Continuous Positive Airway Pressure (CPAP)

Learning objectives

After completion of this session the participant should be able to:

• List possible indications for bCPAP and conditions unlikely to benefit from bCPAP
• Describe how bCPAP works
• Demonstrate ability to place a baby on bCPAP
• Describe how to escalate bCPAP and wean bCPAP
• List possible complications of bCPAP

Definition:

A process of giving continuous flow of air under regulated pressure through the airway.

Indication:

NYI presenting with severe respiratory distress primarily from a respiratory complication

Patients with the following conditions can benefit from bCPAP:

1. RDS: respiratory distress syndrome
2. TTN: transient tachypnea of the newborn
3. Pneumonia/ sepsis
4. MAS: meconium aspiration syndrome
5. PPHN: persistent pulmonary hypertension of the newborn
6. Bronchiolitis
7. Upper airway obstruction
8. Apnea of prematurity

Babies unlikely to benefit from bCPAP

1. Newborn with stage III HIE
2. Newborn with cyanotic congenital heart disease

What is bCPAP?

• bCPAP stands for bubble continuous positive airway pressure.
• It is a constant pressure applied to the airway, generated by continuous, consistent flow of air with the aim of opening collapsed lung segments and maintaining patency in already opened air spaces.

How does bCPAP help?

• On inspiration, bCPAP drives air with additional pressure into collapsed alveoli and opens them. This process is sometimes called ‘recruitment’.
• The pressure is maintained even when the patient breathes out, therefore the alveoli do not collapse at the end of expiration.
• The lung expands easily thus improving oxygenation and reduces the need for increased work of breathing.

Management of a baby on CPAP

Monitor vital signs every 15 minutes until stable then every 30 minutes.

Check oxygen saturation for the first 30 minutes if saturation does not improve then escalate.

Feed through OG tube

Inspect position of the nasal prongs 2 hourly to ensure patent airway. Put nasal drops (normal saline) every 4hrs to prevent nasal dryness.

Who to wean off bCPAP

1. Patient has been on bCPAP at least 24 hours
2. RR less than 60/minute for at least 6 hours (for neonates)
3. Oxygen saturation consistently > 90% for at least 6 hours
4. No significant grunting, recessions, nasal flaring, apnoea or bradycardia for at least 6 hours

How to wean off bCPAP

1. Reduce bCPAP pressure by 1 cm every 6 hours until 5 cm is reached
2. Once 5 cm is reached, start reducing oxygen flow by 0.5 L/min every 6 hours until 1 L/min is reached
3. After 6 hours on 1 L/min or less, and patient is stable, remove bCPAP and place patient on 2 L/min of oxygen
4. Once off bCPAP, review baby at 1 hour, then at 6 hours, then every 12 hours

Complications

• Blocked nostrils
• Nasal irritation and necrosis
• Distended abdomen
• Nose bleed
• Pneumothorax