Continuous Positive Airway Pressure in the Neonatal Intensive Care

Level 1

Mark A. Willing, RRT-NPS

What Does It Do?

Assists in reducing alveolar collapse at end exahalation

Increases the mean airway pressure Reduces the incidence of obstructive

and central apneas

Clinical Uses in the NICU

A bridge between intubation/mechanical ventilation and supplemental oxygen administration

To reduce the incidence of apnea of prematurity

Physiological Considerations for Neonates

Preferential nose breathers Flow and pressure in the airway can stimulate

breathing Predisposed to alveolar collapse at end

exhalation Chest wall compliance is generally greater

than lung compliance Tend to use abdominal breathing

Ways to Deliver CPAP

Mechanical ventilator High-flow nasal cannula Nasal prong CPAP device

Airway Devices

Long or short nasal prongs Tracheostomy tube Nasopharyngeal tube Mask Endotracheal tube

Bubble CPAP

A fluid-filled reservoir is used as a means of maintaining the desired level of CPAP

Provides a natural “pop-off” Oscillations in the circuit have been

speculated to aid in ventilation Simple, inexpensive, and dependable

Clinical Application

The correct size nasal prongs will be those which completely fill the lumen of the nares without stretching them.

Too small of prongs will necessitate the need for an increased flow setting which leads to internal swelling of the nasal passages

Too large of prongs will lead to pressure sores and necrosis

Assessment of Function

Maintain a fine mist of condensation in the prongs

Maintain the proper fluid level in the reservoir

Use the lowest flow setting which will allow for steady bubbling in the reservoir

Patient Management

Maintain patency of the nasal passages Prongs should point posteriorly along

the palate Take steps to reduce pressure sores The patient’s head should be in a

neutral position Take steps to reduce gastric insufflation

Why Won’t It Bubble?

Complete or partial circuit disconnect Complete or partial prong disconnect The prongs are out of the nares Inadequate flow through the circuit Prongs are too small for the patient Patient’s mouth is open

The Circuit Tubing Is Too Hot

Inadequate flow in that part of the circuit High inspiratory flow demands of the

patient Circuit has been off the patient for an

extended period of time

Summary

CPAP can be a safe, effective means of supporting respiration and ventilation in neonates

Diligence and assertive care must be taken to maintain proper breathing mechanics, positioning, and airway patency