scholarly journals Positive Airway Pressure at Extubation Minimizes Subglottic Secretion Leak In Vitro

2022 ◽  
Vol 11 (2) ◽  
pp. 307
Author(s):  
Tzu-Pei Wang ◽  
Hsin-Hsien Li ◽  
Hui-Ling Lin
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Endotracheal Tube ◽  
Negative Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Positive Pressure ◽  
Subglottic Secretion ◽  
Pressure Setting ◽  
Lower Volume

Accumulated secretion above the endotracheal tube cuff can be aspirated during extubation after deflation. The possible techniques for minimizing pulmonary aspiration from subglottic secretion during extubation have not been well explored. This study aimed to determine the effect of different extubation techniques on secretion leakage. An endotracheal tube was placed in a tube mimicking an airway. We measured the leak volume of water or artificial sputum of different viscosities with three extubation techniques—negative pressure with suctioning; positive pressure with a resuscitator; and continuous positive airway pressure set at 5, 10, and 20 cm H2O. Extubation with continuous positive airway pressure resulted in lower secretion leakage than that with negative pressure with suctioning and positive pressure with a resuscitator. Increasing the continuous positive airway pressure level decreased secretion leakage volume during extubation. We further determined a correlation of leak volume with sputum viscosity. Continuous positive airway pressure at 5 cm H2O produced lower volume secretion leakage than the other two techniques, even with higher secretion viscosity. Based on these results, using continuous positive airway pressure with a previous ventilator continuous positive airway pressure/positive end-expiratory pressure setting for extubation is recommended.

scholarly journals Effect of continuous positive airway pressure treatment on permeability, inflammation and mucus production of human epithelial cells

2020 ◽  
Vol 6 (2) ◽  
pp. 00327-2019
Author(s):  
Sandra Grau-Bartual ◽  
Ahmed M. Al-Jumaily ◽  
Paul M. Young ◽  
Daniela Traini ◽  
Maliheh Ghadiri
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Nasal Congestion ◽  
Positive Pressure ◽  
Cpap Therapy ◽  
Upper Airways ◽  
Mucus Production ◽  
Obstructive Sleep

Continuous positive airway pressure (CPAP) therapy is the gold standard treatment for obstructive sleep apnoea, which affects millions of people worldwide. However, this therapy normally results in symptoms such as dryness, sneezing, rhinorrhoea, post-nasal drip, nasal congestion and epistaxis in the upper airways.Using bronchial epithelial (Calu-3) and nasal epithelial (RPMI 2650) cells in an in vitro respiratory model, this study, for the first time, investigates the effect of CPAP positive pressure on the human respiratory epithelial mechanisms that regulate upper airways lubrication characteristics. To understand how the epithelium and mucus are affected by this therapy, several parameters were determined before and after positive pressure application.This work demonstrates that the positive pressure not only compresses the cells, but also reduces their permeability and mucus secretion rate, thus drying the airway surface liquid layer and altering the mucus/water ratio. It is also observed that the respiratory epithelia is equally inflamed without or with external humidification during CPAP application.These findings clearly identify the causes of the side-effects reported by patients under CPAP therapy.

Nonattended Home Automated Continuous Positive Airway Pressure Titration: Comparison with Polysomnography

2003 ◽  
Vol 128 (3) ◽  
pp. 353-357 ◽  
Author(s):  
B. Tucker Woodson ◽  
Adrian Saurejan ◽  
Laura T. Brusky ◽  
Joseph K. Han
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Home Environment ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Case Series ◽  
Positive Pressure ◽  
Apnea Hypopnea Index ◽  
Pressure Setting ◽  
Central Apneas ◽  
Therapeutic Pressure

OBJECTIVE: Automatic adjusting nasal continuous positive airway pressure titration (APAP) has been introduced as an alternative method of establishing pressures for patients with sleep apnea. The performance and accuracy of APAP in nonattended home environment are controversial. This study assessed APAP polysomnographic outcomes and accuracy in a nonattended home environment. STUDY DESIGN AND SETTING: We conducted a retrospective consecutive case series of 24 consecutive patients who had nonattended APAP and simultaneous full polysomnography (PSG). RESULTS: APAP was tolerated and reduced obstructive Apnea-Hypopnea Index (AHI) to < 10 events/h in all patients. Mean AHI decreased from 38.4 (21.2) to 5.9 (6.6) events/h. Central apneas worsened in one patient. A therapeutic pressure was determined in 91% of patients. Autoset accurately measured residual AHI compared with PSG ( R = 0.77, P < 0.001). APAP overestimated the AHI by 1.4 events/h. CONCLUSIONS: Nonattended APAP is successful in many patients in determining a therapeutic positive pressure setting. Reported AHI via Autoset is similar to that of PSG. SIGNIFICANCE: APAP reduces AHI and is tolerated in a nonattended environment.

