scholarly journals Bubble Nasal Continuous Positive Airway Pressure (bNCPAP): An Effective Low-Cost Intervention for Resource-Constrained Settings

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Walufu Ivan Egesa ◽  
William Mugowa Waibi
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Neonatal Intensive Care ◽  
Positive Airway Pressure ◽  
Low Cost ◽  
Failure Criteria ◽  
Resource Constrained ◽  
Care Package ◽  
Tertiary Hospitals ◽  
Physiological Benefits

Preterm birth complications are responsible for almost one-third of the global neonatal mortality burden, and respiratory distress syndrome remains the single most common cause of these preventable deaths. Since its inception, almost half a century ago, nasal continuous positive airway pressure (NCPAP) has evolved to become the primary modality for neonatal respiratory care in both the developed and developing world. Although evidence has demonstrated the effectiveness of low-cost bubble NCPAP in reducing newborn mortality, its widespread use is yet to be seen in resource-constrained settings. Moreover, many tertiary hospitals in developing countries still utilise an inexpensive locally assembled bNCPAP system of unknown efficacy and safety. This review provides a brief overview of the history, physiological benefits, indications, contraindications, and complications of bNCPAP. Evidence regarding the effectiveness of low-cost bNCPAP in the neonatal intensive care unit is also summarised. The article further details a locally assembled bNCPAP system used in resource-constrained settings and highlights the care package for neonates receiving bNCPAP, failure criteria, and strategies for weaning.

scholarly journals Outcome of Respiratory distress in Neonates with Bubble CPAP at Neonatal Intensive Care Unit of a Tertiary Hospital

2019 ◽  
Vol 57 (216) ◽  
Author(s):  
Sunil Raja Manandhar
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Continuous Positive Airway Pressure ◽  
Neonatal Intensive Care Unit ◽  
Respiratory Distress ◽  
Airway Pressure ◽  
Neonatal Intensive Care ◽  
Positive Airway Pressure ◽  
College Teaching ◽  
Medical College

Introduction: Respiratory distress is one of the commonest problem seen in neonates during admission in Neonatal Intensive Care Unit. Hyaline Membrane disease, Meconium Aspiration Syndrome, septicemia, congenital pneumonia, Transient Tachypnea of Newborn are the major causes of respiratory distress in neonates. Bubble Continuous Positive Airway Pressure is a non-invasive respiratory support delivered to a spontaneously breathing newborn to maintain lung volume during expiration. The main objective of this study was to observe the outcome of respiratory distress in neonates with Bubble Continuous Positive Airway Pressure. Methods: This was a descriptive cross-sectional study conducted at Kathmandu Medical College Teaching Hospital over six months (October 2018 – March 2019) period. All preterm, term and post term babies with respiratory distress were included. Ethical clearance was received from Institutional Review Committee of Kathmandu Medical College and statistical analysis was done with SPSS 19 version. Results: Sixty three babies with respiratory distress were included in this study with 45 (71%) male predominance. The mean birth weight receiving Bubble Continuous Positive Airway Pressure was 2661.75±84 gms and gestational age was 36.67±3.4 wks. The Bubble Continuous Positive Airway Pressure was started at 8.05±2 hr of life and duration of Bubble Continuous Positive Airway Pressure required for settling respiratory distress was 95.71±3 hrs. Out of 63 babies, improvement of respiratory distress in neonates with Bubble Continuous Positive Airway Pressure was 39 (61%) with confidence interval of (38-62) whereas 24 (39%) babies required mechanical ventilation and other modalities. Conclusions: This study concludes usefulness of Bubble Continuous Positive Airway Pressure in neonates with respiratory distress.

Discrepancy in the physical dimensions of nose and continuous positive airway pressure (CPAP) interface: a possible reason for high rates of nasal injury in Indian neonates

2020 ◽  
Vol 7 (1) ◽  
pp. 33-39
Author(s):  
Jagjit Singh Dalal ◽  
Sanketh Kumar Ajmera ◽  
Kanika Prajapat ◽  
Tanushree Sahoo ◽  
Chander Prakash Yadav ◽  
...  
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Neonatal Intensive Care ◽  
Positive Airway Pressure ◽  
Three Dimensional ◽  
Cross Sectional Study ◽  
High Rate ◽  
Cross Sectional ◽  
Weight Category ◽  
Nasal Injury

