Care of the Neonate on Nasal Continuous Positive Airway Pressure: A Bedside Guide

Abstract

Respiratory distress continues to be a major cause of neonatal morbidity. Current neonatal practice recommends the use of nasal continuous positive airway pressure (nCPAP) in the immediate resuscitation and continued support of neonates of all gestations with clinical manifestations of respiratory distress. Despite the many short- and long-term benefits of nCPAP, many neonatal care units have met resistance in its routine use. Although there have been numerous recent publications investigating the use and outcomes of various modes of nCPAP delivery, surfactant administration, mechanical ventilation, and other forms of noninvasive respiratory support (high-flow nasal cannula, nasal intermittent positive pressure ventilation), there has been a relative lack of publications addressing the practical bedside care of infants managed on nCPAP. Effective use of nCPAP requires a coordinated interprofessional team approach, ongoing assessment of the neonate, troubleshooting the nCPAP circuit, and parent education.

Standardized nCPAP Care Bundle to Decrease Days to Wean Off nCPAP

“…By assessing the need for suctioning every 3 hours and providing nasopharynx suctioning when clinically indicated, the standardized bnCPAP care bundle ensured airway patency, leading to appropriate administration of positive end-expiratory pressure 9,14–17. In doing so, the positive end-expiratory pressure established and maintained FRC by opening nonrecruited alveoli and maintaining the recruited alveoli 2,5,7,8.…”

“…The catheter was then cleared with normal saline, and the other nare was suctioned with the same technique. In doing so, the nasopharynx was cleared of any obstruction and the appropriate positive end-expiratory pressure was provided to the alveoli while improving ventilation 9,11,14–17…”

“…These interventions that the project focused on were as follows: (1) assess the need for suction every 3 hours and provide nasopharynx suctioning when clinically indicated to ensure airway patency and appropriate positive end-expiratory pressure 9,11,[14][15][16][17] ; (2) maintain proper bnCPAP apparatus placement by setting the circuit tubing along the lateral zygomatic process, curving the nasal cannula naturally along the upper lip, and pointing the prongs 45° downward 9,11,15,18 ; and (3) optimal positioning of a supine infant by placing a shoulder roll to provide slight extension of the neck. 9,11,[14][15][16] Before administering the bnCPAP care bundle, auscultation was performed to establish a baseline and identify any adventitious breath sounds. After oropharynx and external nare suctioning, the lung fields were auscultated again to assess the need for nasopharynx suctioning.…”

“…In doing so, the nasopharynx was cleared of any obstruction and the appropriate positive end-expiratory pressure was provided to the alveoli while improving ventilation. 9,11,[14][15][16][17] Proper bnCPAP positioning on the infant's face included placing the circuit tubing along the lateral zygomatic process, ensuring that the circuit tubing was not touching the skin, and avoidance of torque. 9 If torque was present, the rubber band securing the circuit tubing was released, allowing the circuit tubing to sit naturally along the lateral zygomatic process and the circuit tubing was resecured with the rubber band.…”

Minimally Invasive Surfactant Therapy: An Analytical Report of Our Prospective Dubai Cohort

“…Noninvasive respiratory support is currently the accepted strategy of neonatal care and its basic philosophy is to maximize the alveolar area available for gas exchange by minimizing atelectrauma [1][2][3]. Inherent to this strategy are the early initiation of continuous positive airway pressure (CPAP) and appropriate and optimum use of surfactant to prevent the need for intubation and prolonged ventilation thus avoiding the additional insults of barotraumas and volutrauma [4][5][6]. Surfactant needs to reach the distal airways to be effective which meant intubation was needed for its administration with consequent mechanical ventilation for a variable period [6].…”