CPAP

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Respiratory distress syndrome

• 28% of neonatal deaths are due to prematurity

• The most common respiratory disorder in the preterm is Respiratory distress syndrome due to lack of surfactant

• Typically affects preterm infants below 35 weeks

• Increase in the alveolar surface tension and a tendency for alveolar collapse, progressive atelectasis and reduced compliance

• Treatment –Surfactant,CPAP, mechanical ventilation

Mechanical Ventilation

• Expensive

• Expertise

• Chronic lung disease

• Intraventricular haemorrhage

- CPAP(Continuous positive airway

pressure) • A positive pressure applied to the airways of a

spontaneously breathing baby throughout the respiratory cycle

• First used in the 1970s• Splints the upper airway and decreases obstruction and

apnoea• Expansion of the lungs and prevents alveolar collapse• In so doing, it reduces protein leak and conserves

surfactant• It maintains positive pressure in the airways during

spontaneous breathing hence increasing functional residual capacity and improving oxygenation in infants with RDS

Nasal CPAP

• Nasal CPAP is gas delivered under a low pressure into the nose.

• CPAP is used to treat:• 1. Respiratory distress• 2. Apnoea of prematurity• 3. Weaning from ventilation• 4. Upper airway obstruction• 5. May help in the management of pulmonary

oedema

Effects of Cpap

• It increases the lung volume• It reduces atelectasis• It conserves surfactant• It regularises the respiratory rate• It reduces the incidence of apnoea• When used after extubation it reduces the chance of reintubation• Reduces work of breathing• It supports the nasopharyngeal airway• It improves compliance• It lowers resistance• It reduces pulmonary oedema

Technique of CPAP

• CPAP single nasal tube

• Bi-nasal prongs.

• CPAP is supplied using

- a ventilator set on the CPAP mode,

- “bubbling bottle” system

- Neopuff device

Initiation of CPAP

• Usual Range 3 – 8cm H20• Pressure 5-6 cm H2O• Increase as necessary to improve

oxygenation• Max 8-10 CM H2O• Clinical state,CXR,• Blood gases 30-60min

Weaning

• No exact Science

• Assess saturation ,apnoea ,bradycardia, work of breathing

• FIO2<0.40

• Wean by 1cm steps till Pressure 5cm or less

• Onto low flow oxygen

Failure of CPAP

• Increasing apnoea

• Rising Fio2>60% oxygen

• PaCO2>60mmHg

• Ph>7.25

Complications of CPAP• Displacement,blockage by secretions• Kink• Alveolar overdistension- - pneumothorax - reduced tidal volumes leading to CO2 retention - increased work of breathing, - impaired systemic venous return,decreased cardiac output,renal dysfunction• CPAP belly bowel distension, swallowed air, distended loops So always have NG tube No link to nec• Nasal trauma

Coin Study

• 1999-2006• Australia ,New Zealand,Canada, US• 610 gestation 25-28 weeks• CPAP or Intubation• CPAP - fewer ventilation days - 46% failed and needed mechanical ventilation

Kijabe study

• Dr Omoding(2012)

• 61 preterm neonates

• The median duration of Bubble CPAP treatment was 5 days (IQR 3 to 7 days)

• No report of the major complications

CPAP

• Relatively cheap

• Easy to use

• Complications few

• Saves lives

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ASANTE