Continuous Positive Airway Pressure (CPAP)

Learning objectives

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


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


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?

How does bCPAP help?

Management of a baby on CPAP

Admit the baby near the nurses’ station for close observation.

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