Exam (elaborations)
Continuous Positive Airway Pressure (CPAP) – Q’s & A’s
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Continuous Positive Airway Pressure (CPAP) – Q’s & A’s
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Continuous Positive Airway Pressure (CPAP) – Q’s & A’sCPAP (continuous positive airway pressure) Right Ans - •Refers to the
application of continuous pressure on inspiration and expiration in the
spontaneously breathing neonate
•Constant pressure keeps the alveoli open and increases the functional
residual capacity (FRC) which leads to better gas exchange
V- CPAP Right Ans - Ventilator Derived CPAP
B-CPAP Right Ans - Buble CPAP
IF- CPAP Right Ans - Infant Flow CPAP
Physiological Effects of CPAP Right Ans - - Increases FRC and Vt
- Decreases Intrapulmonary Shunt
- Increases Pulmonary Compliance
- Decreases airway resistance
- Stabilized the chest wall & upper airways, thus preventing obstructive apnea
- Improves the distribution of ventilation, ventilation-to-perfusion, and gas
exchange
- Decreases of WOB, and reduces alveolar dead space
- Protects the developing lung
- Better type 2 pneumocyte function & even recycling of surfactant, thus
contributing to early recovery from Hyaline Membrane Disease (HMD)
- Decreases cellular indicators of lung injury
- Reduces the need for intubation and mechanical ventilation
- Stimulates the J receptors in the pleura and provides positive feedback to the
respiratory center by herring Breuer relfex
Indication for CPAP Right Ans - 1. Premature infants
- delivery room CPAP and Prophylactic CPAP
-RDS
- Apnea of Prematurity
- After extubation from mechanical ventilation
- early surfactant administrating followed by NCPAP
2. Obstructive Airways Diseases
- obstructive apnea
,- laryngeal or tracheal malacia
- viral bronchiolitis
3. Pneumonia
- Viral or bacterial
- Aspiration
4. Transient Tachypnea of the newborn
5 Meconium aspiration syndrome
6. Other Possible indications
- Used in conjunction with Surfactant, NO, Extracorporeal oxygenation
membrane administration
- paralysis of a hemidiaphragm
- CHF, Pulmonary Edema, Pulmonary Hemorrhage
- RR> 30% normal
- paradoxical chest wall movement with suprasternal and substernal
retractions, grunting, nasal flaring, and cyanosis
Contraindication of CPAP Right Ans - - Criteria for CPAP failure requiring
mechanical ventilation
PaCO2 > 60 mmHg Consistently
Ph < 7.25
- Upper airway abnormalities
Choanal atresia
Cleft Palate
Tracheoesophageal fistula
- Untreated congenital diaphragmatic hernia
- Neuromuscular disorder
- Central nervous system depressant medication
- Central or frequent apnea
Hazard and Complication of CPAP Right Ans - - Pneumothorax
- A result of auto-peep when infants are tachypneic
- Decreased Expiratory time
- May also occur after surfactant replacement therapy
- Pulmonary compliance improves and the infant is not weaned
, - Other air leaks syndromes: Pulmonary Interstitial Emphysema,
Pneumomediastinum, pneumatocele
- lung overdistension leading to a decreased venous return to the heart
- Increased ICP
- Decreased Urine Output
- Bowel distention from air swallowing
- Equipment problems: improper fit of nasal prongs or face mask, leaks,
obstruction of nasal prongs, insufficient gas flow
- fluctuating pressures and increased WOB
- Improper fixation of the patient interface
- nasal snubbing and widening of the nares
- breakdown, erosion, and necrosis
- Skin irritation of head and neck from straps, bonnets, and harnesses
How is fresh gas flow generated and positive pressure is maintained Right
Ans - - patient's airway
The delivery systems of CPAP include Right Ans - - humidifier, circuit, and
O2 analyzer
Humidifier temp Right Ans - 37 & 39 C and 100% humidity
Humidifier Servo- regulates Right Ans - - the temperature on the basis of
measurements is acquired at the humidifier probe
Do not place probe within an Right Ans - - in the incubator or directly
beneath a radiant warmer
Delivery System should include Right Ans - - Pop off device
Pop off device Right Ans - - placed close to the airway to protect the patient
from excessive pressure - limit vol delivered
patient interface Right Ans - - the mechanism by which gas flows from the
delivery system to the airway of the infant
- nasal prongs or facemask
CPAP is often administered via Right Ans - - short binasal prongs
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