Comparison of seven infant continuous positive airway pressure systems using simulated neonatal breathing

Drevhammar, Thomas; Nilsson, Kjell; Zetterström, Henrik; Jónsson, Baldvin

doi:10.1097/pcc.0b013e31822f1b79

Cited by 23 publications

(40 citation statements)

References 23 publications

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“…7 This uncomplicated relationship could not be seen in the tested ventilators of this study. There are ventilators that maintain delivered CPAP during leaks but do so with large pressure swings (eg, Engström Carestation).…”

Section: Discussionmentioning

confidence: 41%

“…The setup was similar to our previous studies. 7,8 The lung model reproduced a flow trace from a 3.4-kg infant ( Fig. 1) in a noncompliant mode.…”

Section: Methodsmentioning

confidence: 99%

“…10 The accuracy of the mechanical lung and reproduction of flow profiles was presented in our previous study. 7 The dead space of the lung model was 210 mL at the start of inspiration, and compression of this volume was continuously calculated by the software. A 22 mm T-connector added a dead space of approximately 40 mL (10 mL for the test without leaks).…”

Section: Methodsmentioning

confidence: 99%

“…The CPAP level of 4 cm H 2 O was chosen to allow comparison with our previous study of conventional CPAP systems. 7 The pressure fluctuation during one simulated breath was examined by the amplitude of pressure swings. This variable was used, as it is less complex than other measurements such as the pressure-time product or imposed work of breathing.…”

Section: Limitationsmentioning

confidence: 99%

“…Traditional nasal CPAP systems showed an uncomplicated response to leaks: the more pressure-stable, the less reduction in delivered CPAP. 7 The ventilator-driven nasal CPAP systems have a more complex design compared with traditional nasal CPAP systems. We found that some of them not only delivered CPAP but also a small pressure support, even when they were in CPAP mode.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Seven Ventilators Challenged With Leaks During Neonatal Nasal CPAP: An Experimental Pilot Study

Drevhammar

Nilsson²,

Zetterström

et al. 2015

Respir Care

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Section: Discussionmentioning

confidence: 41%

“…The setup was similar to our previous studies. 7,8 The lung model reproduced a flow trace from a 3.4-kg infant ( Fig. 1) in a noncompliant mode.…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Seven Ventilators Challenged With Leaks During Neonatal Nasal CPAP: An Experimental Pilot Study

Drevhammar

Nilsson²,

Zetterström

et al. 2015

Respir Care

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Comparison of Respiratory Support After Delivery in Infants Born Before 28 Weeks’ Gestational Age

Donaldsson

Drevhammar

et al. 2021

JAMA Pediatr

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IMPORTANCEEstablishing stable breathing is a key event for preterm infants after birth. Delivery of pressure-stable continuous positive airway pressure and avoiding face mask use could be of importance in the delivery room.OBJECTIVE To determine whether using a new respiratory support system with low imposed work of breathing and short binasal prongs decreases delivery room intubations or death compared with a standard T-piece system with a face mask. DESIGN, SETTING, AND PARTICIPANTSIn this unblinded randomized clinical trial, mothers threatening preterm delivery before week 28 of gestation were screened. A total of 365 mothers were enrolled, and 250 infants were randomized before birth and 246 liveborn infants were treated. The trial was conducted in 7 neonatal intensive care units in 5 European countries from March 2016 to May 2020. The follow-up period was 72 hours after intervention.INTERVENTIONS Infants were randomized to either the new respiratory support system with short binasal prongs (n = 124 infants) or the standard T-piece system with face mask (n = 122 infants). The intervention was providing continuous positive airway pressure for 10 to 30 minutes and positive pressure ventilation, if needed, with the randomized system. MAIN OUTCOMES AND MEASURESThe primary outcome was delivery room intubation or death within 30 minutes of birth. Secondary outcomes included respiratory and safety variables. RESULTSOf 246 liveborn infants treated, the mean (SD) gestational age was 25.9 (1.3) weeks, and 127 (51.6%) were female. A total of 41 infants (33.1%) receiving the new respiratory support system were intubated or died in the delivery room compared with 55 infants (45.1%) receiving standard care. The adjusted odds ratio was statistically significant after adjusting for stratification variables (adjusted odds ratio, 0.53; 95% CI, 0.30-0.94; P = .03). No significant differences were seen in secondary outcomes or safety variables. CONCLUSIONS AND RELEVANCEIn this study, using the new respiratory support system reduced delivery room intubation in extremely preterm infants. Stabilizing preterm infants with a system that has low imposed work of breathing and binasal prongs as interface is safe and feasible.

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Breath‐dependent pressure fluctuations in various constant‐ and variable‐flow neonatal CPAP devices

Auer-Hackenberg

Stroicz

Hofstätter

et al. 2022

Pediatric Pulmonology

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Objective: In continuous positive airway pressure (CPAP) devices, pressure can be generated by two different mechanisms: either via an expiratory valve or by one or more jets. Valved CPAP devices are referred to as constant-flow devices, and jet devices are called variable-flow devices. Constant-flow CPAP devices are said to reduce the imposed work of breathing due to lower breath-dependent pressure fluctuations. The present study investigates the performance of various constant-and variable-flow CPAP devices in relation to breath-dependent pressure fluctuations. Design: Experimental study comparing the pressure fluctuations incurred by seven neonatal CPAP devices attached to an active neonatal lung model.Methodology: Spontaneous breathing was simulated using a tidal volume of 6 ml at pressure levels of 5, 7, and 9 mbar. The main outcomes were respiratory pressure fluctuations, tidal volume, and end-expiratory pressure.Results: All CPAP devices tested showed respiratory pressure fluctuations, varying from 0.631 to 3.466 mbar. The generated tidal volume correlated significantly with the pressure fluctuations (r = −0.947; p = 0.001) and varied between 5.550 and 6.316 ml. CPAP devices with jets showed no advantage over CPAP devices with expiratory valves. End-expiratory pressure in the nose deviated from the set pressure between −1.305 and 0.644 mbar and varied depending on whether the pressure was measured in the device or in the tube extending to the nose. Conclusion:During standard spontaneous breathing, breath-dependent pressure fluctuations in constant-and variable-flow devices are comparable. Pressure measurements taken in the tubing system can lead to a considerable deviation of the applied pressure.

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Comparison of seven infant continuous positive airway pressure systems using simulated neonatal breathing

Cited by 23 publications

References 23 publications

Seven Ventilators Challenged With Leaks During Neonatal Nasal CPAP: An Experimental Pilot Study

Seven Ventilators Challenged With Leaks During Neonatal Nasal CPAP: An Experimental Pilot Study

Comparison of Respiratory Support After Delivery in Infants Born Before 28 Weeks’ Gestational Age

Breath‐dependent pressure fluctuations in various constant‐ and variable‐flow neonatal CPAP devices

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