Effects of Nasal Continuous Positive Airway Pressure and Cannula Use in the Neonatal Intensive Care Unit Setting

Abstract

Objective To investigate the effects of nasal continuous positive airway pressure (CPAP) and cannula use in the neonatal intensive care unit. Design Cross-sectional study. Setting Tertiary care children’s hospital. Patients One hundred patients (200 nasal cavities), younger than 1 year, who received at least 7 days of nasal CPAP (n = 91) or cannula supplementation (n = 9) in the neonatal intensive care unit. Interventions External nasal examination and anterior nasal endoscopy with photographic documentation. Main Outcome Measures The incidence and characteristics of internal and external nasal findings of patients with nasal CPAP or cannula use. Results Nasal complications were seen in 12 of the 91 patients (13.2%) with at least 7 days of nasal CPAP exposure, while no complications were seen in the 9 patients with nasal cannula use alone. The external nasal finding of columellar necrosis, seen in 5 patients (5.5%), occurred as early as 10 days after nasal CPAP use. Incidence of intranasal findings attributed to CPAP use, in the 182 nostrils examined, included ulceration in 6 nasal cavities (3.3%), granulation in 3 nasal cavities (1.6%), and vestibular stenosis in 4 nasal cavities (2.2%). Intranasal complications were seen as early as 8 to 9 days after nasal CPAP administration. Nasal complications from CPAP were associated with lower Apgar scores at 1 (P = .02) and 5 (P = .06) minutes. Conclusions External or internal complications of nasal CPAP can be relatively frequent (13.2%) and can occur early, and patients with lower Apgar scores may be at higher risk. Close surveillance for potential complications should be considered during nasal CPAP use.

Medical device-related pressure ulcers

“…The priority placed on the airway often leads to tight securements, leading to ulcers from the securement device (eg, lip ulcers from tape to secure the ET tube), a tight device to maintain a seal (eg, facial ulcers from noninvasive positive pressure ventilation [NIPPV]), or tightening the tubing to prevent dislodgement (eg, tightening up the nasal cannula, leading to ulcers on the ears or face). Jatana et al 10 reported that 13% of children with NIPPV develop ulcers and 6% of them develop necrosis of the columella.…”

Non-Invasive Ventilation and Surfactant Therapy

“…These interfaces are difficult to secure, which may further limit the handling of sick patients, and are also associated with a high incidence of nasal injuries, such as, columellar necrosis and nasal deformities [66,67]. We have experience using a specially designed nasal cannula (Neotech RAM Nasal Cannula) to provide NCPAP as well as NIPPV in the delivery room and in the NICU in over 500 patients, for over 5,000 days with an extremely low incidence of nasal injuries [68].…”

An Assessment Tool for Babies Requiring Continuous Positive Airway Pressure or High Flow

“…One study reports an overall internal or external complication rate of 13.2%, including tissue necrosis, intranasal ulceration, granulation, and vestibular stenosis [4]. Care givers providing close observations, i.e.…”