The discovery of surfactants was one of the most significant events in the history of neonatology. Surfactants undoubtedly saved the lives of premature babies who were otherwise thought to be unviable. However, no progress has been made in the prevention of chronic lung disease (CLD), and it has become clear that a significant portion of the support provided by Surfactant to the premature lung is offset by mechanical ventilation. Biological factors could not explain the variability and therefore respiratory management was considered key to developing or preventing CLD.
The lowest incidence of CLD in the literature has been reported in centers that use bubble CPAP (b-CPAP) as early as possible, preferably in the delivery room, and as the primary mode of respiratory support for all preterm infants with respiratory dysfunction. The bladder CPAP delivery system (bCPAP) consists of a humidified gas source, an interface that connects the CPAP circuit to the infant’s airway via short nasal cannulas, and tubing immersed in a water bottle. As the gas exits the tube, bubbles create small pressure fluctuations in the airways. When these vibrations reach the newborn’s lungs, the result is the better gas exchange and lung function.
The Seattle-Positive Airway Pressure (PAP) plus system uses the proven benefits of bubble CPAP therapy to help babies with shortness of breath breathe easier.1 This unique Dräger design provides oscillating effects similar to high-pressure ventilation.
How does Bubble CPAP work?
The bladder CPAP device is simple; It consists of a breathing circuit with an inspiratory part that delivers a warm, humidified gas mixture to the baby and an expiratory part that is submerged in a tank underwater to create the desired pressure. The gas flow creates bubbles under the water which cause oscillations in the water level and consequently in the pressure delivered to the patient. Therefore, with b-CPAP, the patient receives an oscillating pressure instead of a constant one.
The effect may increase the effectiveness of b-CPAP in volume recruitment. Bubble CPAP has several physiological benefits. Ease the respiratory effort in spontaneously breathing preterm infants by placing a stent in the airway and diaphragm. It stops the air sacs in the lungs, increases the functional residual capacity of the lungs and optimally combines ventilation and perfusion.
CPAP induces a good tension that stimulates lung growth when administered to animals over a long period of time. Several randomized controlled trials have been initiated to compare the effectiveness of early nasal CPAP with mechanical ventilation. These studies did not specify b-CPAP, but used any type of CPAP and did not provide details on competency-based training to ensure its practical use. Despite these caveats, the studies confirmed the feasibility of using CPAP early in preterm infants, including those at the extreme preterm age of 24-25 weeks, with no change in mortality and CLD.
When these studies were considered together in a recent meta-analysis, early use of CPAP had a marginal benefit for the combined outcome of CLD-free survival compared to a prophylactic surfactant with intubation. These findings are inconsistent with recurring reports of reduced CLD in neonatal units using b-CPAP. There are two factors that could explain the reduction in EPC in b-CPAP units. The first is the CPAP type and the nasal cannula type. The second is Nurse Competence
with b-CPAP at the bedside.
The b-CPAP strategy is therefore a complete treatment package that requires clear practice guidelines and a training process. In an effort to help NICUs replicate the success of b-CPAP, we offer a hands-on training program that introduces staff to b-CPAP. -Components of CPAP, indications for use, method of use, maintenance checkpoints, troubleshooting, weaning methods, and b-CPAP failure criteria. Data on short-term endpoints are sparse, including work of breathing and oxygenation, which favored b-CPAP.
However, numerous studies have compared the short-term results of using CPAP, biphasic nasal CPAP, nasal intermittent positive pressure ventilation, and high-flow nasal cannulas when using different facial and nasal interfaces.
Methods
Eligible participants were 1 to 59 months old with severe pneumonia and WHO-defined HIV infection, HIV exposure, severe malnutrition, or hypoxemia and were randomized to receive bCPAP or oxygen. We use time-motion techniques to observe hospital care during treatment initiation or follow-up (maintenance) in four-hour blocks. The study arm calculated the mean HCW time per patient at the bedside during the observation period.
Results
Overall, bCPAP required an average of 34.71 min more per patient than low-flow nasal oxygen for initiation (bCPAP, 118.18 min [standard deviation (SD) 42.73 min]); Oxygen, 83.47 min (SD, 20.0). 18 min), p< 0.01). During baseline, healthcare professionals spent an average of 12.45 min more per patient on Bubble CPAP Setup (p<0.01) and 11.13 min more per patient configuring the nasal interface of bCPAP (p <0.01) compared to oxygen equipment and nasal cannula configuration. The bCPAP 4.57 min (SD, 4.78 min); Oxygen, 1.52 min (SD, 2.50 min), p = 0.03).
Conclusion
Effective implementation of bCPAP in resource-constrained settings will likely burden medical staff more than routine oxygen therapy for pneumonia.
