ◽  
Rawia A. Mohamed ◽  
Safaa F. Draz
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Preterm Infants ◽  
Airway Pressure ◽  
Neonatal Intensive Care ◽  
Positive Airway Pressure ◽  
Skin Condition ◽  
Control Group ◽  
Nasal Cpap ◽  
Skin Breakdown ◽  
Significant Difference

Context: Neonates, particularly those who are born premature, may require ventilation assistance immediately after birth, since their lung may not be fully developed. The use of nasal continuous positive airway pressure (CPAP) is increasing as a means of respiratory support in many premature infants. So, the presence of nasal skin breakdown may be seen as a complication. Aim: To evaluate the effect of nursing protocol regarding nasal skin breakdown for preterm infants receiving nasal continuous positive airway pressure (CPAP). Methods: A quasi-experimental research design utilized to conduct the current study. The study conducted at Neonatal Intensive Care Units (NICUs) and Surgical Neonatal Intensive Care Unit "SNICU" of Benha Specialized Pediatric Hospital at Benha city. A convenient sample of nurses (70) working in NICU sand SNICU and a purposive random sample of (77) preterm infants included from the settings mentioned above. Those premature infants were divided into two groups (study and control) (35) in the control group and (42) in the study group, who selected according to the power analysis equation based on the total number of preterm infants who admitted to the setting mentioned above during 2017. Three tools used. A structured interviewing questionnaire sheet designed to assess nurses’ sociodemographic characteristics, and nurses' knowledge regarding CPAP, care provided to preterm infants undergoing CPAP, and nasal skin breakdown. The second tool was a nursing practice observation checklist to assess nurses' practice regarding nasal CPAP. The third tool was Preterm Medical Assessment Record. It designed to assess the characteristics of preterm infants and medical data of preterm infants. The last tool was the Neonatal Skin Condition Score (NSCS) scale that is designed to assess the neonates’ skin condition. Results: Findings of the present study revealed a statistically significant difference (P<0.05) pre and post nursing protocol implementation regarding CPAP, the role of the nurse caring for preterm infants undergoing nasal CPAP, and nasal skin breakdown. The results also revealed a highly statistically significant difference in nursing practice regarding care for preterm infants undergoing nasal CPAP pre and post nursing protocol implementation at (p<0.001). Nasal Skin Breakdown in the study group was significantly less than in the control group at a different time of assessment at (p˂0.001). Conclusion: It can be concluded that the research hypothesis is accepted, nursing protocol implemented for nurses improved their knowledge and practice as well as reduced nasal skin breakdown in the preterm newborns receiving NCPAP. The study recommended applying the nursing protocol for nurses caring for preterm infants to reduce nasal skin breakdown during CPAP ventilation, which is an effective and safe non-invasive intervention in all NICUs as a standard of care for all preterm infants.

scholarly journals Bi-Level Noninvasive Ventilation in Neonatal Respiratory Distress Syndrome. A Systematic Review and Meta-Analysis

Neonatology ◽  
2021 ◽  
Vol 118 (3) ◽  
pp. 264-273
Author(s):  
Anne Lee Solevåg ◽  
Po-Yin Cheung ◽  
Georg M. Schmölzer
Keyword(s):  
Systematic Review ◽  
Continuous Positive Airway Pressure ◽  
Respiratory Distress Syndrome ◽  
Premature Infants ◽  
Airway Pressure ◽  
Distress Syndrome ◽  
Positive Airway Pressure ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Randomized Controlled

<b><i>Background:</i></b> Bi-level noninvasive ventilation (NIV) has been used in respiratory distress syndrome (RDS) as primary treatment, post-extubation, and to treat apnea. This review summarizes studies on bi-level NIV in premature infants with RDS. Nonsynchronized nasal intermittent positive pressure ventilation (nsNIPPV) and synchronized NIPPV (SNIPPV) use pressure settings ≥ those used during mechanical ventilation (MV), and biphasic continuous positive airway pressure (BiPAP) use two nasal continuous positive airway pressure (NCPAP) levels ≤4 cm H<sub>2</sub>O apart. <b><i>Methods:</i></b> A systematic review (Medline OVID and Pubmed) and meta-analysis of randomized controlled trials. Primary outcomes were bronchopulmonary dysplasia (BPD) and mortality. Secondary outcomes included NIV failure (intubation) and extubation failure (re-intubation). Data were pooled using a fixed-effects model to calculate the relative risk (RR) with 95% confidence interval (CI) between NIV modes (RevMan v 5.3, Copenhagen, Denmark). <b><i>Results:</i></b> Twenty-four randomized controlled trials that largely did not correct for mean airway pressure (MAP) and used outdated ventilators were included. Compared with NCPAP, both nsNIPPV and SNIPPV resulted in less re-intubation (RR 0.88 with 95% CI (0.80, 0.97) and RR 0.20 (0.10, 0.38), respectively) and BPD (RR 0.69 (0.49, 0.97) and RR 0.51 (0.29, 0.88), respectively). nsNIPPV also resulted in less intubation (RR 0.57 (0.45, 0.73) versus NCPAP, with no difference in mortality. One study showed less intubation in BiPAP versus NCPAP. <b><i>Conclusions:</i></b> Bi-level NIV versus NCPAP may reduce MV and BPD in premature infants with RDS. Studies comparing equivalent MAP utilizing currently available machines are needed.

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