Bubble CPAP is a non-invasive ventilation strategy for newborns with infant respiratory distress syndrome (IRDS). It is one of the methods by which continuous positive airway pressure (CPAP) is delivered to a spontaneously breathing newborn to maintain lung volumes during expiration. With this method, blended and humidified oxygen is delivered via short binasal prongs or a nasal mask and pressure in the circuit is maintained by immersing the distal end of the expiratory tubing in water. The depth to which the tubing is immersed underwater determines the pressure generated in the airways of the infant. As the gas flows through the system, it "bubbles" out[1] and prevents buildup of excess pressures.
Bubble CPAP is appealing because of its simplicity and low cost.[2][3] It is also associated with a decreased incidence of bronchopulmonary dysplasia (BPD)[4] compared to mechanical ventilation. Not all infants with IRDS are candidates for initial treatment with CPAP and not all those who are given CPAP can be successfully managed with this modality.[2]
In the early 1970s, Gregory et al. demonstrated that providing CPAP using an anesthesia bag improved oxygenation in preterm infants with respiratory distress syndrome.[5] Subsequently, Jen-Tien Wung at Children's Hospital of New York, Columbia University developed the bubble CPAP system using short nasal prongs.[6] In 1987 Avery et al. reported large differences in the risk-adjusted incidence of BPD in a comparison of 12 academic neonatal intensive care units in the United States.[7] This study first identified the Columbia approach of using bubble CPAP in the delivery room as a possible strategy to reduce the incidence of BPD as compared to mechanical ventilation.[8] During the H1N1 influenza outbreak in 2009, Dr. Aarti Kinikar made a "homemade" bubble CPAP machine in order to transition neonates off of ventilators so that ventilators could be used to help other patients.[9] Over the pandemic's course, "Kinikar used bubble CPAP to support the breathing of hundreds of children at her hospital."[9]
Componentsedit
The bubble CPAP system consists of three major components:[10]
1. Gas source: An oxygen blender connected to a source of oxygen and compressed air is used to supply an appropriate concentration of inspired oxygen (FiO2). The humidified blended oxygen is then circulated through corrugated tubing.
2. Pressure generator: Pressure in the bubble CPAP system is created by placing the distal expiratory tubing in water. Designated pressure is determined by the depth of tubing immersed.
3. Patient interface: Nasal prongs are used as the nasal interface between the circuit and the infant's airway. Short and wide nasal prongs allow for a low resistance to air flow. It is important that the nasal interface be applied to the infant without air leakage while taking measures to prevent nasal trauma.
Nursing careedit
The successful application of bubble CPAP requires elaborate nursing care.[6] There is a learning curve to the implementation of the bubble CPAP respiratory approach that requires a team effort.[2] Respiratory therapists are important members of the team.
The system has to be snugly fitted and stationed on the infant's head. The nasal prongs can be secured by putting on an appropriate sized hat which rests on the lower part of the infant's ears and across the forehead.[6] The tubing can be fastened with the help of safety pins and rubber bands.[11]
Nasal prongs must be properly placed to prevent air leak. Application of a Velcro mustache placed over a piece of hydrocolloid dressing on the philtrum can prevent accidental incarceration of the prong on the nasal septum.[6]
Gentle nasal suctioning is important to maintain clear airways.
Frequent decompression of the infant's stomach with an oro-gastric tube is necessary to promote comfort, and to prevent a distended stomach from splinting the diaphragm and compromising respiration.[6]
Referencesedit
^Morley CJ, Lau R, De Paoli A, Davis PG (July 2005). "Nasal continuous positive airway pressure: does bubbling improve gas exchange?". Archives of Disease in Childhood. Fetal and Neonatal Edition. 90 (4): F343-4. doi:10.1136/adc.2004.062588. PMC1721902. PMID 16036895.
^ abcSahni R (February 2010). "Bubble CPAP: can we predict success or failure?". Indian Pediatrics. 47 (2): 129–30. doi:10.1007/s13312-010-0019-0. PMID 20228427.
^Dada S, Ashworth H, Sobitschka A, Raguveer V, Sharma R, Hamilton RL, Burke T (2021-06-11). "Experiences with implementation of continuous positive airway pressure for neonates and infants in low-resource settings: A scoping review". PLOS ONE. 16 (6): e0252718. Bibcode:2021PLoSO..1652718D. doi:10.1371/journal.pone.0252718. PMC8195417. PMID 34115776.
