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Continuous Positive Airway Pressure in the Neonatal Intensive Care

Continuous Positive Airway Pressure in the Neonatal Intensive Care. Level 1 Mark A. Willing, RRT-NPS. What Does It Do?. Assists in reducing alveolar collapse at end exahalation Increases the mean airway pressure Reduces the incidence of obstructive and central apneas.

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Continuous Positive Airway Pressure in the Neonatal Intensive Care

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  1. Continuous Positive Airway Pressure in the Neonatal Intensive Care Level 1 Mark A. Willing, RRT-NPS

  2. What Does It Do? • Assists in reducing alveolar collapse at end exahalation • Increases the mean airway pressure • Reduces the incidence of obstructive and central apneas

  3. Clinical Uses in the NICU • A bridge between intubation/mechanical ventilation and supplemental oxygen administration • To reduce the incidence of apnea of prematurity

  4. Physiological Considerations for Neonates • Preferential nose breathers • Flow and pressure in the airway can stimulate breathing • Predisposed to alveolar collapse at end exhalation • Chest wall compliance is generally greater than lung compliance • Tend to use abdominal breathing

  5. Ways to Deliver CPAP • Mechanical ventilator • High-flow nasal cannula • Nasal prong CPAP device

  6. Airway Devices • Long or short nasal prongs • Tracheostomy tube • Nasopharyngeal tube • Mask • Endotracheal tube

  7. Bubble CPAP • A fluid-filled reservoir is used as a means of maintaining the desired level of CPAP • Provides a natural “pop-off” • Oscillations in the circuit have been speculated to aid in ventilation • Simple, inexpensive, and dependable

  8. Clinical Application • The correct size nasal prongs will be those which completely fill the lumen of the nares without stretching them. • Too small of prongs will necessitate the need for an increased flow setting which leads to internal swelling of the nasal passages • Too large of prongs will lead to pressure sores and necrosis

  9. Assessment of Function • Maintain a fine mist of condensation in the prongs • Maintain the proper fluid level in the reservoir • Use the lowest flow setting which will allow for steady bubbling in the reservoir

  10. Patient Management • Maintain patency of the nasal passages • Prongs should point posteriorly along the palate • Take steps to reduce pressure sores • The patient’s head should be in a neutral position • Take steps to reduce gastric insufflation

  11. Why Won’t It Bubble? • Complete or partial circuit disconnect • Complete or partial prong disconnect • The prongs are out of the nares • Inadequate flow through the circuit • Prongs are too small for the patient • Patient’s mouth is open

  12. The Circuit Tubing Is Too Hot • Inadequate flow in that part of the circuit • High inspiratory flow demands of the patient • Circuit has been off the patient for an extended period of time

  13. Summary • CPAP can be a safe, effective means of supporting respiration and ventilation in neonates • Diligence and assertive care must be taken to maintain proper breathing mechanics, positioning, and airway patency

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