CPAP

1. CONTINUOUS POSSITIVE
PRESSURE VENTILATION
(CPAP)
Dr KM Parakrama
Registrar
NICU-THK
27 March 2020

2. INTRODUCTION
 Positive intrapulmonary pressure is applied artificially.
 Distending pressure is created in the alveoli.
 Done throughout the respiratory cycle.
 Baby is breathing spontaneously.
 Prevents airway collapse during expiration.

3. EFFECTS OF CPAP IN RESPIRATORY
DISTRESS
 Reduces upper airway occlusion
 Reduces right to left shunting
 Reduces obstructive apneas
 Increases the functional residual capacity
 Reduces the work of breathing.
 Stabilizes the chest wall and counteracts the paradoxical
movements.

4.  Regularizes and reduces the respiratory rate.
 Improves ventilation perfusion mismatch.
 Conserves surfactant on the alveolar surface.
 Diminishes alveolar oedema.
 Nasal CPAP after extubation reduces the ventilator
requirement.
 Improves oxygenation and carbon dioxide elimination

5. INDICATIONS FOR CPAP
 Respiratory distress at birth with spontaneous breathing.
 Increased work of breathing.
 Poorly expanded or infiltrated lung fields on CXR.
 Atelectasis.
 Pulmonary oedema.
 Pulmonary haemorrhage.

6.  Apnoea of prematurity.
 Recent extubation.
 Abnormalities of the airways, predisposing to airway
collapse.
 Phrenic nerve palsy

7. CONTRAINDICATIONS FOR CPAP
 Ventilatory failure—inability to maintain oxygenation and
the arterial PaCO2 < 8 kPa and pH > 7.25.
 Upper airway abnormalities (cleft palate, choanal
atresia).
 Tracheoesophageal fistula.
 Diaphragmatic hernia.
 Severe cardiovascular instability.

8. CPAP DELIVERY SYSTEM
 Consists of three components:
 Circuit for continuous flow of inspired gases,
 Interface connecting the CPAP circuit to the infant’s
airway,
 Method of creating positive pressure in the CPAP Circuit.

9.  Three Types of CPAP Delivery Systems
 1. Ventilator CPAP system
 2. Infant flow driver
 3. Bubble CPAP system

10. INITIATING AND MAINTAINING OPTIMAL
NCPAP
 Correctly set up and maintain low resistance circuit.
 Securely attach interface.
 Assure minimal pressure leaks
 Maintain optimal airway
 Prevent nasal septal injury
 Provide meticulous attention to details

11.  Resist the temptation to ‘improve’ the system.
 Encourage committed and skilled caregivers.

12. CPAP DELIVERY SYSTEM

13. INFANT FLOW DRIVER CPAP

14. “BUBBLE” NASAL CPAP SYSTEM

15. ARGYL NASAL PRONGS

16. HUDSON NASAL PRONGS

17. RECOMMENDED MONITORING
 Respiratory status (RR, work of breathing)
 Pre-ductal oxygen saturation
 Cardiovascular status (HR, BP, perfusion)
 GI status (abdominal distention, bowel sounds)
 Neurological state (tone, activity, responsiveness)
 Thermoregulation (temp).

18. ADVANTAGES AND DISADVANTAGES OF
NASAL PRONGS CPAP
 Advantages
 Easy to apply
 Flexible and enable change in infant’s position
 Low airway resistance,
 Easily controlled,
 Eliminates need for intubation.

19.  Disadvantages
 Nasal septal erosion or necrosis.
 Nasal obstruction from secretions.
 Improper position of CPAP prongs.
 Abdominal distention from swallowing air.

20. CONDITIONS WHEN CPAP FAILS
 Recurrent apnoeic attacks
 Spontaneous episodes of desaturation
 Increasing oxygen requirements
 Worsening respiratory distress
 Agitation not relieved by simple measures
 Worsening blood gases

21. COMPLICATIONS ASSOCIATED WITH
BUBBLE NASAL CPAP
 Pneumothorax/Pulmonary Interstitial Emphysema (PIE)
 PIE is not a contraindication for continuing CPAP.
 Pneumothorax is usually not due to NCPAP.
 Nasal Obstruction
 Injury to Nasal Septum
 Gastric Distention

22. RESPIRATORY FAILURE ON CPAP
 Not receiving effective CPAP
 CPAP is not sufficient to treat the respiratory disease
 Contribution of an underlying condition.

23. WEANING FROM NCPAP?
 If less than 7 days old, must meet all of the following
criteria:
 FiO2: 0.21
 Oxygen saturations > 90%
 No respiratory distress
 No significant apnoea/bradycardia episodes.

24.  If more than 7 days old
 The decision is usually based on the clinical condition.

25. PROCEDURES FOR REMOVAL OF NCPAP
 Suctioning of infant’s nose and mouth.
 Prior to, and after removal of NCPAP.
 Cycle off.
 Carefully monitor after removal of the NCPAP.

26. THANK YOU!