Continuous positive airway pressure: scientific and clinical rationale

Morley, Colin J; Davis, Peter G

doi:10.1097/mop.0b013e3282f63953

Cited by 48 publications

(42 citation statements)

References 60 publications

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“…1 In infants with severe RSV bronchiolitis, CPAP reduces the esophageal pressure time product, and 6 to 7 cm H 2 O CPAP was associated with the greatest muscle unloading, improvement in breathing pattern, and favorable clinical outcome. [2][3][4] In this series, all infants needing NRS were ,1 year old.…”

Section: Discussionmentioning

confidence: 95%

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Continuous Positive Airway Pressure With Helmet Versus Mask in Infants With Bronchiolitis: An RCT

et al. 2015

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BACKGROUND: Noninvasive continuous positive airway pressure (CPAP) is usually applied with a nasal or facial mask to treat mild acute respiratory failure (ARF) in infants. A pediatric helmet has now been introduced in clinical practice to deliver CPAP. This study compared treatment failure rates during CPAP delivered by helmet or facial mask in infants with respiratory syncytial virus-induced ARF. METHODS:In this multicenter randomized controlled trial, 30 infants with respiratory syncytial virus-induced ARF were randomized to receive CPAP by helmet (n = 17) or facial mask (n = 13). The primary endpoint was treatment failure rate (defined as due to intolerance or need for intubation). Secondary outcomes were CPAP application time, number of patients requiring sedation, and complications with each interface.RESULTS: Compared with the facial mask, CPAP by helmet had a lower treatment failure rate due to intolerance (3/17 [17%] vs 7/13 [54%], P = .009), and fewer infants required sedation (6/17 [35%] vs 13/13 [100%], P = .023); the intubation rates were similar. In successfully treated patients, CPAP resulted in better gas exchange and breathing pattern with both interfaces. No major complications due to the interfaces occurred, but CPAP by mask had higher rates of cutaneous sores and leaks.CONCLUSIONS: These findings confirm that CPAP delivered by helmet is better tolerated than CPAP delivered by facial mask and requires less sedation. In addition, it is safe to use and free from adverse events, even in a prolonged clinical setting. WHAT'S KNOWN ON THIS SUBJECT:In a previous short-term physiologic randomized controlled trial, continuous positive airway pressure by helmet was feasible and efficient in improving gas exchange in pediatric acute respiratory failure due to bronchiolitis. WHAT THIS STUDY ADDS:Continuous positive airway pressure administered by helmet reduces the rate of noninvasive respiratory support failure and provides longer application time with less sedation than a facial mask. In addition, it is safe to use and free from adverse events.

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Section: Discussionmentioning

confidence: 95%

“…[1][2][3][4][5] Inflammation triggers the obstruction of small airways, resulting in reduced lung function and rapid, shallow breathing. 4 Up to 8% of infants with acute RSV bronchiolitis are admitted to a PICU needing noninvasive respiratory support (NRS) because of recurrent apnea or acute respiratory failure (ARF).…”

Section: Respiratory Syncytial Virus (Rsv)mentioning

confidence: 99%

Continuous Positive Airway Pressure With Helmet Versus Mask in Infants With Bronchiolitis: An RCT

et al. 2015

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“…These pressure values were chosen on the basis of those reported in clinical practice (22,30). In each condition, following a basal recording of 5 min, the lambs were offered a bottle filled with reconstituted ewe's milk, heated to 39°C.…”

Section: Experimental Equipmentmentioning

confidence: 99%

Effects of nasal continuous positive-airway pressure on nutritive swallowing in lambs

