CPAP (Continous Positive Airway Pressure) provides continuous positive pressure which helps minimize atalectasis and maintain recruitment. In neonates, FRC is lower and closing volume (volume at which terminal airways are no longer open) is higher than in adults. Therefore CPAP is quite effective.
Why nasal? Neonates are obligate nasal breathers (until 5 months of age). Also, mask CPAP can cause pressure necrosis to the face and nose. Nasal CPAP requires placement of an OG for stomach decompression and crying and mouth breathing may compromise effectiveness.
What level of CPAP is best? Use the lowest amount that provides improvement in oxygenation without compromising ventilation.
In non-randomized / historical comparisons, nasal CPAP (nCPAP) has lowered the incidence of BPD when compared to intubation and ventilation. There are concerns that dual nasal prongs may cause nasal trauma, which appears to be related to the duration of use
Nasal CPAP in Infants
- Benefits (reduced BPD) largely supported by non-randomized trials
- Prospective trials have failed to support prophylactic nCPAP
- Nasal trauma clearly related to duration
Anne Greenough, Muralidhar Premkumar, Deena Patel Ventilatory strategies for the extremely premature infant. Paediatr Anaesth: 2008, 18(5);371-7