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 Applications

nCPAP. Nasal continuous positive airway pressure

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nCPAP

nCPAP (nasal Continuous Positive Airway Pressure) is the most commonly used mode of non-invasive respiratory support in premature infants and newborns as well as the basis for several further variants such as NIPPV, SNIPPV and NHFV. When using nCPAP, the patient must be able to breathe spontaneously, since no breaths are administered.

The main parameter in nCPAP therapy is the PEEP (positive end expiratory airway pressure) which describes the pressure at the end of expiration.

During spontaneous breathing without nCPAP, the inspiratory pressures may in some cases reach negative values in the airway. With nCPAP, the patient’s entire respiratory cycle – inspiration as well as expiration ­– can be kept at a positive pressure level. 

  • Improvement in oxygenation

  • Prevention of alveolar collapse

  • Reduction in breathing effort

  • Maintenance of functional residual capacity

  • Stabilization of the airways (Mahmoud RA, Roehr CC, Schmalisch G. Current methods of non-invasive ventilatory support for neonates. Paediatr Respir Rev. 2011;12(3):196-205. doi:10.1016/j.prrv.2010.12.0011​)

Basic mode for all our devices

medinCNO, medinCNOmini and medin-NC3 offer nCPAP in combination with expanded modes such as ApneaCPAP, NIPPV, SNIPPV or NHFV. Our EasyBlender, BubbleCPAP and the medinSINDI work exclusively with nCPAP.

In addition to these special nCPAP devices, many ventilators – for example Hamilton Medical devices – can also be used.

Common to all variants is the fact that they build up pressure in the patient’s airway from the interaction of breathing gas flow and defined resistances. The type of nasal interface plays an important role here.

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Conventional nCPAP, continuous flow CPAP, passive CPAP

The nCPAP interface (Miniflow) is connected to a ventilator, a driver unit or with a BubbleCPAP system via an inspiratory and expiratory branch of the tubing system.

There is a valve at the end of the expiratory branch which opens or closes, depending on the selected PEEP. The gas flow circulating in the system creates the desired pressure at this valve.

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Variable flow CPAP, active CPAP

The nasal interfaces of these systems (Medijet) are equipped with a valve which generates the pressure directly at the interface in conjunction with the gas flow. They are therefore also often referred to as CPAP generators.

It is typical to use a tubing system with only one inspiratory branch in combination with a CPAP device.

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The following parameters are to be set

  • Basic flow: In L/min; In the medinSINDI, EasyBlender, medinCNO, medinCNO and medinNC3 devices as control parameter for the CPAP pressure; In L/min; In the BubbleCPAP system as basic flow in the tubing system
  • Push flow: Additional adjustable breathing gas flow with which a peak pressure can be generated in order to trigger a manual breath (medinCNOmini, medinCNO, medinNC3)
  • BubbleCPAP pressure adjustment: In cm; immersion depth of the expiration cylinder in the water of the surge tank
  • Oxygen supply

1 Peep/CPAP
2 Amplitude of the spontaneous breathing with regard to the PEEP
3 Pressure signal of spontaneous breathing

References

  1. 1. Mahmoud RA, Roehr CC, Schmalisch G. Current methods of non-invasive ventilatory support for neonates. Paediatr Respir Rev. 2011;12(3):196-205. doi:10.1016/j.prrv.2010.12.001

 

Footnotes

 

Current methods of non-invasive ventilatory support for neonates.

Mahmoud RA, Roehr CC, Schmalisch G. Current methods of non-invasive ventilatory support for neonates. Paediatr Respir Rev. 2011;12(3):196-205. doi:10.1016/j.prrv.2010.12.001

Non-invasive ventilatory support can reduce the adverse effects associated with intubation and mechanical ventilation, such as bronchopulmonary dysplasia, sepsis, and trauma to the upper airways. In the last 4 decades, nasal continuous positive airway pressure (CPAP) has been used to wean preterm infants off mechanical ventilation and, more recently, as a primary mode of respiratory support for preterm infants with respiratory insufficiency. Moreover, new methods of respiratory support have been developed, and the devices used to provide non-invasive ventilation (NIV) have improved technically. Use of NIV is increasing, and a variety of equipment is available in different clinical settings. There is evidence that NIV improves gas exchange and reduces extubation failure after mechanical ventilation in infants. However, more research is needed to identify the most suitable devices for particular conditions; the NIV settings that should be used; and whether to employ synchronized or non-synchronized NIV. Furthermore, the optimal treatment strategy and the best time for initiation of NIV remain to be identified. This article provides an overview of the use of non-invasive ventilation (NIV) in newborn infants, and the clinical applications of NIV.