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Basic principles of neonatal bubble CPAP: effects on CPAP delivery and imposed work of breathing when altering the original design

BACKGROUND: The original bubble continuous positive airway pressure (bCPAP) design has wide-bore tubing and a low-resistance interface. This creates a stable airway pressure that is reflected by the submersion depth of the expiratory tubing. Several systems with alterations to the original bCPAP des...

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Autores principales: Baldursdottir, Sonja, Falk, Markus, Donaldsson, Snorri, Jonsson, Baldvin, Drevhammar, Thomas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7547905/
https://www.ncbi.nlm.nih.gov/pubmed/32047029
http://dx.doi.org/10.1136/archdischild-2019-318073
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author Baldursdottir, Sonja
Falk, Markus
Donaldsson, Snorri
Jonsson, Baldvin
Drevhammar, Thomas
author_facet Baldursdottir, Sonja
Falk, Markus
Donaldsson, Snorri
Jonsson, Baldvin
Drevhammar, Thomas
author_sort Baldursdottir, Sonja
collection PubMed
description BACKGROUND: The original bubble continuous positive airway pressure (bCPAP) design has wide-bore tubing and a low-resistance interface. This creates a stable airway pressure that is reflected by the submersion depth of the expiratory tubing. Several systems with alterations to the original bCPAP design are now available. Most of these are aimed for use in low-income and middle-income countries and have not been compared with the original design. OBJECTIVE: We identified three major alterations to the original bCPAP design: (1) resistance of nasal interface, (2) volume of dead space and (3) diameter of expiratory tubing. Our aim was to study the effect of these alterations on CPAP delivery and work of breathing in a mechanical lung model. Dead space should always be avoided and was not further tested. METHODS: The effect of nasal interface resistance and expiratory tubing diameter was evaluated with simulated breathing in a mechanical lung model without interface leakage. The main outcome was delivered CPAP and imposed work of breathing. RESULTS: High-resistance interfaces and narrow expiratory tubing increased the work of breathing. Additionally, narrow expiratory tubing resulted in higher CPAP levels than indicated by the submersion depth. CONCLUSION: Our study shows the significant effect on CPAP delivery and imposed work of breathing when using high-resistance interfaces and narrow expiratory tubing in bCPAP systems. New systems should include low-resistance interfaces and wide-bore tubing and be compared with the original bCPAP. Referring to all systems that bubble as bCPAP is misleading and potentially hazardous.
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spelling pubmed-75479052020-10-22 Basic principles of neonatal bubble CPAP: effects on CPAP delivery and imposed work of breathing when altering the original design Baldursdottir, Sonja Falk, Markus Donaldsson, Snorri Jonsson, Baldvin Drevhammar, Thomas Arch Dis Child Fetal Neonatal Ed Original Research BACKGROUND: The original bubble continuous positive airway pressure (bCPAP) design has wide-bore tubing and a low-resistance interface. This creates a stable airway pressure that is reflected by the submersion depth of the expiratory tubing. Several systems with alterations to the original bCPAP design are now available. Most of these are aimed for use in low-income and middle-income countries and have not been compared with the original design. OBJECTIVE: We identified three major alterations to the original bCPAP design: (1) resistance of nasal interface, (2) volume of dead space and (3) diameter of expiratory tubing. Our aim was to study the effect of these alterations on CPAP delivery and work of breathing in a mechanical lung model. Dead space should always be avoided and was not further tested. METHODS: The effect of nasal interface resistance and expiratory tubing diameter was evaluated with simulated breathing in a mechanical lung model without interface leakage. The main outcome was delivered CPAP and imposed work of breathing. RESULTS: High-resistance interfaces and narrow expiratory tubing increased the work of breathing. Additionally, narrow expiratory tubing resulted in higher CPAP levels than indicated by the submersion depth. CONCLUSION: Our study shows the significant effect on CPAP delivery and imposed work of breathing when using high-resistance interfaces and narrow expiratory tubing in bCPAP systems. New systems should include low-resistance interfaces and wide-bore tubing and be compared with the original bCPAP. Referring to all systems that bubble as bCPAP is misleading and potentially hazardous. BMJ Publishing Group 2020-09 2020-02-11 /pmc/articles/PMC7547905/ /pubmed/32047029 http://dx.doi.org/10.1136/archdischild-2019-318073 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Original Research
Baldursdottir, Sonja
Falk, Markus
Donaldsson, Snorri
Jonsson, Baldvin
Drevhammar, Thomas
Basic principles of neonatal bubble CPAP: effects on CPAP delivery and imposed work of breathing when altering the original design
title Basic principles of neonatal bubble CPAP: effects on CPAP delivery and imposed work of breathing when altering the original design
title_full Basic principles of neonatal bubble CPAP: effects on CPAP delivery and imposed work of breathing when altering the original design
title_fullStr Basic principles of neonatal bubble CPAP: effects on CPAP delivery and imposed work of breathing when altering the original design
title_full_unstemmed Basic principles of neonatal bubble CPAP: effects on CPAP delivery and imposed work of breathing when altering the original design
title_short Basic principles of neonatal bubble CPAP: effects on CPAP delivery and imposed work of breathing when altering the original design
title_sort basic principles of neonatal bubble cpap: effects on cpap delivery and imposed work of breathing when altering the original design
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7547905/
https://www.ncbi.nlm.nih.gov/pubmed/32047029
http://dx.doi.org/10.1136/archdischild-2019-318073
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