A Comparison of Underwater Bubble Continuous Positive Airway Pressure with Ventilator-Derived Continuous Positive Airway Pressure in Premature Neonates Ready for Extubation

Lee, Kyong-Soon; Dunn, Michael; Fenwick, Marsha; Shennan, Andrew

doi:10.1159/000013962

Cited by 160 publications

(106 citation statements)

References 10 publications

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“…Early published data suggest that a tighter seal between the oxygen delivery system and the nose is essential, which presumably results in higher CPAP pressure for a given oxygen flow and ventilatory pattern. 11 The airway pressure generated with high-flow oxygen therapy is variable and unpredictable. 11,12 The use of a tighter seal would increase the propensity for complications such as nasal obstruction, bleeding, and necrosis, which the literature reports are associated with the use of oxygen delivery via nasal cannula.…”

Section: Discussionmentioning

confidence: 99%

“…11 The airway pressure generated with high-flow oxygen therapy is variable and unpredictable. 11,12 The use of a tighter seal would increase the propensity for complications such as nasal obstruction, bleeding, and necrosis, which the literature reports are associated with the use of oxygen delivery via nasal cannula. 13,14 Therefore, clinical practice dictates that the nasal prongs be sized so as not to completely occlude the nares, therefore always maintaining a leak in the system.…”

Section: Discussionmentioning

confidence: 99%

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Evaluating the Effect of Flow and Interface Type on Pressures Delivered With Bubble CPAP in a Simulated Model

Bailes

Firestone²,

Dunn³

et al. 2015

Respir Care

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BACKGROUND: Bubble CPAP, used for spontaneously breathing infants to avoid intubation or postextubation support, can be delivered with different interface types. This study compared the effect that interfaces had on CPAP delivery. We hypothesized that there would be no difference between set and measured levels between interface types. METHODS: A validated preterm infant nasal airway model was attached to the ASL 5000 breathing simulator. The simulator was programmed to deliver active breathing of a surfactant-deficient premature infant with breathing frequency at 70 breaths/min inspiratory time of 0.30 s, resistance of 150 cm H 2 O/L/s, compliance of 0.5 mL/cm H 2 O, tidal volume of 5 mL, and esophageal pressure of ؊10 cm H 2 O. Nasal CPAP prongs, size 4030, newborn and infant RAM cannulas were connected to a nasal airway model and a bubble CPAP system. CPAP levels were set at 4, 5, 6, 7, 8, and 9 cm H 2 O with flows of 6, 8, and 10 L/min each. Measurements were recorded after 1 min of stabilization. The analysis was performed using SAS 9.4. The Kolmogorov-Smirnov test assessed normality of the data. The Friedman test was used to compare non-normally distributed repeated measures. The Wilcoxon signed-rank test was used to conduct post hoc analysis. All tests were 2-sided, and P values of <.05 were considered as indicating significant differences unless otherwise indicated. RESULTS: At lower set CPAP levels, 4 -6 cm H 2 O, measured CPAP dropped precipitously with the nasal prongs with the highest flow setting. At higher CPAP levels, 7-9 cm H 2 O measured CPAP concomitantly increased as the flow setting increased. Statistically significant differences in set and measured CPAP occurred for all devices across all CPAP levels, with the measured CPAP less than set for all conditions, P < .001. CONCLUSIONS: Set flow had a profound effect on measured CPAP. The concomitant drop in measured pressure with high and low flows could be attributed to increased resistance to spontaneous breathing or insufficient flow to meet inspiratory demand. Clinicians should be aware of the effect that the interface and flow have on CPAP delivery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evaluating the Effect of Flow and Interface Type on Pressures Delivered With Bubble CPAP in a Simulated Model

Bailes

Firestone²,

Dunn³

et al. 2015

Respir Care

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“…3 Benefits to gas exchange and lung recruitment during B-NCPAP, due to the high-frequency oscillatory content of the bubbling, have been hypothesized. [4][5][6][7] It is still a widely held belief that the delivered mean intraprong pressure during B-NCPAP may be estimated by the submersion depth of the expiratory tubing and is independent of the flow rate. 8 However, the bubbling in a B-NCPAP system causes variability in the delivered mean B-NCPAP pressure, and has been shown to be dependent on the bias flow rate.…”