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).

Continuous Positive Airway Pressure

PEDIATRICS ◽  
1972 ◽  
Vol 49 (3) ◽  
pp. 468-469
Author(s):  
Peter A. M. Auld ◽  
Alfred N. Krauss ◽  
David B. Klain
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Negative Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Clinical Course ◽  
Lower Extremities ◽  
Hyaline Membrane Disease ◽  
Positive Pressure ◽  
Hyaline Membrane ◽  
Intermittent Positive Pressure Breathing

The recent enthusiastic report of the use of continuous positive airway pressure (CPAP) prompts us to report our own experience with this method of therapy in infants with severe hyaline membrane disease. In 1968, four severely affected infants with hyaline membrane disease were treated with CPAP. The therapy was undertaken in infants whose clinical course was deteriorating under intermittent positive pressure breathing. The CPAP was applied by a negative pressure chamber that enclosed a child's chest, abdomen, and lower extremities.

Nasal Intermittent Positive Pressure Ventilation versus Continuous Positive Airway Pressure and Apnea of Prematurity: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Bayane Sabsabi ◽  
Ava Harrison ◽  
Laura Banfield ◽  
Amit Mukerji
Keyword(s):  
Systematic Review ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Primary Outcome ◽  
Positive Pressure Ventilation ◽  
Positive Airway Pressure ◽  
Meta Analysis ◽  
Intermittent Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Apnea Of Prematurity

Objective The study aimed to systematically review and analyze the impact of nasal intermittent positive pressure ventilation (NIPPV) versus continuous positive airway pressure (CPAP) on apnea of prematurity (AOP) in preterm neonates. Study Design In this systematic review and meta-analysis, experimental studies enrolling preterm infants comparing NIPPV (synchronized, nonsynchronized, and bi-level) and CPAP (all types) were searched in multiple databases and screened for the assessment of AOP. Primary outcome was AOP frequency per hour (as defined by authors of included studies). Results Out of 4,980 articles identified, 18 studies were included with eight studies contributing to the primary outcome. All studies had a high risk of bias, with significant heterogeneity in definition and measurement of AOP. There was no difference in AOPs per hour between NIPPV versus CPAP (weighted mean difference = −0.19; 95% confidence interval [CI]: −0.76 to 0.37; eight studies, 456 patients). However, in a post hoc analysis evaluating the presence of any AOP (over varying time periods), the pooled odds ratio (OR) was lower with NIPPV (OR: 0.46; 95% CI: 0.32–0.67; 10 studies, 872 patients). Conclusion NIPPV was not associated with decrease in AOP frequency, although demonstrated lower odds of developing any AOP. However, definite recommendations cannot be made based on the quality of the published evidence. Key Points

Care of the Neonate on Nasal Continuous Positive Airway Pressure: A Bedside Guide

2018 ◽  
Vol 37 (1) ◽  
pp. 24-32
Author(s):  
Jennifer M. Guay ◽  
Dru Carvi ◽  
Deborah A. Raines ◽  
Wendy A. Luce
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Respiratory Distress ◽  
Parent Education ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Clinical Manifestations ◽  
Neonatal Morbidity ◽  
Intermittent Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Team Approach

Respiratory distress continues to be a major cause of neonatal morbidity. Current neonatal practice recommends the use of nasal continuous positive airway pressure (nCPAP) in the immediate resuscitation and continued support of neonates of all gestations with clinical manifestations of respiratory distress. Despite the many short- and long-term benefits of nCPAP, many neonatal care units have met resistance in its routine use. Although there have been numerous recent publications investigating the use and outcomes of various modes of nCPAP delivery, surfactant administration, mechanical ventilation, and other forms of noninvasive respiratory support (high-flow nasal cannula, nasal intermittent positive pressure ventilation), there has been a relative lack of publications addressing the practical bedside care of infants managed on nCPAP. Effective use of nCPAP requires a coordinated interprofessional team approach, ongoing assessment of the neonate, troubleshooting the nCPAP circuit, and parent education.

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