^Polin RA, Sahni R (October 2002). "Newer experience with CPAP". Seminars in Neonatology. 7 (5): 379–89. doi:10.1053/siny.2002.0132. PMID 12464500.
^Gregory GA, Kitterman JA, Phibbs RH, Tooley WH, Hamilton WK (June 1971). "Treatment of the idiopathic respiratory-distress syndrome with continuous positive airway pressure". The New England Journal of Medicine. 284 (24): 1333–40. doi:10.1056/NEJM197106172842401. PMID 4930602.
^ abcdeChan SY, Chan CK, Hou SM, Ng C (2007). "The Use of Bubble CPAP in Premature Infants: Local experience" (PDF). Hong Kong Journal of Paediatrics. 12 (2): 86–92. doi:10.1016/S1561-5413(08)60006-X.
^Avery ME, Tooley WH, Keller JB, Hurd SS, Bryan MH, Cotton RB, et al. (January 1987). "Is chronic lung disease in low birth weight infants preventable? A survey of eight centers". Pediatrics. 79 (1): 26–30. doi:10.1542/peds.79.1.26. PMID 3797169. S2CID 21853784.
^ abFink, Sheri. Five Days at Memorial : Life and Death in a Storm-Ravaged Hospital. Atlantic Books, 2013.
^Won A, Suarez-Rebling D, Baker AL, Burke TF, Nelson BD (August 2019). "Bubble CPAP devices for infants and children in resource-limited settings: review of the literature". Paediatrics and International Child Health. 39 (3): 168–176. doi:10.1080/20469047.2018.1534389. PMID 30375281. S2CID 53113380.
^"Averting Newborn Deaths: Blending Oxygen and Bubble CPAP". Vayu Global Health Innovations.
April 11, 2024
bubble, cpap, invasive, ventilation, strategy, newborns, with, infant, respiratory, distress, syndrome, irds, methods, which, continuous, positive, airway, pressure, cpap, delivered, spontaneously, breathing, newborn, maintain, lung, volumes, during, expiratio. Bubble CPAP is a non invasive ventilation strategy for newborns with infant respiratory distress syndrome IRDS It is one of the methods by which continuous positive airway pressure CPAP is delivered to a spontaneously breathing newborn to maintain lung volumes during expiration With this method blended and humidified oxygen is delivered via short binasal prongs or a nasal mask and pressure in the circuit is maintained by immersing the distal end of the expiratory tubing in water The depth to which the tubing is immersed underwater determines the pressure generated in the airways of the infant As the gas flows through the system it bubbles out 1 and prevents buildup of excess pressures Bubble CPAPSpecialtyNeonatology edit on Wikidata Bubble CPAP is appealing because of its simplicity and low cost 2 3 It is also associated with a decreased incidence of bronchopulmonary dysplasia BPD 4 compared to mechanical ventilation Not all infants with IRDS are candidates for initial treatment with CPAP and not all those who are given CPAP can be successfully managed with this modality 2 Contents 1 History 2 Components 3 Nursing care 4 ReferencesHistory editIn the early 1970s Gregory et al demonstrated that providing CPAP using an anesthesia bag improved oxygenation in preterm infants with respiratory distress syndrome 5 Subsequently Jen Tien Wung at Children s Hospital of New York Columbia University developed the bubble CPAP system using short nasal prongs 6 In 1987 Avery et al reported large differences in the risk adjusted incidence of BPD in a comparison of 12 academic neonatal intensive care units in the United States 7 This study first identified the Columbia approach of using bubble CPAP in the delivery room as a possible strategy to reduce the incidence of BPD as compared to mechanical ventilation 8 During the H1N1 influenza outbreak in 2009 Dr Aarti Kinikar made a homemade bubble CPAP machine in order to transition neonates off of ventilators so that ventilators could be used to help other patients 9 Over the pandemic s course Kinikar used bubble CPAP to support the breathing of hundreds of children at her hospital 9 Components editThe bubble CPAP system consists of three major components 10 1 Gas source An oxygen blender connected to a source of oxygen and compressed air is used to supply an appropriate