CPAP

Continuous Positive Airway Pressure

:

CDP
CPAP

PEEP

 Atelectotrauma Biotrauma Volutrauma

Barotrauma

Methods of CPAP
Continuous

flow CPAP Bubble CPAP Variable flow CPAP

Endotracheal

CPAP

Advantages

Ease to use Minimal to no leakage in the system Ability to achieve high pressure with low flow Ease to switching back & forth to Mechanical ventilation Ease of fixation of the tube

Disadvantages

Difficulty for babies to breathe for prolonged period Increased dead space Intubation is invasive Increased number of apnea episodes

Head box and face chamber CPAP

Hydrocephalus Nerve

palsies Local neck ulcerations

Face mask
Less

work of breathing Severe gastric distention & rupture Trauma to the facial skins & eyes Intracerebellar hemorrhage

Mini touch
VLBW

(less than 1500 gr) Early use of NCPAP

INSURE

Intubation Surfactant administration Rapid extubation to NCPAP

CPAP
Treatment

for AOP Post extubation management Early management of RDS

Other conditions:

Postoperative respiratory management Abdominal wall defects Differentiating congenital cyanotic heart disease from pulmonary disorders Meconium aspiration syn. Wet lungs Pneumonia , PDA ,pulmonary edema Laryngomalacia ,tracheomalacia Pulmonary hemorrhage , PPHN

CPAP
Better

oxygenation Lower PaCO2 values Higher PH Less radiographic atelectasis

Adverse effects & complications

Mal

position Airway obstruction by secretion Kinking Local irritation to the nares Trauma to the nose Nasal deformity

CPAP & PEEP Complications

Air trapping Air leak Retention of CO2 Impaired systemic venous return Decreased in GFR and urine output Increased ICP Decreased GI blood flow Bowel distention Gastric perforation

Contraindication to CPAP
Progressive Res. failure & unable to maintain oxygenation, PaCO2<60 mmHg, PH>7.25 Cong. Malformations (CDH, TE fistula, Choanal atresia, Cleft palate ) Severe cardiovascular instability Unstable Res. Drive ( frequently apnea , bradycardia ,oxygen desaturation )

What is the best level of CPAP?

ABG Chest

Radiography

Increase Pressure
Atelectasis Increased

fluid Poor compliance

Decrease Pressure
Overinflated

Air

trapping

Weaning from CPAP

Oxygen

saturation Occurrence of apnea Bradycardia Work of breathing

CPAP Weaning
Decrease

pressure to 5 cm H2O

FiO2<40%