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

Singh, Neetu; McNally, Matthew J; Darnall, Robert A.

doi:10.1055/s-0038-1675330

Cited by 35 publications

(43 citation statements)

References 16 publications

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“…19 Recent evaluation of pharyngeal pressures with the RAM cannula demonstrated a decrease in the pressure of up to 2.45 cmH 2 O compared with an increase of 0.40 cmH 2 O with the SBP prongs. 17 The increases in the transmission pressures with the larger RAM cannulas (newborn and infant) in our in vitro studies are consistent with the decreasing resistance in the RAM tubing found on their FDA-approved data (www. neotechproducts.com).…”

Section: Discussionsupporting

confidence: 88%

Use of the RAM Cannula with Early Bubble Continuous Positive Airway Pressure Requires Higher Pressures: Clinical and In vitro Evaluations

et al. 2020

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Objective Early bubble continuous positive airway pressure (bCPAP) in the delivery room (DR) reduces early intubation, mechanical ventilation, and bronchopulmonary dysplasia. The RAM cannula, adopted for ease of patient care, is a high resistance nasal interface that, when used with bCPAP, only transmits a portion of set pressures and attenuates the bubble effects. This study aimed to review early bCPAP pressures and bCPAP failure with the RAM cannula interface over a 6-year period. Study Design Retrospective, single-center study of infants delivered <1,250 g from 2013 to 2018 (n = 735) begun on bCPAP in the DR with the RAM cannula. In vitro testing of bCPAP pressure transmission was also performed for multiple nasal interfaces and nasal occlusion percentages. Results The percentage of infants intubated in the DR decreased over time (59 to 42%), while the average bCPAP pressure increased from 5.3 to 6.8 cmH2O. A total of 355 infants (48%) were admitted to the neonatal intensive care unit (NICU) from the DR on BCPAP. The failure rate for bCPAP in NICU within 72 hours decreased from 45 to 24% as the maximum CPAP increased from 5.8 to 7.6 cmH2O. Pneumothorax rates did not change. CPAP pressure transmission decreased with all sizes of the RAM cannula. Conclusion When utilizing the RAM cannula for bCPAP, higher CPAP levels were associated with decreases in DR intubations and CPAP failure within the first 72 hours. If clinicians choose to use the RAM cannula for bCPAP, they will need higher set pressures to achieve lung inflation and the beneficial oscillatory effect will be diminished. Key Points

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Section: Discussionsupporting

confidence: 88%

Use of the RAM Cannula with Early Bubble Continuous Positive Airway Pressure Requires Higher Pressures: Clinical and In vitro Evaluations

et al. 2020

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“…However, in the absence of an analog recording of pressure waveform, we recorded displayed digital values and calculated mean of these values to quantify delivered pressures with each nasal interface.To the best of our knowledge, this is the first study comparing delivered oropharyngeal CPAP with three different commonly used nasal interfaces. Similar to the results of our study, Gerdes et al7 and Singh et al6 also found that delivered oropharyngeal pressures were significantly less than the set CPAP with the use of RAM cannula. However, in the study by Singh et al6 delivered in vivo pressures were measured by closing the mouth which may not actually simulate the CPAP delivery method at many centers where active closure of mouth for CPAP delivery is not practiced.…”

supporting

confidence: 91%

“…[11][12][13][14] Many factors affect the actual delivered pressure when applying nasal CPAP including nasal interface, bias flow, leak around the nose, and leak from the mouth. 7,[11][12][13][14][15][16] Type of nasal interface is one of Singh et al 6 in their study reported higher delivered mean pressures than the set pressures with the use of Hudson prongs, whereas, in our study, the mean delivered pressure with Hudson prongs were 0.9 and 0.8 cm H 2 O less than the set CPAP of 5 and 6 cm H 2 O, respectively. The use of different flow rates and closure of the mouth during pressure recordings may be the reasons for the observed differences in the studies.…”

Section: Discussioncontrasting

confidence: 52%

“…Off-label use of RAM nasal cannula by the physicians has increased because of its perceived ease of use and less nasal injury. 6 However there is an increasing concern that RAM cannula interface delivers suboptimal pressures in comparison with already in-use nasal interfaces. 7 To the best our knowledge, no previous studies compared in vivo pressures delivered with the three most commonly used nasal interfaces, that is, Hudson short binasal prongs, nasal mask, and RAM cannula.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of delivered distending pressures in the oropharynx in preterm infant on bubble CPAP and on three different nasal interfaces

