A Comparison of two nasal continuous positive airway pressure interfaces – a randomized crossover study

Abstract

BACKGROUND: In spite of widespread use of nasal CPAP there are comparatively few studies to guide the choice of nasal prongs. OBJECTIVES: To determine whether the Fisher & Paykel Healthcare (FPH) neonatal continuous positive airway pressure (CPAP) interface was effective in providing bubble CPAP when compared to the Hudson prong interface. METHODS:The study was a randomized cross-over study of twenty newborn infants 500 g or more requiring CPAP for respiratory support at birth. Infants were randomized to either the Fisher & Paykel Healthcare or Hudson CPAP interface for twenty four hours. Crossover between interfaces occurred after subsequent twenty four hour periods. The primary outcome was the provision of desired CPAP pressures, defined as provision of CPAP within ± one cm H 2 O of set pressure. RESULTS: The percentage time CPAP was within ± one cm H 2 O of set pressure was 66.5% for the Hudson and 71.8% for the FPH interface (p = 0.66). Oxygen saturations for the Hudson interface were in target range for a median of 97.8% of the time, and, with the FPH interface, for a median of 98.2% of the time (p = 0.76). Clinically significant differences in primary or secondary outcomes between the two groups were not detected. CONCLUSIONS: The nasal CPAP interfaces studied were equally effective in achieving desired bubble CPAP pressures and target saturations.

Severe Sepsis in Severely Malnourished Young Bangladeshi Children with Pneumonia: A Retrospective Case Control Study

“…The observation of significantly higher case-fatality in pneumonic SAM children with severe sepsis compared to those without severe sepsis is an important but understandable observation. Data from a number of recent studies conducted in children in the critical care ward are consistent with our observation [ 14 , 26 , 27 ]. Severe malnutrition is associated with depressed cell mediated and humoral immune responses [ 28 , 29 ], and is highly susceptible to infectious disease, including pneumonia [ 18 ], and is often associated with severe sepsis [ 30 ].…”

Factors influencing delivered mean airway pressure during nasal CPAP with the RAM cannula

“…In a recent randomized crossover study by Bushell et al, two specific nasal prong types were compared for effectiveness in maintaining NCPAP to within 1 cmH 2 O of the set pressure using a standard NCPAP interface. The two prong types were found to be equally effective in maintaining these levels between 66% and 72% of the time, with the suboptimal times most likely due to leakage around the prongs or through the mouth . Those results are consistent with our results for the Dräger NCPAP interface with which we obtained MAP within 0.5 cmH 2 O of set pressure with the simulated mouth in the closed condition.…”

Does the RAM Cannula Provide Continuous Positive Airway Pressure as Effectively as the Hudson Prongs in Preterm Neonates?

“…While many binasal prongs/interfaces are available, few studies have evaluated the delivered mean airway pressure with specific CPAP devices. 6,8,[13][14][15] Multiple factors affect the actual delivered pressure when applying CPAP including the CPAP generating device/nasal interface, 6,7,13,14,[16][17][18] bias flow rate, 11,13,15 leak around the nares, and leak from the mouth. 8,11,12,15 Type of nasal interface is one of the important factors influencing the transmitted pressure from CPAP device.…”