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Work of Breathing During Nasal Continuous Positive Airway Pressure in Preterm Infants: A Comparison of Bubble vs Variable-Flow Devices

Abstract

OBJECTIVE:

To compare work of breathing and breathing asynchrony during bubble nasal continuous positive airway pressure (NCPAP) vs variable-flow (VF)-NCPAP in premature infants.

STUDY DESIGN:

We studied 18 premature infants of birth weight <1500 g who required NCPAP for mild respiratory distress. Each infant was studied on bubble and VF-NCPAP at 8, 6, 4, and 0 cmH2O. Tidal volumes were obtained by calibrated respiratory inductance plethysmography. Esophageal pressure estimated intrapleural pressure. Inspiratory and resistive work of breathing were calculated from pressure–volume data. Breathing asynchrony was assessed with phase angle. The results at all NCPAP levels were referenced to VF-NCPAP values at 8 cmH2O.

RESULTS:

Provision of NCPAP with either device decreased inspiratory work of breathing, tidal volume, and minute ventilation relative to NCPAP of 0 cmH2O. Bubble NCPAP did not decrease resistive work of breathing relative to 0 cmH2O. Resistive work of breathing (p=0.01), respiratory rate (p<0.03), and phase angle (p=0.002) were all greater with bubble compared to VF-NCPAP.

CONCLUSION:

The more labored and asynchronous breathing seen with bubble NCPAP may lead to higher failure rates over the long term than with VF-NCPAP.

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Acknowledgements

We are grateful to Leonid Liptsen, MD for his schematic of our bubble NCPAP system.

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Statistical Consultant: Gerald Arnold, PhD MPH, Senior Statistician Research, Planning and Evaluation, American College of Physicians, Philadelphia, PA, USA.

Funded in part by SensorMedics, Inc.

Presented in part at the Society for Pediatric Research annual meeting in San Francisco, CA, May 2004.

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Liptsen, E., Aghai, Z., Pyon, K. et al. Work of Breathing During Nasal Continuous Positive Airway Pressure in Preterm Infants: A Comparison of Bubble vs Variable-Flow Devices. J Perinatol 25, 453–458 (2005). https://doi.org/10.1038/sj.jp.7211325

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