Modification of Umbilical Plastic Clamp To Secure Nasopharyngeal Prongs Used To Administer CPAP

PEDIATRICS ◽  
1976 ◽  
Vol 58 (1) ◽  
pp. 118-120
Author(s):  
Bedford W. Bonta ◽  
Joseph B. Warshaw
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Endotracheal Tube ◽  
Endotracheal Intubation ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Endotracheal Tubes

Since the introduction of continuous positive airway pressure (CPAP) via endotracheal tube by Gregory et al.1 in 1971, several alternate methods of delivering CPAP without the need for endotracheal intubation have been suggested, including the use of nasopharyngeal prongs.2 A major peoblem, however, in delivering CPAP either by endotracheal tube or by nasal prongs has been that of securing the endotracheal tube (or prongs) in place. Recently, Cussel et al.3 have suggested the use of a Hollister plastic clamp adapted for this use. We have used this method successfully for securing endotracheal tubes in place and recently have modified the clamp to secure nasal prongs used to deliver "benign" CPAP without the need for endotracheal intubation in selected patients.

When Pressure is Positive: A Literature Review of the Prehospital Use of Continuous Positive Airway Pressure

2012 ◽  
Vol 28 (1) ◽  
pp. 52-60 ◽  
Author(s):  
Brett Williams ◽  
Malcolm Boyle ◽  
Nicole Robertson ◽  
Coco Giddings
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Literature Review ◽  
Pulmonary Edema ◽  
Endotracheal Intubation ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Hospital Setting ◽  
Acute Pulmonary Edema ◽  
Cpap Therapy ◽  
Short Term

AbstractBackgroundHeart failure poses a significant burden of disease, resulting in 2,658 Australian deaths in 2008, and listed as an associated cause of death in a further 14,466 cases. Common in the hospital setting, continuous positive airway pressure (CPAP) therapy is a non-invasive ventilation technique used to prevent airway collapse and manage acute pulmonary edema (APO). In the hospital setting, CPAP has been known to decrease the need for endotracheal intubation in patients with APO. Therefore the objective of this literature review was to identify the effectiveness of CPAP therapy in the prehospital environment.MethodsA review of selected electronic medical databases (Cochrane, Medline, EMBASE, and CINAHL) was conducted from their commencement date through the end of May 2012. Inclusion criterion was any study type reporting the use of CPAP therapy in the prehospital environment, specifically in the treatment of heart failure and acute pulmonary edema. References of relevant articles were also reviewed.ResultsThe literature search located 1,253 articles, 12 of which met the inclusion criteria. The majority of studies found that the use of CPAP therapy in the prehospital environment is associated with reduced short-term mortality as well as reduced rates of endotracheal intubation. Continuous positive airway pressure therapy was also shown to improve patient vital signs during prehospital transport and reduce myocardial damage.DiscussionThe studies conducted of prehospital use of CPAP to manage APO have all demonstrated improvement in patient outcomes in the short term.ConclusionAvailable evidence suggests that the use of CPAP therapy in the prehospital environment may be beneficial to patients with acute pulmonary edema as it can potentially decrease the need for endotracheal intubation, improve vital signs during transport to hospital, and improve short-term mortality.WilliamsB, BoyleM, RobertsonN, GiddingsC. When pressure is positive: a literature review of the prehospital use of continuous positive airway pressure. Prehosp Disaster Med.2013;28(1):1-10.

Face Masks Defended

PEDIATRICS ◽  
1976 ◽  
Vol 58 (4) ◽  
pp. 621-623
Author(s):  
Robert M. Shuman ◽  
Thomas K. Oliver
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Endotracheal Tube ◽  
Airway Pressure ◽  
Low Birthweight ◽  
Positive Pressure Ventilation ◽  
Positive Airway Pressure ◽  
Face Mask ◽  
Intermittent Positive Pressure Ventilation ◽  
Positive Pressure

Pediatricians caring for the newborn are particularly aware of unexpected deleterious outcomes of well-intentioned therapy. Oxygen, chloramphenicol, sulfadiazine, and continuous positive airway pressure are examples. Elsewhere in this issue Pape et al.1 suggest that intermittent positive-pressure ventilation provided by a tight-fitting face mask in low-birthweight infants is yet another example. They observed a 30% incidence of significant intracerebellar hemorrhages in infants so treated (groups A and D). Such hemorrhages were seen in 10% of babies who were ventilated by an endotracheal tube rather than by mask (groups B and C), and were not seen in their 13 nonventilated babies (group E).

