What CPAP to use in the delivery room? Bench comparison of two methods to provide continuous positive airways pressure in neonates
Background Continuous positive airway pressure (CPAP) is a recommended first-line therapy for infants with respiratory distress at birth. Resuscitation devices incorporating CPAP delivery can have significantly different imposed resistances affecting airway pressure stability and work of breathing.A...
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BMJ Publishing Group
2024-11-01
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| Series: | BMJ Paediatrics Open |
| Online Access: | https://bmjpaedsopen.bmj.com/content/8/1/e002948.full |
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| author | Mark Brian Tracy Thomas Drevhammar Murray Kenneth Hinder Mithilesh Dronavalli Stephanie Morakeas Viktoria Gruber |
| author_facet | Mark Brian Tracy Thomas Drevhammar Murray Kenneth Hinder Mithilesh Dronavalli Stephanie Morakeas Viktoria Gruber |
| author_sort | Mark Brian Tracy |
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| description | Background Continuous positive airway pressure (CPAP) is a recommended first-line therapy for infants with respiratory distress at birth. Resuscitation devices incorporating CPAP delivery can have significantly different imposed resistances affecting airway pressure stability and work of breathing.Aim To compare CPAP performance of two resuscitation devices (Neopuff T-piece resuscitator and rPAP) in a neonatal lung model simulating spontaneous breathing effort at birth.Methods The parameters assessed were variation in delivered pressures (∆P), tidal volume (VT), inspiratory effort (model pressure respiratory muscle (PRM)) and work of breathing (WOB). Two data sequences were required with Neopuff and one with rPAP: (1) set PRM with changes in VT and (2) constant VT (preterm 6 mL, term 22 mL) with increased effort. Data were collected at CPAP settings of 5, 7 and 9 cmH2O using a 1 kg preterm (Compliance: 0.5 mL/cmH2O) and 3.5 kg term (1.0 mL/cmH2O) model.Results 2298 breaths were analysed (760 rPAP, 795 Neopuff constant VT, 743 Neopuff constant PRM). With CPAP at 9 cmH2O and set VT the mean ∆P (cmH2O) rPAP vs Neopuff 1.1 vs 5.6 (preterm) and 1.9 vs 13.4 (term), WOB (mJ) 4.6 vs 6.1 (preterm) and 35.3 vs 44.5 (term), and with set PRM mean VT (ml) decreased to 6.2 vs 5.2 (preterm) and 22.3 vs 17.5 (term) p<0.001. Similar results were found at pressures of 5 and 7 cmH2O.Conclusion rPAP had smaller pressure swings than Neopuff at all CPAP levels and was thus more pressure stable. WOB was higher with Neopuff when VT was held constant. VT reduced with Neopuff when respiratory effort was constant. |
| format | Article |
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| institution | DOAJ |
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| language | English |
| publishDate | 2024-11-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Paediatrics Open |
| spelling | doaj-art-7d2d64643efe4681a3651e491636e7bd2025-08-20T03:10:04ZengBMJ Publishing GroupBMJ Paediatrics Open2399-97722024-11-018110.1136/bmjpo-2024-002948What CPAP to use in the delivery room? Bench comparison of two methods to provide continuous positive airways pressure in neonatesMark Brian Tracy0Thomas Drevhammar1Murray Kenneth Hinder2Mithilesh Dronavalli3Stephanie Morakeas4Viktoria Gruber5Newborn Intensive Care Unit, Westmead Hospital Western Sydney LHD, Westmead, New South Wales, AustraliaDepartment of Anesthesiology, Östersunds sjukhus, Ostersund, SwedenDepartment of Paediatrics and Child Health, The University of Sydney, Westmead Campus, New South Wales, AustraliaDiscipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, AustraliaNewborn Intensive Care Unit, Westmead Hospital Western Sydney LHD, Westmead, New South Wales, AustraliaDepartment of Paediatrics and Adolescent Medicine, Division of Neonatology, Medical University of Graz, Graz, Steiermark, AustriaBackground Continuous positive airway pressure (CPAP) is a recommended first-line therapy for infants with respiratory distress at birth. Resuscitation devices incorporating CPAP delivery can have significantly different imposed resistances affecting airway pressure stability and work of breathing.Aim To compare CPAP performance of two resuscitation devices (Neopuff T-piece resuscitator and rPAP) in a neonatal lung model simulating spontaneous breathing effort at birth.Methods The parameters assessed were variation in delivered pressures (∆P), tidal volume (VT), inspiratory effort (model pressure respiratory muscle (PRM)) and work of breathing (WOB). Two data sequences were required with Neopuff and one with rPAP: (1) set PRM with changes in VT and (2) constant VT (preterm 6 mL, term 22 mL) with increased effort. Data were collected at CPAP settings of 5, 7 and 9 cmH2O using a 1 kg preterm (Compliance: 0.5 mL/cmH2O) and 3.5 kg term (1.0 mL/cmH2O) model.Results 2298 breaths were analysed (760 rPAP, 795 Neopuff constant VT, 743 Neopuff constant PRM). With CPAP at 9 cmH2O and set VT the mean ∆P (cmH2O) rPAP vs Neopuff 1.1 vs 5.6 (preterm) and 1.9 vs 13.4 (term), WOB (mJ) 4.6 vs 6.1 (preterm) and 35.3 vs 44.5 (term), and with set PRM mean VT (ml) decreased to 6.2 vs 5.2 (preterm) and 22.3 vs 17.5 (term) p<0.001. Similar results were found at pressures of 5 and 7 cmH2O.Conclusion rPAP had smaller pressure swings than Neopuff at all CPAP levels and was thus more pressure stable. WOB was higher with Neopuff when VT was held constant. VT reduced with Neopuff when respiratory effort was constant.https://bmjpaedsopen.bmj.com/content/8/1/e002948.full |
| spellingShingle | Mark Brian Tracy Thomas Drevhammar Murray Kenneth Hinder Mithilesh Dronavalli Stephanie Morakeas Viktoria Gruber What CPAP to use in the delivery room? Bench comparison of two methods to provide continuous positive airways pressure in neonates BMJ Paediatrics Open |
| title | What CPAP to use in the delivery room? Bench comparison of two methods to provide continuous positive airways pressure in neonates |
| title_full | What CPAP to use in the delivery room? Bench comparison of two methods to provide continuous positive airways pressure in neonates |
| title_fullStr | What CPAP to use in the delivery room? Bench comparison of two methods to provide continuous positive airways pressure in neonates |
| title_full_unstemmed | What CPAP to use in the delivery room? Bench comparison of two methods to provide continuous positive airways pressure in neonates |
| title_short | What CPAP to use in the delivery room? Bench comparison of two methods to provide continuous positive airways pressure in neonates |
| title_sort | what cpap to use in the delivery room bench comparison of two methods to provide continuous positive airways pressure in neonates |
| url | https://bmjpaedsopen.bmj.com/content/8/1/e002948.full |
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