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CPAP

CPAP. Murila fv. Respiratory distress syndrome. 28% of neonatal deaths are due to prematurity The most common respiratory disorder in the preterm is Respiratory distress syndrome due to lack of surfactant Typically affects preterm infants below 35 weeks

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CPAP

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  1. CPAP Murila fv

  2. Respiratory distress syndrome • 28% of neonatal deaths are due to prematurity • The most common respiratory disorder in the preterm is Respiratory distress syndrome due to lack of surfactant • Typically affects preterm infants below 35 weeks • Increase in the alveolar surface tension and a tendency for alveolar collapse, progressive atelectasis and reduced compliance • Treatment –Surfactant,CPAP, mechanical ventilation

  3. Mechanical Ventilation • Expensive • Expertise • Chronic lung disease • Intraventricular haemorrhage

  4. - CPAP(Continuous positive airway pressure) • A positive pressure applied to the airways of a spontaneously breathing baby throughout the respiratory cycle • First used in the 1970s • Splints the upper airway and decreases obstruction and apnoea • Expansion of the lungs and prevents alveolar collapse • In so doing, it reduces protein leak and conserves surfactant • It maintains positive pressure in the airways during spontaneous breathing hence increasing functional residual capacity and improving oxygenation in infants with RDS

  5. Nasal CPAP • Nasal CPAP is gas delivered under a low pressure into the nose. • CPAP is used to treat: • 1. Respiratory distress • 2. Apnoea of prematurity • 3. Weaning from ventilation • 4. Upper airway obstruction • 5. May help in the management of pulmonary oedema

  6. Effects of Cpap • It increases the lung volume • It reduces atelectasis • It conserves surfactant • It regularises the respiratory rate • It reduces the incidence of apnoea • When used after extubation it reduces the chance of reintubation • Reduces work of breathing • It supports the nasopharyngeal airway • It improves compliance • It lowers resistance • It reduces pulmonary oedema

  7. Technique of CPAP • CPAP single nasal tube • Bi-nasal prongs. • CPAP is supplied using - a ventilator set on the CPAP mode, - “bubbling bottle” system - Neopuff device

  8. Initiation of CPAP • Usual Range 3 – 8cm H20 • Pressure 5-6 cm H2O • Increase as necessary to improve oxygenation • Max 8-10 CM H2O • Clinical state,CXR, • Blood gases 30-60min

  9. Weaning • No exact Science • Assess saturation ,apnoea ,bradycardia, work of breathing • FIO2<0.40 • Wean by 1cm steps till Pressure 5cm or less • Onto low flow oxygen

  10. Failure of CPAP • Increasing apnoea • Rising Fio2>60% oxygen • PaCO2>60mmHg • Ph>7.25

  11. Complications of CPAP • Displacement,blockage by secretions • Kink • Alveolar overdistension- - pneumothorax - reduced tidal volumes leading to CO2 retention - increased work of breathing, - impaired systemic venous return,decreased cardiac output,renal dysfunction • CPAP belly bowel distension, swallowed air, distended loops So always have NG tube No link to nec • Nasal trauma

  12. Coin Study • 1999-2006 • Australia ,New Zealand,Canada, US • 610 gestation 25-28 weeks • CPAP or Intubation • CPAP - fewer ventilation days - 46% failed and needed mechanical ventilation

  13. Kijabe study • Dr Omoding(2012) • 61 preterm neonates • The median duration of Bubble CPAP treatment was 5 days (IQR 3 to 7 days) • No report of the major complications

  14. CPAP • Relatively cheap • Easy to use • Complications few • Saves lives

  15. ` ASANTE

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