BackgroundProperly fitting continuous positive airway pressure (CPAP) interface is critical to the efficacy and safety of nasal CPAP therapy in preterm. Unfortunately, there is a perception that CPAP interfaces being used in Indian neonatal intensive care units do not fit well and cause a high rate of nasal injury.ObjectivesTo determine the nasal anthropometric dimensions in preterm (<35 weeks) Indian neonates and compare them with those of commercially available CPAP interfaces.MethodsIn this cross-sectional study, relevant anterior nasal parameters were measured by three dimensional imaging in 32 preterm newborn (26+0–34+6 weeks) and compared with commercially available 17 short binasal CPAP prongs of multiple sizes made by five manufacturers. Dimensions for best-suited interfaces were generated for Indian neonates.ResultsThe mean (SD) gestation and birth weight of enrolled neonates were 30.6 (3.0) weeks and 1338 (575) g, respectively. The inter prong distance was narrower than the upper bound of the 95% CI of the columellar width in Hudson type CPAP interfaces in <1250 g weight category with discrepancy in measurement varying from 0.2 to 0.5 mm and 0.9–1.4 mm at midpoint and base of columella, respectively. Similarly, the lower bound of 95% CI of the distance between the lateral walls of the nostrils was narrower than the width of the prongs by 1–3 mm.ConclusionsThere is mismatch between nasal prongs and nose dimension of Indian neonates resulting in possible erosion of columella and distension of nostrils.

A Low-Resource Oxygen Blender Prototype for Use in Modified Bubble CPAP Circuits

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Jared Floersch ◽  
Elsa Hauschildt ◽  
Adam Keester ◽  
Samuel Poganski ◽  
Kiet Tran ◽  
...  
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Low Cost ◽  
World Health ◽  
Pure Oxygen ◽  
Hypodermic Needle ◽  
Low Resource Settings ◽  
Low Resource ◽  
Tract Infections

Abstract Continuous positive airway pressure (CPAP) is a method of respiratory support used around the world to treat children with lower respiratory tract infections (LRTI) (WHO, 2016, Oxygen Therapy for Children, World Health Organization, Geneva, Switzerland, Report). Bubble continuous positive airway pressure (bCPAP) is an effective form of CPAP that is currently used in both high- and low-resource countries. Low-cost, modified bCPAP devices have been designed as an ideal form of CPAP in low-resource areas (Bjorklund, A. R., Mpora, B. O., Steiner, M. E., Fischer, G., Davey, C. S., and Slusher, T. M., 2018, “Use of a Modified Bubble Continuous Positive Airway Pressure (bCPAP) Device for Children in Respiratory Distress in Low- and Middle-Income Countries: A Safety Study,” Paediatr. Int. Child Health, 39(3), pp. 1–8). However, patients in low-resource settings undergoing bCPAP treatment are often given pure oxygen, which has been linked to retinopathy of prematurity, cardiovascular complications, and patient mortality (Rodgers, J. L., Iyer, D., Rodgers, L. E., Vanthenapalli, S., and Panguluri, S. K., 2019, “Impact of Hyperoxia on Cardiac Pathophysiology,” J. Cell. Physiol., 234(8), pp. 1–9; Ramgopal, S., Dezfulian, C., Hickey, R. W., Au, A. K., Venkataraman, S., Clark, R. S. B., and Horvat, C. M., 2019, “Association of Severe Hyperoxemia Events and Mortality Among Patients Admitted to a Pediatric Intensive Care Unit,” JAMA Network Open, 2(8), p. e199812). This problem is typically avoided by using commercial oxygen blenders, which can titrate down the concentration of oxygen delivered to the minimum needed; however, these blenders can cost nearly 1000 USD and are almost always unavailable in low-resource settings. The lack of available low-cost oxygen blenders compatible with modified bCPAP circuits creates a barrier for low-resource hospitals to be able to provide blended oxygen to patients. There is a need for a low-cost oxygen blender for use in low-resource settings. We propose a passive oxygen blender that operates via entrainment of atmospheric air. The device can easily be assembled in low-resource areas using a 22 gauge hypodermic needle, two 3 cc syringes, tape or super glue, and the materials required for bCPAP—for approximately 1.40 USD per device. The blender has not been clinically tested yet, but can achieve oxygen concentrations as low as 60% with bCPAP levels of 5 cm H2O (490 Pa) when used in a standard bCPAP circuit without a patient.

