Work of Breathing During Nasal Continuous Positive Airway Pressure in Preterm Infants: A Comparison of Bubble vs Variable-Flow Devices

Liptsen, Ellina; Aghai, Zubair H.; Pyon, Kee H.; Saslow, Judy; Nakhla, Tarek; Long, Jennifer L.; Steele, A.; Habib, Robert H.; Courtney, Sherry E.

doi:10.1038/sj.jp.7211325

Cited by 89 publications

(65 citation statements)

References 17 publications

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“…Clinical studies demonstrate increased work of breathing with constant flow CPAP systems compared with CPAP systems with variable flow capabilities. 17 Increasing the constant flow through a system with increased resistance may further encumber breathing. It is important for the respiratory therapist to understand the type of bubble CPAP system that is used and the effect that leak has on delivered pressures.…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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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“…Whether the results found in these studies apply to CPAP applied to premature infants through the nasal route rather than through an endotracheal tube is unknown. One previous study has shown that infant flow NCPAP (IF-NCPAP) improves work of breathing (WOB) and respiratory asynchrony in premature infants compared to both B-NCPAP and V-NCPAP, 11 whereas another recent study found lower extubation failure rates and shorter duration of CPAP support with B-NCPAP compared to infant flow NCPAP in low-birth-weight infants ventilated for less than 14 days. 12 There are no published studies comparing respiratory parameters between B-NCPAP and V-NCPAP in infants while ensuring equal pressure delivery at the nasal prongs.…”

Section: Introductionmentioning

confidence: 99%

Bubble and ventilator-derived nasal continuous positive airway pressure in premature infants: work of breathing and gas exchange

et al. 2010

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Objective: During bubble nasal continuous positive airway pressure (B-NCPAP), gas flows through the expiratory limb of CPAP tubing submerged underwater to a depth in centimeters considered equal to the desired end expiratory pressure. Ventilator-derived NCPAP (V-NCPAP) controls the delivered pressure at the expiratory orifice. Limited data exist comparing the two forms of NCPAP on work of breathing (WOB) and other short-term respiratory outcomes. We compared WOB and gas exchange between B-NCPAP and V-NCPAP at equivalent delivered nasal prong pressures among a cohort of preterm infants on NCPAP.Study Design: We performed a randomized crossover study in 18 premature infants <1500 g (BW 1101±254 g, GA 28±2 weeks, study age 13 ± 8 days (means ± s.d.)), who were already on NCPAP for mild respiratory distress, comparing B-NCPAP to V-NCPAP. Each infant was studied at a constant flow rate and varying pressures of 3, 5, 7, 4 and 2 cm H 2 O in that order. Tidal volumes were obtained by calibrated respiratory inductance plethysmography. Intrapleural pressure was estimated by an esophageal catheter. WOB (inspiratory, elastic and resistive) was calculated from pressure volume data. Breathing asynchrony was assessed with phase angle. Comparisons of respiratory rate, heart rate, tidal volume, minute ventilation, breathing asynchrony, lung compliance, oxygen saturation and transcutaneous (Tc) O 2 and CO 2 were also made.Result: WOB and most respiratory parameters were not different between B-NCPAP and V-NCPAP. TcO 2 was higher with B-NCPAP compared to V-NCPAP (P ¼ 0.01). TcCO 2 was not different. None of the other measured parameters was significantly different between the two devices.Conclusion: WOB and ventilation with B-NCPAP and V-NCPAP are similar when equivalent delivered prong pressures are assured. Improved oxygenation with B-NCPAP is intriguing and requires further investigation.

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“…With this device, gas flowing through nasal prongs is facilitated during exhalation via a fluidic-flip design. 4,5 IF-CPAP has been shown to decrease oxygen requirement, improve respiratory effort [6][7][8][9] and prevent extubation failure in preterm infants when compared to traditional nasal prong systems and bubble CPAP. 9,10 However, nasal prong CPAP devices have been shown to damage the nares of infants, causing discomfort and rarely, long-term disfigurement.…”

Section: Introductionmentioning

confidence: 99%

“…4,5 IF-CPAP has been shown to decrease oxygen requirement, improve respiratory effort [6][7][8][9] and prevent extubation failure in preterm infants when compared to traditional nasal prong systems and bubble CPAP. 9,10 However, nasal prong CPAP devices have been shown to damage the nares of infants, causing discomfort and rarely, long-term disfigurement. 11,12 Simple nasal cannula has recently been shown to generate positive end-expiratory pressure (PEEP) in preterm infants if air or oxygen is delivered at a high flow rate (i.e.…”

Section: Introductionmentioning

confidence: 99%

Nasal continuous positive airway pressure from high flow cannula versus Infant Flow for preterm infants

et al. 2006

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Objective: To compare the feasibility of continuous positive airway pressure (CPAP) support generated by high flow nasal cannula with conventional CPAP for prevention of reintubation among preterm infants with a birth weight of p1250 g.Study Design: Preterm infants were randomized to CPAP generated via high flow cannula or the Infant Flow Nasal CPAP System (VIASYS, Conshohocken, PA, USA) at extubation. Primary outcome was incidence of reintubation within 7 days. Secondary outcomes included change in oxygen use and frequency of apnea and bradycardias postextubation.Results: Forty neonates were randomized. Twelve of 20 infants randomized to high flow cannula CPAP were reintubated compared to three of 20 using Infant Flow (P ¼ 0.003). The high flow cannula group had increased oxygen use and more apneas and bradycardias postextubation.Conclusions: CPAP delivered by high flow nasal cannula failed to maintain extubation status among preterm infants p1250 g as effectively as Infant Flow CPAP.

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Work of Breathing During Nasal Continuous Positive Airway Pressure in Preterm Infants: A Comparison of Bubble vs Variable-Flow Devices

Abstract: The more labored and asynchronous breathing seen with bubble NCPAP may lead to higher failure rates over the long term than with VF-NCPAP.

Cited by 89 publications

References 17 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

Bubble and ventilator-derived nasal continuous positive airway pressure in premature infants: work of breathing and gas exchange

Nasal continuous positive airway pressure from high flow cannula versus Infant Flow for preterm infants

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