CPAP and Mechanical Ventilation

Abstract

Respiratory insufficiency has previously been a frequent cause of neonatal death, especially in preterm infants. As late as in 1967, Silverman and associates (66) found that in infants with hyaline membrane disease (HMD), mechanical ventilation with a body-enclosing negative pressure respirator did not improve survival. Before 1970, the mortality among infants who required respiratory therapy was high (20;46;70). At the end of the 1960s and the beginning of the 1970s, several new methods were introduced to improve ventilation of newborn infants. Kirby and coworkers (41) introduced intermittent mandatory ventilation as a way of weaning from mechanical ventilation. In a series of studies, Reynolds and coworkers evaluated the effects of different peak airway pressures, respiratory frequencies, and inspiratory:expiratory ratios on arterial blood gases and right to left shunts (32;58;59;60).

Randomized controlled trial of discontinuation of nasal-CPAP in stable preterm infants breathing room air

“…Therefore, an infant requiring low FiO 2 has higher lung compliance and needs less CPAP. Clinical observations, however, have indicated that some preterm infants require nasal-CPAP for some time after their FiO 2 requirements have reached atmospheric levels (9,10), and in Rigshospitalet the tradition is, in general, not to decrease CPAP pressure below 4 cmH 2 O. In the present trial, oxygenation variables dropped after discontinuation of CPAP.…”

Good outcomes using mask continuous positive airway pressure in elderly patients with acute pulmonary oedema

“…This carried significant risks and had considerable resource implications, particularly the need for specially trained staff to care for the patient and the need for expensive ventilatory and monitoring equipment, usually only available in intensive care units (ICU), In Australia, mechanical ventilation is unlikely to be offered to patients aged over 85 years while practice for those aged 80 to 85 years varies. CPAP therapy by face mask has been suggested as an alternative adjunctive therapy in the treatment of APO 1,2,5–8 and has shown to be effective 3,4,8 .…”

Indications for Continuous Positive Airway Pressure and Respirator Therapy

“…Continuous positive airway pressure can also increase the work of breathing (2;11). Technical aspects of continuous positive airway pressure are further discussed by Sedin (26).…”