concentration of inspired oxygen FiO2 The humidified blended oxygen is then circulated through corrugated tubing 2 Pressure generator Pressure in the bubble CPAP system is created by placing the distal expiratory tubing in water Designated pressure is determined by the depth of tubing immersed 3 Patient interface Nasal prongs are used as the nasal interface between the circuit and the infant s airway Short and wide nasal prongs allow for a low resistance to air flow It is important that the nasal interface be applied to the infant without air leakage while taking measures to prevent nasal trauma Nursing care editThe successful application of bubble CPAP requires elaborate nursing care 6 There is a learning curve to the implementation of the bubble CPAP respiratory approach that requires a team effort 2 Respiratory therapists are important members of the team The system has to be snugly fitted and stationed on the infant s head The nasal prongs can be secured by putting on an appropriate sized hat which rests on the lower part of the infant s ears and across the forehead 6 The tubing can be fastened with the help of safety pins and rubber bands 11 Nasal prongs must be properly placed to prevent air leak Application of a Velcro mustache placed over a piece of hydrocolloid dressing on the philtrum can prevent accidental incarceration of the prong on the nasal septum 6 Gentle nasal suctioning is important to maintain clear airways Frequent decompression of the infant s stomach with an oro gastric tube is necessary to promote comfort and to prevent a distended stomach from splinting the diaphragm and compromising respiration 6 References edit Morley CJ Lau R De Paoli A Davis PG July 2005 Nasal continuous positive airway pressure does bubbling improve gas exchange Archives of Disease in Childhood Fetal and Neonatal Edition 90 4 F343 4 doi 10 1136 adc 2004 062588 PMC 1721902 PMID 16036895 a b c Sahni R February 2010 Bubble CPAP can we predict success or failure Indian Pediatrics 47 2 129 30 doi 10 1007 s13312 010 0019 0 PMID 20228427 Dada S Ashworth H Sobitschka A Raguveer V Sharma R Hamilton RL Burke T 2021 06 11 Experiences with implementation of continuous positive airway pressure for neonates and infants in low resource settings A scoping review PLOS ONE 16 6 e0252718 Bibcode 2021PLoSO 1652718D doi 10 1371 journal pone 0252718 PMC 8195417 PMID 34115776 Polin RA Sahni R October 2002 Newer experience with CPAP Seminars in Neonatology 7 5 379 89 doi 10 1053 siny 2002 0132 PMID 12464500 Gregory GA Kitterman JA Phibbs RH Tooley WH Hamilton WK June 1971 Treatment of the idiopathic respiratory distress syndrome with continuous positive airway pressure The New England Journal of Medicine 284 24 1333 40 doi 10 1056 NEJM197106172842401 PMID 4930602 a b c d e Chan SY Chan CK Hou SM Ng C 2007 The Use of Bubble CPAP in Premature Infants Local experience PDF Hong Kong Journal of Paediatrics 12 2 86 92 doi 10 1016 S1561 5413 08 60006 X Avery ME Tooley WH Keller JB Hurd SS Bryan MH Cotton RB et al January 1987 Is chronic lung disease in low birth weight infants preventable A survey of eight centers Pediatrics 79 1 26 30 doi 10 1542 peds 79 1 26 PMID 3797169 S2CID 21853784 Narendran V Donovan EF Hoath SB Akinbi HT Steichen JJ Jobe AH Apr May 2003 Early bubble CPAP and outcomes in ELBW preterm infants Journal of Perinatology 23 3 195 9 doi 10 1038 sj jp 7210904 PMID 12732855 a b Fink Sheri Five Days at Memorial Life and Death in a Storm Ravaged Hospital Atlantic Books 2013 Won A Suarez Rebling D Baker AL Burke TF Nelson BD August 2019 Bubble CPAP devices for infants and children in resource limited settings review of the literature Paediatrics and International Child Health 39 3 168 176 doi 10 1080 20469047 2018 1534389 PMID 30375281 S2CID 53113380 Averting Newborn Deaths Blending Oxygen and Bubble CPAP Vayu Global Health Innovations Retrieved from https en wikipedia org w index php title Bubble CPAP amp oldid 1194396289, wikipedia, wiki, book, books, library,
