Volume Oscillations Delivered to a Lung Model Using 4 Different Bubble CPAP Systems

Poli, Jonathan A; Richardson, C Peter; DiBlasi, Robert M

doi:10.4187/respcare.03432

Cited by 32 publications

(23 citation statements)

References 20 publications

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“…The use of a tighter seal did not result in an improvement in delivered CPAP levels. These results were similar to those reported by Poli et al, 10 where the prongs fit tightly in the nares and did not allow for a leak. However, the risk associated with a tight seal far outweighs the clinical benefit by increasing the propensity for skin breakdown.…”

Section: Discussionsupporting

confidence: 82%

“…This particular device incorporates a baffle/diffuser to provide a more constant CPAP delivery, despite the oscillatory effect of the bubbling system. 10 Since this device does not deliver wide variations of CPAP, the measured delivered CPAP levels were relatively stable, and differences between set and measured CPAP levels delivered to the lung model were more reflective of the type of interface used rather that the combination of the system and the interface. This system also incorporates a pressure relief value to minimize the propensity of delivering excessive pressures that can contribute to overdistention and lung injury.…”

Section: Discussionmentioning

confidence: 99%

“…Poli et al 10 reported that the delivery of a set level of CPAP was also dependent on the percentage of the nares, the CPAP device occluded. Early published data suggest that a tighter seal between the oxygen delivery system and the nose is essential, which presumably results in higher CPAP pressure for a given oxygen flow and ventilatory pattern.…”

Section: Discussionmentioning

confidence: 99%

“…This system is a closed water bubble CPAP system, which prevents large fluctuations in the CPAP level when the system may experience movement that naturally occurs during patient care or transport. 10 The use of the Babi-Plus in this investigation controlled for a confounding variable, specifically variations in CPAP attributed to how the bubble CPAP delivery system functions. This particular device incorporates a baffle/diffuser to provide a more constant CPAP delivery, despite the oscillatory effect of the bubbling system.…”

Section: Discussionmentioning

confidence: 99%

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Evaluating the Effect of Flow and Interface Type on Pressures Delivered With Bubble CPAP in a Simulated Model

Bailes

Firestone²,

Dunn³

et al. 2015

Respir Care

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BACKGROUND: Bubble CPAP, used for spontaneously breathing infants to avoid intubation or postextubation support, can be delivered with different interface types. This study compared the effect that interfaces had on CPAP delivery. We hypothesized that there would be no difference between set and measured levels between interface types. METHODS: A validated preterm infant nasal airway model was attached to the ASL 5000 breathing simulator. The simulator was programmed to deliver active breathing of a surfactant-deficient premature infant with breathing frequency at 70 breaths/min inspiratory time of 0.30 s, resistance of 150 cm H 2 O/L/s, compliance of 0.5 mL/cm H 2 O, tidal volume of 5 mL, and esophageal pressure of ؊10 cm H 2 O. Nasal CPAP prongs, size 4030, newborn and infant RAM cannulas were connected to a nasal airway model and a bubble CPAP system. CPAP levels were set at 4, 5, 6, 7, 8, and 9 cm H 2 O with flows of 6, 8, and 10 L/min each. Measurements were recorded after 1 min of stabilization. The analysis was performed using SAS 9.4. The Kolmogorov-Smirnov test assessed normality of the data. The Friedman test was used to compare non-normally distributed repeated measures. The Wilcoxon signed-rank test was used to conduct post hoc analysis. All tests were 2-sided, and P values of <.05 were considered as indicating significant differences unless otherwise indicated. RESULTS: At lower set CPAP levels, 4 -6 cm H 2 O, measured CPAP dropped precipitously with the nasal prongs with the highest flow setting. At higher CPAP levels, 7-9 cm H 2 O measured CPAP concomitantly increased as the flow setting increased. Statistically significant differences in set and measured CPAP occurred for all devices across all CPAP levels, with the measured CPAP less than set for all conditions, P < .001. CONCLUSIONS: Set flow had a profound effect on measured CPAP. The concomitant drop in measured pressure with high and low flows could be attributed to increased resistance to spontaneous breathing or insufficient flow to meet inspiratory demand. Clinicians should be aware of the effect that the interface and flow have on CPAP delivery.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Evaluating the Effect of Flow and Interface Type on Pressures Delivered With Bubble CPAP in a Simulated Model

Bailes

Firestone²,

Dunn³

et al. 2015

Respir Care

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show abstract

“…bCPAP generates a variable distending pressure, unlike ventilator-generated CPAP, due to the propagation and bursting of the bubble at the end of the exhalation limb [3, 4]. These pressure fluctuations, the “noise” of bCPAP, may contribute to gas mixing in a manner similar to high-frequency oscillatory ventilation [4, 5]. In preterm sheep, bCPAP improves oxygenation and lung recruitment over ventilator-derived CPAP [6].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Bubble CPAP Devices Using RAM Cannula for Extubation Failure in Very Low Birth Weight Infants: Randomized and Cohort Studies

et al. 2018

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Introduction: Bubble continuous positive airway pressure (bCPAP) generates a variable pressure due to bubble size and frequency, and these pressure oscillations may contribute to lung recruitment and gas exchange. Single-outlet bCPAP devices generate larger pressure fluctuation than bCPAP devices with diffusers, but clinical efficacy is unclear. Our hypothesis was that a single-outlet bCPAP device (B&B Bubbler^©) would decrease extubation failure and improve oxygenation compared with a bCPAP device with a diffuser (BabiPlus^©). Methods: Bench testing of bCPAP devices with the RAM^© cannula determined pressure averages, fluctuations, and CPAP transmission at prongs. The B&B Bubbler^© and the BabiPlus^© devices were compared for oxygenation and bCPAP failure within 72 h of extubation in a randomized trial in infants less than 1,250 g (n = 43). Additionally, a cohort study with infants extubated to BabiPlus^© (n = 128), B&B Bubbler^© (n = 119), and noninvasive positive pressure ventilation (NIPPV) (n = 107) were compared. Results: Small differences in pressure fluctuations between bCPAP devices are attenuated by the RAM^© cannula. Pressures at RAM^© prongs are 62% of set pressure. The bCPAP extubation failure rate (35%) and oxygenation were similar between the bCPAP devices. bCPAP success was associated with lower FiO₂ at extubation and decreased need for additional FiO₂ in both groups. In the setting of the RAM^© cannula, there were no differences in extubation failure rate for infants extubated to bCPAP or NIPPV. Conclusions: There were no clinical differences at extubation between the B&B Bubbler^© and BabiPlus^© devices. Oxygenation may predict bCPAP failure. The use of the RAM^© cannula as a bCPAP interface should be more closely examined.

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Chest physiotherapy for pneumonia in children

Chaves

Freitas²,

Santino

et al. 2019

Cochrane Database of Systematic Reviews

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Volume Oscillations Delivered to a Lung Model Using 4 Different Bubble CPAP Systems

Cited by 32 publications

References 20 publications

Evaluating the Effect of Flow and Interface Type on Pressures Delivered With Bubble CPAP in a Simulated Model

Evaluating the Effect of Flow and Interface Type on Pressures Delivered With Bubble CPAP in a Simulated Model

Comparison of Bubble CPAP Devices Using RAM Cannula for Extubation Failure in Very Low Birth Weight Infants: Randomized and Cohort Studies

Chest physiotherapy for pneumonia in children

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