Continuous positive airway pressure: current controversies

Abstract

Existing evidence suggests that short binasal prongs are most effective, nasal intermittent positive pressure ventilation is a useful way of augmenting neonatal continuous positive airway pressure and that very premature infants can be managed with neonatal continuous positive airway pressure in the delivery room as part of the resuscitation. Further research is required to determine whether important outcomes are improved with the use of nasal continuous positive airway pressure rather than endotracheal intubation and, if so, whether surfactant should be given to infants so managed. Definition of optimal levels of continuous positive airway pressure for infants at varying stages of their disease also requires further research.

Hydrocolloid dressing in preventing nasal trauma secondary to nasal continuous positive airway pressure in preterm infants

“…[2][3][4] Kattwinkel et al [13] first described the initial experience using short bi-nasal prongs to deliver CPAP in a small case series of infants supported using nasal prongs and a T-piece CPAP system, similar to that reported by Gregory et al That 82% never required any other form of support, including mechanical ventilation. Although various devices had been developed to deliver continuous positive airway pressure such as nasopharyngeal tube, different prong systems and mask CPAP, the bi-nasal prongs have been most widely used in the respiratory management of neonates.…”

“…nCPAP can improve oxygenation, maintain lung volume, lower upper airway resistance, reduce obstructive apnoea, and most importantly eliminate an ETT/ ventilator and the associated risks. [1,2] A nasal prong is the most commonly used for delivering CPAP because it is less invasive. [3,4] However, nasal trauma is a well documented complication of noninvasive respiratory support.…”

Nasal continuous positive airway pressure and outcomes in preterm infants: A retrospective analysis

“…Over the past 10 years, it has been increasingly used worldwide, partially based on published evidence of effectiveness, but mainly based on clinical experience showing that it is a safe, inexpensive and effective alternative to endotracheal intubation and mechanical ventilation (21).…”

Controversies about the resuscitation of extremely preterm infants in the delivery room

“…Entretanto, ensaios clínicos randomizados são necessários para demonstrar os possíveis benefícios, critérios de tratamento e riscos dessa terapia 43 . Ressalta-se que as normas preconizadas no ano 2000 1,2 para reanimar o prematuro extremo não contemplam o uso de PEEP ou de CPAP na sala de parto.…”