Continuous positive airway pressure causes lung injury in a model of sepsis

2005 ◽  
Vol 289 (4) ◽  
pp. L554-L564 ◽  
Author(s):  
Shinya Tsuchida ◽  
Doreen Engelberts ◽  
Matthias Roth ◽  
Colin McKerlie ◽  
Martin Post ◽  
...  
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Lung Injury ◽  
Circuit Design ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Low Cost ◽  
Conventional Mechanical Ventilation ◽  
Pulmonary Atelectasis ◽  
Primary Form

Continuous positive airway pressure, aimed at preventing pulmonary atelectasis, has been used for decades to reduce lung injury in critically ill patients. In neonatal practice, it is increasingly used worldwide as a primary form of respiratory support due to its low cost and because it reduces the need for endotracheal intubation and conventional mechanical ventilation. We studied the anesthetized in vivo rat and determined the optimal circuit design for delivery of continuous positive airway pressure. We investigated the effects of continuous positive airway pressure following lipopolysaccharide administration in the anesthetized rat. Whereas neither continuous positive airway pressure nor lipopolysaccharide alone caused lung injury, continuous positive airway pressure applied following intravenous lipopolysaccharide resulted in increased microvascular permeability, elevated cytokine protein and mRNA production, and impaired static compliance. A dose-response relationship was demonstrated whereby higher levels of continuous positive airway pressure (up to 6 cmH2O) caused greater lung injury. Lung injury was attenuated by pretreatment with dexamethasone. These data demonstrate that despite optimal circuit design, continuous positive airway pressure causes significant lung injury (proportional to the airway pressure) in the setting of circulating lipopolysaccharide. Although we would currently avoid direct extrapolation of these findings to clinical practice, we believe that in the context of increasing clinical use, these data are grounds for concern and warrant further investigation.

scholarly journals Management of Continuous Positive Airway Pressure in the Newborn: Impact of Lecture-based Interactive Workshops on Training for Neonatal Intensive Care Nurses

Aquichan ◽  
2016 ◽  
Vol 16 (2) ◽  
pp. 159-168 ◽  
Author(s):  
Öznur Tiryaki ◽  
Nursan Cinar
Keyword(s):  
Intensive Care ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Neonatal Intensive Care ◽  
Positive Airway Pressure ◽  
Intensive Care Nurses

Objetivos: el objetivo de este estudio fue determinar cómo la formación impartida a través de talleres estructurados relacionados con el manejo de la presión positiva continua en las vías respiratorias en el recién nacido afecta el conocimiento de las enfermeras que trabajan en cuidados intensivos neonatales. Métodos: un grupo de enfermeras asistieron a un taller interactivo basado en una conferencia sobre el manejo de la presión positiva continua en las vías respiratorias en el recién nacido. Las enfermeras en cuestión habían aceptado una invitación para asistir a la presentación antes del evento de capacitación. La información sobre las características diferenciadoras de los participantes se recogió a través de un cuestionario elaborado por los propios investigadores. Una evaluación de los conocimientos de las enfermeras sobre el tema se llevó a cabo a través de un cuestionario de selección múltiple (CSM), el cual fue elaborado por los investigadores en relación con la literatura. El CSM fue enviado por correo a unos expertos en Turquía (siete personas) y unos expertos en el exterior (cinco personas), y sus opiniones fueron tomadas en cuenta. A la luz de sus sugerencias, al CSM se le dio su forma final y el número de preguntas se fijó en 20. El CSM, que consta de 20 preguntas, fue respondido por los participantes antes y después del taller interactivo. A los participantes no se les dijo si la prueba se repitió después del taller de formación. Resultados: treinta y seis enfermeras de la unidad neonatal participaron en el estudio. Cada pregunta en el CSM se consideró como un (1) punto. La puntuación máxima posible en la prueba fue 20. Hubo una mejora significativa en la puntuación de la prueba media después de la conferencia, si se compara con la puntuación preconferencia (media = 19,6, SD = 0,8 vs. media = 13,1, SD = 3.0, P <0,001). Conclusiones: un taller interactivo basado en una conferencia sobre el manejo de la presión positiva continua en las vías respiratorias en el recién nacido ayuda a mejorar el conocimiento de las enfermeras. También ayuda a superar las deficiencias en la formación de enfermeras.

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