Work of Breathing During Constant- and Variable-Flow Nasal Continuous Positive Airway Pressure in Preterm Neonates

PEDIATRICS ◽  
2001 ◽  
Vol 108 (3) ◽  
pp. 682-685 ◽  
Author(s):  
P. B. Pandit ◽  
S. E. Courtney ◽  
K. H. Pyon ◽  
J. G. Saslow ◽  
R. H. Habib
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Work Of Breathing ◽  
Preterm Neonates ◽  
Variable Flow

scholarly journals Comparison of inspiratory effort with three variable-flow nasal continuous positive airway pressure devices in preterm infants: a cross-over study

2021 ◽  
pp. fetalneonatal-2020-320531
Author(s):  
Alice Bordessoule ◽  
Amelia Moreira ◽  
cristina Felice Civitillo ◽  
Christophe Combescure ◽  
Angelo Polito ◽  
...  
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Preterm Infants ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Work Of Breathing ◽  
Heart Beat ◽  
Inspiratory Effort ◽  
Variable Flow ◽  
The Difference ◽  
Oxygen Requirements

ObjectivePatient’s work of breathing may vary between different neonatal nasal continuous positive airway pressure (NCPAP) devices. Therefore, we aimed to compare the inspiratory effort of three variable-flow NCPAP delivery systems used in preterm infants.DesignCross-over study.Patients/settingFrom June 2015 to August 2016, 20 preterm infants weighing ≤2500 g requiring NCPAP for mild respiratory distress syndrome were enrolled.InterventionsEach patient was successively supported by three randomly assigned variable-flow NCPAP systems (MedinCNO, Infant Flow and Servo-i) for 20 min while maintaining the same continuous positive airway pressure level as the patient was on before the study period.Main outcome measuresPatients’ inspiratory effort was estimated by calculating the sum of the difference between maximal inspiratory and baseline electrical activity of the diaphragm (∆EAdi) for 30 consecutive breaths, and after normalising this obtained value for the timing of the 30 breaths.ResultsPhysiological parameters (oxygen saturation measured by pulse oximetry, respiratory rate, heart beat, transcutaneous partial pressure CO2) and oxygen requirements remained identical between the three NCPAP systems. Although a wide variability in inspiratory effort could be observed, there were no statistically significant differences between the three systems for the sum of ∆EAdi for 30 breaths: CNO, 262 (±119) µV; IF, 352 (±262) µV; and SERVO-i, 286 (±126) µV, and the ∆EAdi reported on the timing of 30 breaths (sum ∆EAdi/s): CNO, 6.1 (±2.3) µV/s; IF, 7.9 (±4.9) µV/s; SERVO-i, 7.6 (±3.6) µV/s.ConclusionIn a neonatal population of preterm infants, inspiratory effort is comparable between the three tested modern variable-flow NCPAP devices.

Nasal CPAP and Work of Breathing Study Questioned

PEDIATRICS ◽  
1980 ◽  
Vol 65 (5) ◽  
pp. 1051-1051
Author(s):  
John Kattwinkel
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Work Of Breathing ◽  
Mechanics Of Breathing ◽  
Nasal Cpap ◽  
Sampling Catheter

The paper by Goldman et al (Pediatrics 64:160, 1979) comparing the mechanics of breathing in neonates treated with nasal vs mask continuous positive airway pressure (CPAP) recommends that, since nasal CPAP appeared to increase the work of breathing, "other methods be considered for the delivery of CDP (continuous distending pressure)." As a strong proponent of nasal CPAP, I would like to express several concerns with the study and its interpretation. First, according to the authors' drawing, the nasal device used for the study had been modified with a PE 20 sampling catheter inserted through one of the prongs.

