Đang tải... (xem toàn văn)
(BQ) Part 2 book “Atlas of procedures in neonatology” has contents: Peripheral intravenous line placement, peripheral arterial cannulation, central venous catheterization, umbilical artery, central venous catheterization, exchange transfusions, catheterization, umbilical vein catheterization,… and other contents.
VI Respiratory Care 35 Bubble Nasal Continuous Positive Airway Pressure 36 Endotracheal Intubation 230 LWBK1090-C35_p230-235.indd 230 11/07/12 11:16 PM 35 Hany Aly Bubble Nasal Continuous Positive Airway Pressure M.A Mohamed A Definition Continuous positive airway pressure (CPAP) is a noninvasive, continuous flow respiratory system that maintains positive pressure in the infant’s airway during spontaneous breathing CPAP was developed by George A Gregory in the late 1960s (1) Positive pressure was originally applied by placing the neonate’s head into a semiairtight “box” (the Gregory box) and, subsequently, by a fitted face mask covering the mouth and nose (2) A major problem with both these methods of application was the fact that it was difficult to feed the baby without discontinuing the CPAP, thus the evolution to the current method of applying CPAP through bilateral nasal prongs (3) “Bubble CPAP” (b-CPAP) is a modern resurgence of the original method of supplying CPAP, wherein pressure is generated in the breathing circuit by immersing the distal end of the expiratory limb of the breathing circuit under a water seal (4–6) (Fig 35.1) Bubble CPAP allows provision of CPAP without use of a ventilator, and it is currently primarily used for early treatment of low-birthweight premature infants with or at risk for respiratory distress syndrome and/or with frequent apnea/ bradycardia (7) In addition to cost considerations, there is early evidence that b-CPAP may be more effective in small premature babies than ventilator-derived CPAP (8) CPAP has the Following Physiologic Actions Prevents alveolar collapse and increases functional residual capacity Splints the airway and diaphragm Stimulates the act of breathing and decreases apnea Conserves surfactant via decreased inflammatory responses (9) Stimulates lung growth when applied for extended duration (10) B Indications Premature infants with/at high risk for respiratory distress syndrome Premature infants with frequent apnea and bradycardia of prematurity Infants with transient tachypnea of the newborn Infants who have weaned from mechanical ventilation Infants with paralysis of the diaphragm or tracheoma lacia When to Start b-CPAP? a Premature infants with a birthweight 60 breaths/min (2) Mild to moderate grunting (3) Mild to moderate respiratory retraction (4) Preductal oxygen saturation