Section: Introductionmentioning

confidence: 99%

Bubble and ventilator-derived nasal continuous positive airway pressure in premature infants: work of breathing and gas exchange

et al. 2010

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Objective: During bubble nasal continuous positive airway pressure (B-NCPAP), gas flows through the expiratory limb of CPAP tubing submerged underwater to a depth in centimeters considered equal to the desired end expiratory pressure. Ventilator-derived NCPAP (V-NCPAP) controls the delivered pressure at the expiratory orifice. Limited data exist comparing the two forms of NCPAP on work of breathing (WOB) and other short-term respiratory outcomes. We compared WOB and gas exchange between B-NCPAP and V-NCPAP at equivalent delivered nasal prong pressures among a cohort of preterm infants on NCPAP.Study Design: We performed a randomized crossover study in 18 premature infants <1500 g (BW 1101±254 g, GA 28±2 weeks, study age 13 ± 8 days (means ± s.d.)), who were already on NCPAP for mild respiratory distress, comparing B-NCPAP to V-NCPAP. Each infant was studied at a constant flow rate and varying pressures of 3, 5, 7, 4 and 2 cm H 2 O in that order. Tidal volumes were obtained by calibrated respiratory inductance plethysmography. Intrapleural pressure was estimated by an esophageal catheter. WOB (inspiratory, elastic and resistive) was calculated from pressure volume data. Breathing asynchrony was assessed with phase angle. Comparisons of respiratory rate, heart rate, tidal volume, minute ventilation, breathing asynchrony, lung compliance, oxygen saturation and transcutaneous (Tc) O 2 and CO 2 were also made.Result: WOB and most respiratory parameters were not different between B-NCPAP and V-NCPAP. TcO 2 was higher with B-NCPAP compared to V-NCPAP (P ¼ 0.01). TcCO 2 was not different. None of the other measured parameters was significantly different between the two devices.Conclusion: WOB and ventilation with B-NCPAP and V-NCPAP are similar when equivalent delivered prong pressures are assured. Improved oxygenation with B-NCPAP is intriguing and requires further investigation.

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“…They state that the vibrations produced by the water seal CPAP s bubbling are transmitted to the chests of the babies on this type of ventilatory support and could contribute to gas exchange. 8 The mechanism by which gas exchanges occur during high-frequency ventilation have not been completed explained, but they probably include direct ventilation of the proximal alveoli and increased diffusion because of the increased activity of the gas molecules or even by means of coaxial diffusion in which the air enters via the center and the CO 2 and other gasses are exhaled via the peripheries of the airways. 1,21,22 …”

Section: Test Lungmentioning

confidence: 99%

“…1,4,5 Continuous positive airway pressure could be defined as an artificial system for generating positive transpulmonary pressure during spontaneous respiration thus affording an increase in residual functional capacity (RFC), which is extremely important for newborn babies since it functions as an oxygen reservoir during those periods when there is no inward airflow, such as when crying or feeding, in addition to impacting on respiratory workload. [5][6][7][8][9][10] For many years, nasal CPAP was reserved for mild to moderate hyaline membrane disease, in larger preterms. 5,11 However, CPAP is coming to be employed as a successful therapy in around 37% of newborn babies weighing less than 1,000g, in 59% if newborn babies with weights between 1,000 and 1,500g and in 83% of preterms weighing more than 1,500 g. 11,12 The use of CPAP with very low birth weight preterm newborn babies is, in fact, debatable.…”

Section: Introductionmentioning

confidence: 99%

Comparação dos níveis de pressão positiva contínua nas vias aéreas através de dois sistemas

Lima¹,

Freire²,

Andrade³

et al. 2004

J. Pediatr. (Rio J.)

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Objective: To compare the generation of continuous positive airway pressure using a hand-made device (underwater seal) or a ventilator (Inter 3 ® ).Method: Two positive airway pressure generation systems were compared through laboratory simulations. Measurements were not considered if the mechanical ventilator required calibration or in the presence of gas flow variation (flowmeter sphere oscillation). Recordings were assessed in terms of the capacity to produce the desired pressure (3, 5 and 6 cmH 2 O) when submitted to three different flow values (8, 10 and 12 l/min). For that end, Student s t test for paired samples and the nonparametric Man-Whitney test for independent samples were employed.

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A Comparison of Underwater Bubble Continuous Positive Airway Pressure with Ventilator-Derived Continuous Positive Airway Pressure in Premature Neonates Ready for Extubation

Cited by 160 publications

References 10 publications

Evaluating the Effect of Flow and Interface Type on Pressures Delivered With Bubble CPAP in a Simulated Model

Evaluating the Effect of Flow and Interface Type on Pressures Delivered With Bubble CPAP in a Simulated Model

Bubble and ventilator-derived nasal continuous positive airway pressure in premature infants: work of breathing and gas exchange

Comparação dos níveis de pressão positiva contínua nas vias aéreas através de dois sistemas

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