Original Article
Effect of Nasal Continuous and Biphasic Positive Airway Pressure on Lung Volume in Preterm Infants

https://doi.org/10.1016/j.jpeds.2012.09.027Get rights and content

Objective

To monitor regional changes in end-expiratory lung volume (EELV), tidal volumes, and their ventilation distribution during different levels of nasal continuous positive airway pressure (nCPAP) and nasal biphasic positive airway pressure (BiPAP) in stable preterm infants.

Study design

By using electrical impedance tomography and respiratory inductive plethysmography, we measured changes in EELV and tidal volumes in 22 preterm infants (gestational age 29.7 ± 1.5 weeks) during 3 nCPAP levels (2, 4, and 6 cmH2O) and unsynchronized BiPAP (nCPAP = 6 cmH2O; pressure amplitude = 3 cmH2O; frequency = 50/min; inspiration time = 0.5 seconds) at 10-minute intervals. We assessed the distribution of these volumes in ventral and dorsal chest regions by using electrical impedance tomography.

Results

EELV increased with increasing nCPAP with no difference between the ventral and dorsal lung regions. Tidal volume also increased, and a decrease in phase angle and respiratory rate was noted by respiratory induction plethysmography. At the regional level, electrical impedance tomography data showed a more dorsally oriented ventilation distribution. BiPAP resulted in a small increase in EELV but without changes in tidal volume or its regional distribution.

Conclusion

Increasing nCPAP in the range of 2 to 6 cmH2O results in a homogeneous increase in EELV and an increase in tidal volume in preterm infants with a more physiologic ventilation distribution. Unsynchronized BiPAP does not improve tidal volume compared with nCPAP.

Section snippets

Methods

The study was performed in the neonatal intensive care unit of the Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands. The study was approved by the central committee on research involving human subjects, and written informed consent was obtained from both parents. Infants born at less than 32 weeks of gestation and who were younger than 7 days of age were eligible for enrollment if they were treated with nCPAP and were clinically stable (fraction of inspired oxygen

Results

Twenty-two preterm infants were included and finished the study protocol without experiencing any complications (Table I). Despite extensive efforts, we were not able to establish consistent synchronization via the Graseby capsule during the BiPAP mode in the third phase of the study. The limited number of triggered breaths prevented meaningful analyses; thus, only the data from the phases 1 and 2 are reported.

Discussion

We investigated the effect of different nCPAP levels and BiPAP on the regional changes in EELV and ventilation measured with electrical impedance tomography. Our main findings are that increasing nCPAP levels result in a homogeneous increase in EELV and a more dorsal, physiologic distribution of ventilation. Unsynchronized BiPAP also increased EELV but did not affect the tidal volume and its distribution.

We simultaneously measured lung volume changes with respiratory induction plethysmography

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    The electrical impedance tomography device was provided by CareFusion. The authors declare no conflicts of interest.

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