Bubble versus other continuous positive airway pressure forms: a systematic review and meta-analysis

2020 ◽  
Vol 105 (5) ◽  
pp. 526-531 ◽  
Author(s):  
Shruti K Bharadwaj ◽  
Abdullah Alonazi ◽  
Laura Banfield ◽  
Sourabh Dutta ◽  
Amit Mukerji
Keyword(s):  
Systematic Review ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Experimental Studies ◽  
Preterm Neonates ◽  
Close Monitoring ◽  
Nasal Injury ◽  
Bubble Cpap ◽  
Cpap Failure

BackgroundUse of bubble continuous positive airway pressure (CPAP) has generated considerable interest in neonatal care, but its comparative effectiveness compared with other forms of CPAP, especially in developed countries, remains unclear.ObjectiveTo systematically review and meta-analyse short-term clinical outcomes among preterm infants treated with bubble CPAP vs all other forms of CPAP.MethodsProspective experimental studies published from 1995 onward until October 2018 comparing bubble versus other CPAP forms in preterm neonates <37 weeks’ gestational age were included after a systematic review of multiple databases using pre-specified search criteria.ResultsA total of 978 articles were identified, of which 19 articles were included in meta-analyses. Of these, 5 had a high risk of bias, 8 had unclear risk and 6 had low risk. The risk of the primary outcome (CPAP failure within 7 days) was lower with bubble CPAP (0.75; 95% CI 0.57 to 0.98; 12 studies, 1194 subjects, I2=21%). Among secondary outcomes, only nasal injury was higher with use of bubble CPAP (risk ratio (RR) 2.04, 95% CI 1.33 to 3.14; 9 studies, 983 subjects; I2=42%) whereas no differences in mortality (RR 0.82, 95% CI 0.47 to 1.92; 9 studies, 1212 subjects, I2=20%) or bronchopulmonary dysplasia (BPD) (RR 0.8, 95% CI 0.53 to 1.21; 8 studies, 816 subjects, I2=0%) were noted.ConclusionBubble CPAP may lead to lower incidence of CPAP failure compared with other CPAP forms. However, it does not appear to translate to improvement in mortality or BPD and potential for nasal injury warrants close monitoring during clinical application.Trial registration numberCRD42019120411.

scholarly journals IMPACT OF HIGH LEVELS OF CONTINUOUS POSITIVE AIRWAY PRESSURE ON CARDIAC OUTPUT IN PRETERM NEONATES: A PROSPECTIVE PHYSIOLOGICAL STUDY

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e16-e17
Author(s):  
Amit Mukerji ◽  
Abdul Gani Muzafar Wahab ◽  
Souvik Mitra ◽  
Tapas Mondal ◽  
Debie Paterson ◽  
...  
Keyword(s):  
Heart Rate ◽  
Cardiac Output ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Preterm Neonates ◽  
Velocity Time Integral ◽  
Time Integral ◽  
Postmenstrual Age ◽  
Physiological Impact

Abstract BACKGROUND Many NICUs employ high (>8 cmH2O) positive end-expiratory pressures (PEEP) on nasal continuous positive airway pressure (NCPAP) to prevent intubation and associated ventilator-induced lung injury, despite limited safety/efficacy data. OBJECTIVES This study sought to evaluate the physiological impact of high NCPAP PEEP. DESIGN/METHODS Fifteen preterm neonates at postmenstrual age ≥32 weeks (without congenital anomalies or acute intercurrent illness) on NCPAP PEEP of 5 cmH2O were enrolled. PEEP was increased by 2 cmH2O increments until 13 cmH2O. At each increment, following 5 minutes washout, cardiac output (aortic velocity-time integral x heart rate) and cardiorespiratory parameters including blood pressure, heart rate, respiratory rate were measured over 10 minutes. Predefined cut-off values for changes in cardiorespiratory parameters were used as termination criteria. Data are presented as mean (SD), and were compared using one-way ANOVA. RESULTS The mean GA, age at study, and weight of subjects were 27.4 (2.6) weeks, 58.5 (35.5) days, and 2.3 (0.6) kg, respectively. Cardiac output (mL/kg/min) at PEEPs of 5, 7, 9, 11, and 13 cmH2O were not different at 295 (75), 290 (66), 281 (69), 286 (73), and 292 (58), respectively (P=0.986), as shown in Figure 1a. Importantly there were also no differences in either aortic velocity-time integral or heart rate over these PEEP ranges (Figures 1b and 1c). There were no significant differences in cardiorespiratory parameters; no subjects met cut-off criteria. Data collection was terminated in 2 subjects after PEEP 9 cmH2O due to lung over-distension subjectively noted on echocardiogram. CONCLUSION High levels of NCPAP PEEP were well tolerated for short durations. Further physiological and clinical research is required on safety/efficacy in neonates with more severe lung disease, as well as its impact over longer durations.

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