Continuous possitive pressure ventilation (cpap)

CPAP

1. CONTINUOUS POSSITIVE PRESSURE VENTILATION (CPAP) Dr KM Parakrama Registrar NICU-THK 27 March 2020

2. INTRODUCTION Positive intrapulmonary pressure is applied artificially. Distending pressure is created in the alveoli. Done throughout the respiratory cycle . Baby is breathing spontaneously. Prevents airway collapse during expiration.

3. EFFECTS OF CPAP IN RESPIRATORY DISTRESS Reduces upper airway occlusion Reduces right to left shunting Reduces obstructive apneas Increases the functional residual capacity Reduces the work of breathing. Stabilizes the chest wall and counteracts the paradoxical movements .

4. Regularizes and reduces the respiratory rate . Improves ventilation perfusion mismatch . Conserves surfactant on the alveolar surface . Diminishes alveolar oedema. Nasal CPAP after extubation reduces the ventilator requirement. Improves oxygenation and carbon dioxide elimination

5. INDICATIONS FOR CPAP Respiratory distress at birth with spontaneous breathing. Increased work of breathing. Poorly expanded or infiltrated lung fields on CXR. Atelectasis. Pulmonary oedema. Pulmonary haemorrhage.

6. Apnoea of prematurity. Recent extubation. Abnormalities of the airways, predisposing to airway collapse. Phrenic nerve palsy

7. CONTRAINDICATIONS FOR CPAP Ventilatory failure—inability to maintain oxygenation and the arterial PaCO2 < 8 kPa and pH > 7.25 . Upper airway abnormalities (cleft palate, choanal atresia ). Tracheoesophageal fistula. Diaphragmatic hernia. Severe cardiovascular instability.

8. CPAP DELIVERY SYSTEM Consists of three components : Circuit for continuous flow of inspired gases, Interface connecting the CPAP circuit to the infant’s airway, Method of creating positive pressure in the CPAP Circuit.

9. Three Types of CPAP Delivery Systems 1. Ventilator CPAP system 2 . Infant flow driver 3 . Bubble CPAP system

10. INITIATING AND MAINTAINING OPTIMAL NCPAP Correctly set up and maintain low resistance circuit. Securely attach interface. Assure minimal pressure leaks Maintain optimal airway Prevent nasal septal injury Provide meticulous attention to details

11. Resist the temptation to ‘improve’ the system. Encourage committed and skilled caregivers.

12. CPAP DELIVERY SYSTEM

13. INFANT FLOW DRIVER CPAP

14. “BUBBLE” NASAL CPAP SYSTEM

15. ARGYL NASAL PRONGS

16. HUDSON NASAL PRONGS

17. RECOMMENDED MONITORING Respiratory status (RR, work of breathing) Pre-ductal oxygen saturation Cardiovascular status (HR, BP, perfusion) GI status (abdominal distention, bowel sounds) Neurological state (tone, activity, responsiveness) Thermoregulation (temp).

18. ADVANTAGES AND DISADVANTAGES OF NASAL PRONGS CPAP Advantages Easy to apply Flexible and enable change in infant’s position Low airway resistance , Easily controlled, Eliminates need for intubation.

19. Disadvantages Nasal septal erosion or necrosis . Nasal obstruction from secretions. Improper position of CPAP prongs. Abdominal distention from swallowing air.

20. CONDITIONS WHEN CPAP FAILS Recurrent apnoeic attacks Spontaneous episodes of desaturation Increasing oxygen requirements Worsening respiratory distress Agitation not relieved by simple measures Worsening blood gases

21. COMPLICATIONS ASSOCIATED WITH BUBBLE NASAL CPAP Pneumothorax/Pulmonary Interstitial Emphysema (PIE) PIE is not a contraindication for continuing CPAP. Pneumothorax is usually not due to NCPAP . Nasal Obstruction Injury to Nasal Septum Gastric Distention

22. RESPIRATORY FAILURE ON CPAP Not receiving effective CPAP CPAP is not sufficient to treat the respiratory disease Contribution of an underlying condition.

23. WEANING FROM NCPAP? If less than 7 days old , must meet all of the following criteria: FiO2: 0.21 Oxygen saturations > 90% No respiratory distress No significant apnoea/bradycardia episodes.

24. If more than 7 days old The decision is usually based on the clinical condition.

25. PROCEDURES FOR REMOVAL OF NCPAP Suctioning of infant’s nose and mouth. Prior to, and after removal of NCPAP. Cycle off. Carefully monitor after removal of the NCPAP.

26. THANK YOU!