The Role of Gentle Ventilation in Prevention of Subglottic Stenosis in the Newborn

1993 ◽  
Vol 109 (4) ◽  
pp. 701-706 ◽  
Author(s):  
Edward B. Gaynor ◽  
Stuart J. Danoff
Keyword(s):  
Mechanical Ventilation ◽  
Continuous Positive Airway Pressure ◽  
Respiratory Distress ◽  
Endotracheal Intubation ◽  
Airway Pressure ◽  
Intraventricular Hemorrhage ◽  
Positive Airway Pressure ◽  
Standard Of Care ◽  
Subglottic Stenosis

Prolonged endotracheal intubation has become the standard of care in most neonatal units for maintenance of mechanical ventilation in the presence of respiratory distress. Unfortunately this approach has become associated with significant complications, including acquired subglottic stenosis. We have successfully used nasal continuous positive airway pressure to avoid or decrease the incidence and duration of endotracheal intubation. With use of this technique we have been able to significantly reduce sequelae (i.e., bronchopulmonary dysplasia, chronic lung disease, intraventricular hemorrhage) and have not encountered subglottic stenosis in more than 200 cases. The use of this technique may be of significant value in preventing or reducing the incidence of acquired subglottic stenosis

On the Use of Nasal Continuous Positive Airway Pressure

PEDIATRICS ◽  
1974 ◽  
Vol 53 (5) ◽  
pp. 768-768
Author(s):  
Thomas R. Harris ◽  
Richard C. Stevens ◽  
Michael Nugent
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Pressure Drop ◽  
Endotracheal Tube ◽  
Delivery System ◽  
Airway Pressure ◽  
Flow Resistance ◽  
Positive Airway Pressure ◽  
Face Mask ◽  
Nasal Cannula ◽  
Nasal Route

Although the application of continuous positive airway pressure (CPAP) by endotracheal tube, head chamber and face mask is quite straightforward, its successful application by nasal cannula or prongs as recently described by Novogroder et al. and Kattwinkel et al. presupposes an understanding of certain crucial points not emphasized in these original articles. The new factor that comes into play when applying CPAP by nasal route is the variable leak at the mouth. When a large mouth leak is present in a delivery system that also has an appreciable flow resistance at the site of the nasal prongs or beyond in the nasal passages, a significant pressure drop may occur across these points.

Successful Direct Extubation of Very Low Birth Weight Infants From Low Intermittent Mandatory Ventilation Rate

PEDIATRICS ◽  
1987 ◽  
Vol 80 (3) ◽  
pp. 409-414
Author(s):  
Eun H. Kim ◽  
Walter C. Boutwell
Keyword(s):  
Birth Weight ◽  
Continuous Positive Airway Pressure ◽  
Low Birth Weight ◽  
Airway Pressure ◽  
Very Low Birth Weight ◽  
Positive Airway Pressure ◽  
Respiratory Acidosis ◽  
Low Birth Weight Infants ◽  
Intermittent Mandatory Ventilation ◽  
Endotracheal Tubes

It is common practice to use endotracheal continuous positive airway pressure for various time periods up to 24 hours before attempting extubation in infants who are mechanically ventilated. A few studies in newborns have indicated that airway resistance is increased through small endotracheal tubes. This increases the work of breathing and the likelihood of subsequent ventilatory failure. In this study, 27 very low birth weight infants who were ½ to 28 days old at the time of extubation were randomly divided into two groups. One group of 13 study infants were extubated directly from intermittent mandatory ventilation rates of six to ten per minute, and the other 14 control infants were placed on continuous positive airway pressure through endotracheal tubes for six hours prior to an attempt to extubate. There was no difference between the two groups in gestational age, postnatal age, weight, or severity of lung disease at the time of extubation. All 13 study infants were successfully extubated without significant apnea or respiratory acidosis. Of the 14 control infants, only seven were successfully extubated; six infants had significant apnea and in one infant respiratory acidosis with pH 7.13 and Pco2 65 developed while receiving continuous positive airway pressure (13/13 v 7/14, P < .005). The seven infants who failed the preextubation trial of continuous positive airway pressure were later extubated from low intermittent mandatory ventilation rates without significant pnea or respiratory acidosis. Furthermore, slight CO2 retention developed in the very low birth weight infants after six hours of continuous positive airway pressure but not after direct extubation (mean change Pco2 ± SD: 4.43 ± 3.87 v -0.23 ± 3.79 mm Hg, P < .01). This study demonstrates that the recommended preextubation trial of continuous positive airway pressure through an endotracheal tube is not only unnecessary but detrimental to very low birth weight infants, in whom more apnea and slight CO2 retention develop probably because of increased airway resistance through small endotracheal tubes.

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