1. Continuous Positive Airway Pressure in the Neonatal Intensive Care Level 1 Mark A. Willing, RRT-NPS

2. What Does It Do? Assists in reducing alveolar collapse at end exahalation Increases the mean airway pressure Reduces the incidence of obstructive and central apneas

3. Clinical Uses in the NICU A bridge between intubation/mechanical ventilation and supplemental oxygen administration To reduce the incidence of apnea of prematurity

4. Physiological Considerations for Neonates Preferential nose breathers Flow and pressure in the airway can stimulate breathing Predisposed to alveolar collapse at end exhalation Chest wall compliance is generally greater than lung compliance Tend to use abdominal breathing

5. Ways to Deliver CPAP Mechanical ventilator High-flow nasal cannula Nasal prong CPAP device

6. Airway Devices Long or short nasal prongs Tracheostomy tube Nasopharyngeal tube Mask Endotracheal tube

7. Bubble CPAP A fluid-filled reservoir is used as a means of maintaining the desired level of CPAP Provides a natural “pop-off” Oscillations in the circuit have been speculated to aid in ventilation Simple, inexpensive, and dependable

8. Clinical Application The correct size nasal prongs will be those which completely fill the lumen of the nares without stretching them. Too small of prongs will necessitate the need for an increased flow setting which leads to internal swelling of the nasal passages Too large of prongs will lead to pressure sores and necrosis

9. Assessment of Function Maintain a fine mist of condensation in the prongs Maintain the proper fluid level in the reservoir Use the lowest flow setting which will allow for steady bubbling in the reservoir

10. Patient Management Maintain patency of the nasal passages Prongs should point posteriorly along the palate Take steps to reduce pressure sores The patient’s head should be in a neutral position Take steps to reduce gastric insufflation

11. Why Won’t It Bubble? Complete or partial circuit disconnect Complete or partial prong disconnect The prongs are out of the nares Inadequate flow through the circuit Prongs are too small for the patient Patient’s mouth is open

12. The Circuit Tubing Is Too Hot Inadequate flow in that part of the circuit High inspiratory flow demands of the patient Circuit has been off the patient for an extended period of time

13. Summary CPAP can be a safe, effective means of supporting respiration and ventilation in neonates Diligence and assertive care must be taken to maintain proper breathing mechanics, positioning, and airway patency