CPAP

1
CPAP

• Murila fv

2
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

3
Mechanical Ventilation

• Expensive
• Expertise
• Chronic lung disease
• Intraventricular haemorrhage

4
- 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

5
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

6
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

7
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

8
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

9
Weaning

• No exact Science
• Assess saturation ,apnoea ,bradycardia, work of
  breathing
• FIO2lt0.40
• Wean by 1cm steps till Pressure 5cm or less
• Onto low flow oxygen

10
Failure of CPAP

• Increasing apnoea
• Rising Fio2gt60 oxygen
• PaCO2gt60mmHg
• Phgt7.25

11
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

12
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

13
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

14
CPAP

• Relatively cheap
• Easy to use
• Complications few
• Saves lives

15

• ASANTE