Nasal continuous positive airway pressure: does bubbling improve gas exchange?

Morley, C J

doi:10.1136/adc.2004.062588

Cited by 67 publications

(38 citation statements)

References 5 publications

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“…They also found, however, that increasing the intensity of the flow rate on B-CPAP did not have additional benefits over lower flow rates. This is in keeping with a study by Morley et al 6 that found an increased CPAP prong pressure but no difference in TcPCO 2 , TcPO 2 , SaO 2 and RR between a low flow-rate and higher flow-rate group of premature infants on B-NCPAP. We found little difference in most short-term respiratory outcomes tested between B-NCPAP and V-NCPAP; however, TcO 2 was higher in our study during B-NCPAP.…”

Section: Comparison Of Bubble and Ventilator-derived Ncpap Se Courtnesupporting

confidence: 92%

“…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. 6 We have previously shown in both a lung model and in premature infants that pressure delivered to the nasal prongs in a B-NCPAP system is greater than the immersion depth of the expiratory tubing, even at the lowest flow that causes gentle continuous bubbling. 9,10 We also showed that this pressure overshoot was systematically greater as the flow magnitude increased.…”

Section: Introductionmentioning

confidence: 98%

“…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%

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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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Section: Comparison Of Bubble and Ventilator-derived Ncpap Se Courtnesupporting

confidence: 92%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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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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“…18,26,27 Although the water seal bubble CPAP system employed in other reports of preferential early NCPAP has theoretical advantages in lung recruitment and differential effects in response to variable lung compliance, 17 varying the degree of oscillation does not alter short-term oxygenation or ventilation in preterm infants. 28 Further, no differential effects on lung mechanics were demonstrated after short-term support of preterm infants with the variable-flow system compared to the water seal bubble system, except for slightly lower respiratory rates and resistive work of breathing during variable-flow NCPAP support. 19 We did not observe any significant increases in mortality or other neonatal morbidities in our ELBW infants after our practice change.…”

Section: Discussionmentioning

confidence: 78%

Early variable-flow nasal continuous positive airway pressure in infants ⩽1000 grams at birth

2006

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Objective: To compare the incidence of chronic lung disease (CLD) in extremely low birth weight (ELBW, p1000 g) infants before and after the introduction of early, preferential application of nasal continuous airway pressure (NCPAP) utilizing a variable flow delivery system. Study design:A retrospective cohort study of ELBW infants 2 years prior to (Pre-early NCPAP, n ¼ 96) and 2 years following (Early NCPAP, n ¼ 75) the initiation of an early NCPAP policy.Results: There were no significant changes (Pre-early NCPAP vs Early NCPAP) in the incidences of CLD (35 vs 33%, P ¼ 0.81) or CLD or death (50 vs 43%, P ¼ 0.34). Infants in the Early NCPAP group weaned off mechanical ventilation and supplemental oxygen more rapidly than infants in the Pre-early NCPAP group (hazard ratio (HR) 1.80, P ¼ 0.002 and HR 1.69, P ¼ 0.01). Conclusion:A policy of early NCPAP has not decreased the incidence of CLD despite a decrease in time to successful tracheal extubation.

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“…In a multicenter, randomized study, 80% of ELBW infants required intubation by 7 days of age. 30 34 showed that bubbling rates during bubble CPAP had no effect on ventilation or oxygenation. In preterm lambs, lung volumes were higher with bubble CPAP as compared to conventional CPAP.…”

Section: Noninvasive Ventilation Strategiesmentioning

confidence: 99%

Lung protective ventilatory strategies in very low birth weight infants

Ramanathan

Sardesai

2008

J Perinatol

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Respiratory distress syndrome (RDS) is the most common respiratory diagnosis in preterm infants. Surfactant therapy and mechanical ventilation using conventional or high-frequency ventilation have been the standard of care in the management of RDS. Bronchopulmonary dysplasia (BPD) continues to remain as a major morbidity in very low birth weight infants despite these treatments. There is no significant difference in pulmonary outcome when an optimal lung volume strategy is used with conventional or high-frequency ventilation. Lung injury is directly related to the duration of invasive ventilation via the endotracheal tube. Studies using noninvasive ventilation, such as nasal continuous positive airway pressure and noninvasive positive pressure ventilation, have shown to decrease postextubation failures as well as a trend toward reduced risk of BPD. Lung protective ventilatory strategy may involve noninvasive ventilation as a primary therapy or following surfactant administration in very preterm infants with RDS. Initial steps in the management of preterm infants may also include sustained inflation to establish functional residual capacity, followed by noninvasive ventilation to minimize lung injury and subsequent development of BPD.

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Nasal continuous positive airway pressure: does bubbling improve gas exchange?

Cited by 67 publications

References 5 publications

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

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

Early variable-flow nasal continuous positive airway pressure in infants ⩽1000 grams at birth

Lung protective ventilatory strategies in very low birth weight infants

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