WHO Collaborative Centre for Training and Research in Newborn Care Ashok Deorari MD, FNNF,FAMS Department of Pediatrics All India Institute of Medical.

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Presentation transcript:

WHO Collaborative Centre for Training and Research in Newborn Care Ashok Deorari MD, FNNF,FAMS Department of Pediatrics All India Institute of Medical Sciences Science & Physiology behind C P A P

Definition Maintenance of an increased (positive) transpulmonary pressure during the inspiratory & expiratory phase of respiration, with the patient breathing spontaneously. Maintenance of an increased (positive) transpulmonary pressure during the inspiratory & expiratory phase of respiration, with the patient breathing spontaneously.

Physiology of CPAP Pulmonary Increases FRC Decreases V/Q mismatch Splints upper airway –  airway resistance  Tidal volume  Work of breathing Conserves surfactant  lung compliance

Effect of Ventilator on Preterm Lamb Lung No ventilation 24 h ventilation Limitations of premature lung 1.Underdeveloped architect to hold the lung open 2.Thicker and few septa so less SA for gas exchange Pinkerton KE, et al J Appl Physiol, 1994

nCPAP C V Preterm Lambs at 72 Hours Preterm Lambs at 72 Hours - Distal Airspace Wall Thickness -

Ventilator induced lung injury Biotrauma with tubeBiotrauma with tube AtelectotraumaAtelectotrauma

Ventilator induced lung injury BarotraumaBarotrauma VolutraumaVolutrauma

CPAP magic Opens the lung at FRC Opens the lung at FRC Keeps it open by minimal constant pressure –least baro and volutrauma Keeps it open by minimal constant pressure –least baro and volutrauma No ET tubes- no biotrauma No ET tubes- no biotrauma Pulmonary arterial pressure are least with improved blood flow, hence less V/Q mismatchPulmonary arterial pressure are least with improved blood flow, hence less V/Q mismatch

PVR Increases at Lung Volumes Below and Above FRC PVR Lung Volume

r = 3 T = 6 P = (2 x 6) / 3 P = 4 Law of LaPlace : P = 2T/r P : pressure T : surface tension r : radius

Larger alveolus r = 1.5 T = 3 P = (2 x 3) / 1.5 P = 4 Smaller alveolus r = 1 T = 3 P = (2 x 3) / 1 P = 6 CPAP Law of LaPlace : P = 2T/r P : pressure T : surface tension r : radius

Surface tension Imagine a human chain !! CPAP Surfactant

What did we learn ? 1. 1.CPAP causes less lung injury 2. 2.Give adequate CPAP to open lung at FRC 3. 3.Surfactant and CPAP have additive effect 4. 4.Maximum dividends if - Good delivery room care ; ANS for preterm labor -Acceptance by TEAM

The Best Ventilator… Least damage The Best Ventilator… Least damage