Bernier

Catelin

Ahmed

et al. 2012

Journal of Applied Physiology

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Praud JP. Effects of nasal continuous positive-airway pressure on nutritive swallowing in lambs. J Appl Physiol 112: 1984 -1991, 2012. First published April 12, 2012 doi:10.1152/japplphysiol.01559.2011.-Current knowledge suggests that, to be successful, oral feeding in preterm infants should be initiated as soon as possible, often at an age where immature respiration still requires ventilatory support in the form of nasal continuous positive airway pressure (nCPAP). While some neonatologist teams claim great success with initiation of oral feeding in immature infants with nCPAP, others strictly wait for this ventilatory support to be no longer necessary before any attempt at oral feeding, fearing laryngeal penetration and tracheal aspiration. Therefore, the aim of the present study was to provide a first assessment of the effect of various levels of nCPAP on bottle-feeding in a neonatal ovine model, including feeding safety, feeding efficiency, and nutritive swallowing-breathing coordination. Eight lambs born at term were surgically instrumented 48 h after birth to collect recordings of electrical activity of laryngeal constrictor muscle, electrocardiography, and arterial blood gases. Two days after surgery, lambs were bottle-fed under five randomized nCPAP conditions, including without any nCPAP or nasal mask and nCPAP of 0, 4, 7, and 10 cmH2O. Results revealed that application of nCPAP in the full-term lamb had no deleterious effect on feeding safety and efficiency or on nutritive swallowing-breathing coordination. The present study provides a first and unique insight on the effect of nCPAP on oral feeding, demonstrating its safety in newborn lambs born at term. These results open the way for further research in preterm lambs to better mimic the problems encountered in neonatology.

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“…The concurrent concerns are essentially the same (Chess et al, 2006), with emphasis on such techniques as elective high frequency oscillatory ventilation (Cools et al, 2009), early nasal continuous positive airway pressure (te Pas et al, 2007;Morley and Davis, 2008), extracorporeal membrane oxygenation [ECMO] (Petrou and Edwards, 2004), and the addition of small amounts of nitric oxide [NO] to the inhalant gas (Da-Silva and Dellinger, 2004). Indeed, the overall problem remains as great as or even more prevalent than in decades past with renewed emphasis on the public health aspects, seeking the prevention of premature birth as the best prophylaxis for neonatal respiratory distress (Morken, 2010).…”

Section: Introductionmentioning

confidence: 99%

On the pulmonary toxicity of oxygen: III. The induction of oxygen dependency by oxygen use

Shanklin

2010

Experimental and Molecular Pathology

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Oxygen is central to the development of neonatal lung injury. The increase in oxygen exposure of the neonatal lung during the onset of extrauterine air breathing is an order of magnitude, from a range of 10-12 to 110-120 Torr. The contributions of oxygen and the volume and pressure relationships of ventilatory support to lung injury are not easily distinguished in the clinical setting. Sequential changes in inspired air or 100% oxygen were studied in 536 newborn rabbits without ventilatory support. Bilateral cervical vagotomies (BCV) were performed at 24 hours post natal to induce ventilatory distress which eventuates in hyaline membrane disease. The sequences applied yielded evidence for an induced state of oxygen dependency from oxygen use which was reflected in differences in survival and the extent of pulmonary injury. The median survival for animals kept in air throughout was 3 hours. Oxygen before vagotomy or during the first 3 hours afterwards extended the survival significantly but produced more extensive, more severe, and more rapid lung lesions. Returning animals to air after prior oxygen exposure reduced the number of survivors past 10 hours and shortened the maximum survival in those groups. These features indicate the development of a dependency of the defense mechanisms on the availability of oxygen at the higher level for metabolic and possibly other aspects of the pulmonary and systemic response to injury, beyond the usual physiological need.Subset analysis revealed additive and latent effects of oxygen and demonstrated a remarkable rapidity in onset of severe lesions under some circumstances, illustrating the toxicity of oxygen per se.

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Continuous positive airway pressure: scientific and clinical rationale

Abstract: Noninvasive ventilation has partially fulfilled its promise as a gentler alternative to ventilation via an endotracheal tube. Appropriately designed randomized clinical trials are required to determine the best nasal interfaces and pressure generators.

Cited by 48 publications

References 60 publications

Continuous Positive Airway Pressure With Helmet Versus Mask in Infants With Bronchiolitis: An RCT

Continuous Positive Airway Pressure With Helmet Versus Mask in Infants With Bronchiolitis: An RCT

Effects of nasal continuous positive-airway pressure on nutritive swallowing in lambs

On the pulmonary toxicity of oxygen: III. The induction of oxygen dependency by oxygen use

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