Continuous Positive Airway Pressure
Continuous Positive Airway Pressure
CPAP is indicated when an infant has spontaneous respirations and a heart rate of at least 100 bpm but has labored breathing. Tachypnea, nasal flaring, and chest retractions are indicators of labored breathing in the newly born.
An infant with a dedicated CPAP device in place.
CPAP helps the lungs of a baby who is spontaneously breathing reach FRC. CPAP is like PEEP during PPV, but PEEP pertains only to the exhalation phase of the breath cycle. CPAP exerts a constant level of pressure in the lungs during inspiration and exhalation. Unlike PPV, CPAP does not actively deliver a breath to the baby.
Key Takeaway
CPAP helps to maintain pressure within the lungs of a baby that is spontaneously breathing.
CPAP benefits preterm infants because their lungs are noncompliant due to a surfactant deficiency. Because of its high surface tension, surfactant is responsible for keeping the alveoli expanded at the end of each exhalation phase. CPAP prevents surfactant-deficient lungs from collapsing at the end of each exhalation phase. If the infant has retained fluid in the alveoli, the continuous fixed pressure of CPAP helps push the fluid out.
CPAP is most commonly initiated in the delivery room with a mask and self-inflating bag or mask and T-piece resuscitator. A tight seal between the face mask and the baby’s face is necessary for effective CPAP. The CPAP setting is achieved the same way PEEP is set during PPV. The PEEP knob or flow-control valve is adjusted to achieve the desired pressure.
A manometer provides visual confirmation of the CPAP setting. A setting of 5 cm H2O is good to start. Once the equipment is ready and checked, the mask is placed gently on the baby’s face. A tight seal is made by lifting the infant’s jaw toward the mask. CPAP pressure can be increased as needed but generally should not exceed 8 cm H2O.
Key Takeaway
During any assessment, if the heart rate or respiratory effort declines, the team must consider the MR. SOPA corrective interventions.
When CPAP is needed for a prolonged period, the baby is transitioned to a dedicated CPAP device that attaches to the baby via nasal prongs or a nasal mask and some type of headgear. Numerous devices are available for neonatal CPAP. Some are standalone flow generators. Others use a bubbling water system (bubble CPAP). Most neonatal ICU mechanical ventilators can also deliver nasal CPAP.
Depending on hospital protocols, transitioning to an independent CPAP device may occur in the delivery room just before transfer to the neonatal intensive care unit (NICU) or immediately upon arrival in the NICU.