Benefits of BCPAP Guidelines and the Reduction of BPD in the NICU

Abstract

Background: Continuous positive airway pressure (CPAP) is a noninvasive method to deliver positive pressure with the goal of increasing the preterm infant’s functional residual capacity (FRC) and improving gas exchange. Use of CPAP has been shown to aid in the prevention of atelectasis while reducing the number of obstructive and central apnea events for preterm infants. Bubble CPAP (BCPAP) is one modality to provide CPAP to infants. Some preterm infants suffer from Bronchopulmonary Dysplasia (BPD), which is a form of chronic lung disease. Due to the immaturity of the lungs, infants born prematurely, less than 33 weeks and of low birth weight are at a greater likelihood to develop the disease. BPD is associated with inflammation and scarring in the lungs, caused by mechanical ventilation and long-term use of oxygen. The amount of oxygen or respiratory support an infant requires at a corrected gestational age of 36 weeks determines the severity of BPD. Methods: Data and criteria presented at a major institution with notably low BPD rates prompted the development of practice guidelines. A multidisciplinary team of Nursing, Respiratory Care, Nurse Practitioners and Neonatology assessed the BPD rates of the Vermont Oxford Network (VON) and compared our institutional BPD rate. Based on our data and the guidelines of another institution, the practice guidelines include the level of CPAP at initiation, increasing or decreasing CPAP level based on oxygen requirements, and criteria to trial off. Because infants less than 30 weeks are generally in a low birth weight category, they were the group of patients concentrated on for the guidelines. The data collected in regards to the BPD rate included the number of ventilation days and number of CPAP days. Modification to the trail off criteria evolved after review of other facilities trialing off CPAP at an earlier state and maintaining low BPD rates. Results: Implementation of BCPAP guidelines decreased our BPD rate to 26% from 36-41% in previous years 2014-2017; respectively, intubation rates for very low birth weight, and improved consistency of CPAP therapy utilization. Conclusions: Guideline implementation for initiation, maintenance, and weaning BCPAP decreases BPD in the preterm infant.