Cpap

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Bubble nasal CPAP manual
Riyadh AL-Kharj Hospital Programme Neonatal intensive care 2005 Amer Ammari, MB, BS Fawaz Kashlan, MD Faisal Ezzedeen, MD Atyah AL-Zahrani, MD John Kawas, RRT M.A. Majeed-Saidan, MB. Ch.B., FRCP
Adapted from the “NCPAP Education and training manual” By J.M. Conner, R. de Klerk and A. de Klerk.

PREFACE
Respiratory Distress Syndrome (RDS) is due to a deficiencyof pulmonary surfactant. Seventy one % of very low birth weight infants had RDS, and 35% of them still required oxygen at 36 weeks adjusted age (Vermont Oxford Network 2001). Along with significant mortality, RDS is associated with significant morbidity and high costs to society. Pulmonary surfactant lines the surface of the alveoli in the lung, thereby reducing surface tension and preventingalveolar collapse. Surfactant deficiency results in progressive atelectasis of the alveoli, decreased pulmonary compliance, increased work of breathing, respiratory failure, and lung injury. The earlier the gestational age, at which birth occurs, the higher the risk that severe respiratory distress syndrome will develop. Historically, conventional therapy for this disorder has consisted of continuouspositive airway pressure (CPAP) or mechanical ventilation, along with appropriate supportive care. In the past decade, surfactant replacement has led to significant improvements in survival, particularly for infants less than 1000 grams. However, attempts to treat RDS may lead to lung injury, and secondary complications including bronchopulmonary dysplasia (BPD) and chronic lung

2 disease(CLD). This lung injury is thought to result from the effect of mechanical injury due to assisted ventilation, oxygen toxicity, and lung inflammation among other factors. The following materials comprise the bubble nasal CPAP Manual. This manual provides a training tool in the administration of nasal CPAP using a bubble bottle system, following guidelines established at The Children’s Hospital of NewYork at New York Presbyterian Medical Center (Columbia-Presbyterian Medical Center).

CONTENTS
Introduction Section 1: Background and Theory Section 2: Initiation of nasal CPAP Section 3: Maintenance of nasal CPAP NCPAP Checklist: Maintaining the nasal CPAP System Section 4: Complications Associated with nasal CPAP Section 5: Removal of nasal CPAP Section 6: Respiratory Failure on nasal CPAPNCPAP Checklist: Respiratory Failure on nasal CPAP Section 7: Troubleshooting the nasal CPAP Delivery System References Appendix A: Equipment List and Manufacturers Section 8: Delivery room protocol for the respiratory management of preterm infants

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INTRODUCTION
Purpose The purpose of the nasal CPAP Training and Education Manual is to provide a training tool in the administration of nasalcontinuous positive airway pressure (CPAP) using a bubble system following guidelines established at Columbia-Presbyterian Medical Center in New York. As you work through this training manual, you will learn the skills to successfully administer nasal CPAP to premature infants using a bubble system. The sections outlined below contain information regarding the theory and the application of the nasalCPAP bubble system. Section One: Background and Theory provides a brief review of the physiology of continuous positive airway pressure, and pertinent literature supporting CPAP use in the premature infant. Section Two: Initiation of nasal CPAP describes the nasal CPAP delivery system and the steps necessary for stabilization and initiation of NCPAP in the delivery room. This chapter describeshow to determine the appropriate size and fit of each component in the nasal CPAP delivery system. Section Three: Maintenance on nasal CPAP describes how to evaluate and to maintain a properly functioning CPAP system, including the use of the nasal CPAP Checklist: Maintaining the nasal CPAP System. Section Four: Complications Associated with nasal CPAP describes complications that may occur to...