Sharma

Murki

Maram

et al. 2020

Pediatric Pulmonology

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Objective To compare the level of continuous positive airway pressure (CPAP) delivered by three different CPAP delivery interfaces (RAM cannula system, Hudson prongs, and nasal mask) in preterm neonates with respiratory distress. Methods Preterm neonates with gestation between 28 weeks and 34 weeks and birth weight more than or equal to 1000 g and requiring nasal CPAP for respiratory distress were eligible for the study. During the study period, consecutive infants requiring CPAP were started on Hudson prongs or RAM cannula or nasal mask in that order. We measured the mean oropharyngeal pressure, which approximates the applied CPAP level. Oropharyngeal pressures in the recruited neonates were measured between 24 and 48 hours of postnatal age, when stable and in sleep or quiet awake state. Comparison of the delivered oropharyngeal pressures when on three different nasal interfaces at the same set flow rate and at set CPAP of 5 cm or 6 cm of H2O was the primary outcome. Results Data was analyzed from 30 neonates in each group. We found that measured oropharyngeal pressures were less than set CPAP level in all three studied interfaces. Maximum drop in oropharyngeal pressure was observed with use of RAM cannula with measured oropharyngeal pressures being 1.1 and 1.2 cm H2O less than set CPAP of 5 and 6 cm H2O respectively. Pharyngeal pressure best correlated to set CPAP level with the use of nasal mask. Conclusion None of the nasal interfaces delivered oropharyngeal pressure equivalent to the set CPAP. However, nasal mask delivered oropharyngeal pressure best matched to the set CPAP.

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“…Several other interfaces are widely used for CPAP treatment. The RAM cannula interface has been used for providing CPAP and nasal intermittent positive pressure ventilation 23–26. This is not Food and Drug Administration approved, and the use is off-label.…”

Section: Discussionmentioning

confidence: 99%

Basic principles of neonatal bubble CPAP: effects on CPAP delivery and imposed work of breathing when altering the original design

Baldursdottir

Falk

Donaldsson

et al. 2020

Arch Dis Child Fetal Neonatal Ed

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BackgroundThe original bubble continuous positive airway pressure (bCPAP) design has wide-bore tubing and a low-resistance interface. This creates a stable airway pressure that is reflected by the submersion depth of the expiratory tubing. Several systems with alterations to the original bCPAP design are now available. Most of these are aimed for use in low-income and middle-income countries and have not been compared with the original design.ObjectiveWe identified three major alterations to the original bCPAP design: (1) resistance of nasal interface, (2) volume of dead space and (3) diameter of expiratory tubing. Our aim was to study the effect of these alterations on CPAP delivery and work of breathing in a mechanical lung model. Dead space should always be avoided and was not further tested.MethodsThe effect of nasal interface resistance and expiratory tubing diameter was evaluated with simulated breathing in a mechanical lung model without interface leakage. The main outcome was delivered CPAP and imposed work of breathing.ResultsHigh-resistance interfaces and narrow expiratory tubing increased the work of breathing. Additionally, narrow expiratory tubing resulted in higher CPAP levels than indicated by the submersion depth.ConclusionOur study shows the significant effect on CPAP delivery and imposed work of breathing when using high-resistance interfaces and narrow expiratory tubing in bCPAP systems. New systems should include low-resistance interfaces and wide-bore tubing and be compared with the original bCPAP. Referring to all systems that bubble as bCPAP is misleading and potentially hazardous.

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

Cited by 35 publications

References 16 publications

Use of the RAM Cannula with Early Bubble Continuous Positive Airway Pressure Requires Higher Pressures: Clinical and In vitro Evaluations

Use of the RAM Cannula with Early Bubble Continuous Positive Airway Pressure Requires Higher Pressures: Clinical and In vitro Evaluations

Comparison of delivered distending pressures in the oropharynx in preterm infant on bubble CPAP and on three different nasal interfaces

Basic principles of neonatal bubble CPAP: effects on CPAP delivery and imposed work of breathing when altering the original design

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