Short term evaluation of respiratory effort by premature infants supported with bubble nasal continuous airway pressure using Seattle-PAP and a standard bubble device

Abstract

BackgroundAlmost one million prematurely born infants die annually from respiratory insufficiency, predominantly in countries with limited access to respiratory support for neonates. The primary hypothesis tested in the present study was that a modified device for bubble nasal continuous positive airway pressure (Bn-CPAP) would provide lower work of spontaneous breathing, estimated by esophageal pressure-rate products.MethodsInfants born <32 weeks gestation and stable on Bn-CPAP with FiO2 <0.30 were studied within 72 h following delivery. Esophageal pressures during spontaneous breathing were measured during 2 h on standard Bn-CPAP, then 2 h with Bn-CPAP using a modified bubble device presently termed Seattle-PAP, which produces a different pattern of pressure fluctuations and which provided greater respiratory support in preclinical studies, then 2 h on standard Bn-CPAP.ResultsAll 40 infants enrolled completed the study and follow-up through 36 wks post menstrual age or hospital discharge, whichever came first. No infants were on supplemental oxygen at completion of follow-up. No infants developed pneumothoraces or nasal trauma, and no adverse events attributed to the study were observed. Pressure-rate products on the two devices were not different, but effort of breathing, assessed by areas under esophageal pressure-time curves, was lower with Seattle-PAP than with standard Bn-CPAP.ConclusionUse of Seattle-PAP to implement Bn-CPAP lowers the effort of breathing exerted even by relatively healthy spontaneously breathing premature neonates. Whether the lower effort of breathing observed with Seattle-PAP translates to improvements in neonatal mortality or morbidity will need to be determined by studies in appropriate patient populations.

Comparison of Bubble CPAP Devices Using RAM Cannula for Extubation Failure in Very Low Birth Weight Infants: Randomized and Cohort Studies

“…The pressure fluctuations can be further increased (Seattle-PAP) by adding an angled extension to the underwater tube [12]. Seattle-PAP can maintain ventilation in paralyzed, saline-lavaged rabbits on bCPAP, lowered breathing effort in infants, and is currently in a randomized trial (NCT03085329) [12, 20]. The similarities between devices may have negated any bubble effects, and other devices with more exaggerated pressure fluctuations could have different results.…”

An in‐line high frequency flow interrupter applied to nasal CPAP: Improved carbon dioxide clearance in a premature infant lung model

“…Nonetheless, improving gas exchange noninvasively continues to be of prime importance in the respiratory support of small infants. Recent attempts at improving BCPAP efficacy have been put forward, for eg, by slanting the distal end of the immersion tube to produce larger amplitude bubble oscillations, resulting in lower infant work of breathing …”

“…Recent attempts at improving BCPAP efficacy have been put forward, for eg, by slanting the distal end of the immersion tube to produce larger amplitude bubble oscillations, resulting in lower infant work of breathing. [17][18][19] Along this line, in a previous bench study, we explored the feasibility of applying high frequency to other forms of noninvasive respiratory support modalities by adding a simple flow interrupter operating at 4 to 10 Hz to the supply flow of an HFNC system. Using this device, we showed improved CO 2 clearance compared to nonoscillated flow.…”

The Importance of Synchronization During Neonatal Noninvasive Ventilation

“…In several studies, PTP and pressure-rate product measured with esophageal pressure monitoring has been used to evaluate indices of WOB in infants on NIV. 18,[35][36][37][38] Subject synchrony and measured PTP could have easily been addressed in the current study to evaluate synchronized and non-synchronized breaths. It is unclear why most neonatal studies that involve NIV-NAVA focus on synchrony and WOB in the absence of esophageal pressure.…”