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Bubble and ventilator-derived nasal continuous positive airway pressure in premature infants: work of breathing and gas exchange

Abstract

Objective:

During bubble nasal continuous positive airway pressure (B-NCPAP), gas flows through the expiratory limb of CPAP tubing submerged underwater to a depth in centimeters considered equal to the desired end expiratory pressure. Ventilator-derived NCPAP (V-NCPAP) controls the delivered pressure at the expiratory orifice. Limited data exist comparing the two forms of NCPAP on work of breathing (WOB) and other short-term respiratory outcomes. We compared WOB and gas exchange between B-NCPAP and V-NCPAP at equivalent delivered nasal prong pressures among a cohort of preterm infants on NCPAP.

Study Design:

We performed a randomized crossover study in 18 premature infants <1500 g (BW 1101±254 g, GA 28±2 weeks, study age 13±8 days (means±s.d.)), who were already on NCPAP for mild respiratory distress, comparing B-NCPAP to V-NCPAP. Each infant was studied at a constant flow rate and varying pressures of 3, 5, 7, 4 and 2 cm H2O in that order. Tidal volumes were obtained by calibrated respiratory inductance plethysmography. Intrapleural pressure was estimated by an esophageal catheter. WOB (inspiratory, elastic and resistive) was calculated from pressure volume data. Breathing asynchrony was assessed with phase angle. Comparisons of respiratory rate, heart rate, tidal volume, minute ventilation, breathing asynchrony, lung compliance, oxygen saturation and transcutaneous (Tc) O2 and CO2 were also made.

Result:

WOB and most respiratory parameters were not different between B-NCPAP and V-NCPAP. TcO2 was higher with B-NCPAP compared to V-NCPAP (P=0.01). TcCO2 was not different. None of the other measured parameters was significantly different between the two devices.

Conclusion:

WOB and ventilation with B-NCPAP and V-NCPAP are similar when equivalent delivered prong pressures are assured. Improved oxygenation with B-NCPAP is intriguing and requires further investigation.

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References

  1. Clark RH, Gerstmann DR, Jobe AH, Moffitt ST, Slutsky AS, Yoder B . Lung injury in neonates: causes, strategies for prevention, and long-term consequences. J Pediatr 2001; 139: 478–486.

    Article  CAS  Google Scholar 

  2. Carney D, DiRocco J, Nieman G . Dynamic alveolar mechanics and ventilator-induced lung injury. Crit Care Med 2005; 33: S122–S128.

    Article  Google Scholar 

  3. Avery ME, Tooley WH, Keller JB, Hurd SS, Bryan MH, Cotton RB et al. Is chronic lung disease in low birth weight infants preventable? A survey of eight centers. Pediatrics 1987; 79: 26–30.

    CAS  PubMed  Google Scholar 

  4. Lee KS, Dunn MS, Fenwick M, Shennan AT . A comparison of underwater bubble continuous positive airway pressure with ventilator-derived continuous positive airway pressure in premature neonates ready for extubation. Biol Neonate 1998; 73: 69–75.

    Article  CAS  Google Scholar 

  5. Pillow JJ, Travadi JN . Bubble CPAP: is noise important? An in vitro study. Pediatr Res 2005; 57: 826–830.

    Article  Google Scholar 

  6. Morley CJ, Lau R, De Paoli A, Davis PG . Nasal continuous positive airway pressure: does bubbling improve gas exchange? Arch Dis Child Fetal Neonatal Ed 2005; 90: F343–F344.

    Article  CAS  Google Scholar 

  7. Pillow JJ, Hillman N, Moss TJ, Polglase G, Bold G, Beaumont C et al. Bubble continuous positive airway pressure enhances lung volume and gas exchange in preterm lambs. Am J Respir Crit Care Med 2007; 176: 63–69.

    Article  Google Scholar 

  8. Ramanathan R, Sardesai S . Lung protective ventilator strategies in very low birth weight infants. J Perinatol 2008; 28: S41–S46.

    Article  Google Scholar 

  9. Kahn DJ, Courtney SE, Steele AM, Habib RH . Unpredictability of delivered bubble nasal continuous positive airway pressure: role of bias flow magnitude and prong-nares air leaks. Pediatr Res 2007; 62: 343–347.

    Article  Google Scholar 

  10. Kahn DJ, Habib RH, Courtney SE . Effects of flow amplitudes on intraprong pressures during bubble versus ventilator-generated nasal continuous positive airway pressure in premature infants. Pediatrics 2008; 122: 1009–1013.

    Article  Google Scholar 

  11. Liptsen E, Aghai ZH, Pyon KH, Saslow JG, Nakhla T, Long J et al. Work of breathing during nasal continuous positive airway pressure in preterm infants: a comparison of bubble vs variable-flow devices. J Perinatol 2005; 25: 453–458.

    Article  Google Scholar 

  12. Gupta S, Sinha SK, Tin W, Donn SM . A randomized controlled trial of post-extubation bubble continuous positive airway pressure versus infant flow driver continuous positive airway pressure in preterm infants with respiratory distress syndrome. J Pediatr 2009; 154: 645–650.

    Article  Google Scholar 

  13. Courtney SE, Pyon KH, Saslow JG, Arnold GK, Pandit PB, Habib RH . Lung recruitment and breathing pattern during variable versus continuous flow nasal continuous positive airway pressure in premature infants: an evaluation of three devices. Pediatrics 2001; 107: 304–308.

    Article  CAS  Google Scholar 

  14. Neto GS, Gerhardt TO, Claure N, Duara S, Bancalari E . Influence of chest wall distortion and esophageal catheter position on esophageal manometry in preterm infants. Pediatr Res 1995; 37: 617–622.

    Article  Google Scholar 

  15. Pandit PB, Courtney SE, Pyon KH, Saslow JG, Habib RH . Work of breathing during constant- and variable-flow nasal continuous positive airway pressure in preterm neonates. Pediatrics 2001; 108: 682–685.

    Article  CAS  Google Scholar 

  16. Ho JJ, Henderson-Smart DJ, Davis PG . Early versus delayed initiation of continuous distending pressure for respiratory distress syndrome in preterm infants. Cochrane Database Syst Rev 2002; Issue 2; Art. No.:CD002975. doi:10.1002/14651858.CD002975.13.

  17. Davis PG, Henderson-Smart DJ . Nasal continuous positive airway pressure immediately after extubation for preventing morbidity in preterm infants. Cochrane Database Syst Rev 2003; Issue 2; Art. No.: CD000143. doi:10.1002/14651858.CD000143.

  18. Weber K, Courtney SE, Pyon KH, Chang GY, Pandit PB, Habib RH . Detecting lung overdistention in newborns treated with high-frequency oscillatory ventilation. J Appl Physiol 2000; 89: 364–372.

    Article  CAS  Google Scholar 

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Correspondence to S E Courtney.

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The authors declare no conflict of interest.

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Presented in part at the Society for Pediatric Research annual meeting, Toronto, CA, 5–8 May 2007.

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Courtney, S., Kahn, D., Singh, R. et al. Bubble and ventilator-derived nasal continuous positive airway pressure in premature infants: work of breathing and gas exchange. J Perinatol 31, 44–50 (2011). https://doi.org/10.1038/jp.2010.55

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