Presentation is loading. Please wait.

Presentation is loading. Please wait.

Dr. Gautam Ghosh CPAP Workshop Dr. Gautam Ghosh Dr. Chandan Roy Dr. Ashok Modi Dr. Debjani Gupta Dr. Amit Roy.

Similar presentations

Presentation on theme: "Dr. Gautam Ghosh CPAP Workshop Dr. Gautam Ghosh Dr. Chandan Roy Dr. Ashok Modi Dr. Debjani Gupta Dr. Amit Roy."— Presentation transcript:

1 Dr. Gautam Ghosh CPAP Workshop Dr. Gautam Ghosh Dr. Chandan Roy Dr. Ashok Modi Dr. Debjani Gupta Dr. Amit Roy

2 Dr. Gautam Ghosh Definition CPAP : It is a modality of respiratory support in which increased pulmonary pressure is provided artificially during the expiratory phase of the respiration in a spontaneously breathing neonate. IPPV or IMV : Breathing is taken over completely by the machine & increased pulmonary pressure occurs during both inspiration & expiration.

3 Dr. Gautam Ghosh Historical review Poulton & Oxam 1936 Gregory et. Al 1971: first trial Agostino 1973 : first RDS managed with CPAP. Bubble & Dual flow CPAP (Infant flow drive)

4 Dr. Gautam Ghosh Types of CPAP Oxygen hood Bubble CPAP & Dual flow CPAP machine Ventilator

5 Dr. Gautam Ghosh Physiological effects Organ System BenefitRisk Pulmona ry FRC / Static compliance / Pa02 IP Shunt/ WOB / PVR Splinting airway& diaphragm /surfactant +++ Air-leak syndrome / Decreased compliance at high pressure. CVS/ CNS CPP = MABP( ) --- ICP ( ) VR / CO ICT/ Renal /GIT ADH /Aldos. Urine / Gut distension

6 Dr. Gautam Ghosh Various Modes of CPAP MethodsAdvantagesDisadvantages ET TubeStable ++/ good control & ventilator access Invasive / Airway resistance ++ Nasal Prongs Easy / low resistance /easy feeding / non- invasive Septal erosion /nasal obstruction /abd. distension Nasophary ng. tube Non-invasive / easy feeding Leaks /pressure necrosis/abd. distension Mask CPAP mask Easiest applicationOral care difficult /leak / aspiration Head boxEasy applicationLeak /high flow 02 / access difficult

7 Dr. Gautam Ghosh Newer CPAP Bubble CPAP : vibration (high frequency?) / may be less CLD (?) Dual flow : Infant flow driver / fluidic flip mechanism / more stable PEEP control / failed nasal CPAP – try Dual flow CPAP— failed –try IMV

8 Dr. Gautam Ghosh Effect on Blood gases Oxygen : Improves due to increase in FRC through recruitment of atelectatic alveoli. CO2 : Decreases due to availability of greater surface area for gas exchange due to recruitment of alveoli. Excessive CPAP(> 7 cm) leads to over-distension of alveoli and CO2 retention. CPAP improves p O2, p CO2 change is secondary.

9 Dr. Gautam Ghosh CPAP Ranges RangesET TubeNasalComment Low3—44—5CPAP< 3 not useful Medium5—76—8Good range High Adverse effects common Fi O2 controlled from 0.2 to 1.0 with CPAP.

10 Dr. Gautam Ghosh Indications of CPAP Respiratory distress, moderate /severe: retraction or grunt. Recurrent apnea P aO2 0.6 ( O2 hood). Early : within 2 hrs of distress. Late ; after FiO2 requirement > 0.6

11 Dr. Gautam Ghosh Guidelines for CPAP Start with nasal CPAP of 5—6 cm & FiO2 0.4— 0.5 Increase CPAP by 1 cm if required Reach a CPAP of 8—9 cm. Now increase FiO2 in small steps of 0.05 up to 0.8 Clinical /ABG / SpO2 > 30min in each step Do not raise FiO2 before pressure : may remove hypoxic stimulus -- apnea Revert to IMV if not responding

12 Dr. Gautam Ghosh Weaning from CPAP Reduce nasal CPAP TO 8 cm Reduce FiO2 by 0.05 to 0.4 Reduce CPAP by 1 cm decrements Reach a level of CPAP 4cm / FiO2 0.4 Remove CPAP and replace a O2 hood.

13 Dr. Gautam Ghosh Optimum CPAP Comfortable baby / pink / normal BP No retraction / grunt No cyanosis / normal CRT CRT < 3 SEC SpO2 > % ABG : PaO / PaCO /p H Diagnosis ; Xray Chest in supine : Post. Intercostal space 7-8 (if > 8 : reduce PEEP / IF < 5 : raise PEEP)

14 Dr. Gautam Ghosh Failure of CPAP Retraction / Grunt ++ Apnea on CPAP PaO2 0.8 ( nasal CPAP >8cm) PaCO2 > 55 Baby not tolerating CPAP. Commonest cause : delay in starting

15 Dr. Gautam Ghosh Monitoring CPAP Clinical : comfort /RR,grunt,retraction /Cyanosis/HR, pulse / CRT,BP / Temp./ Abd.girth / Urine / CPAP machine Pulse Oximetry ; set alarm at 88%(L) & 95%(H). ABG : wait for min after each setting.

16 Dr. Gautam Ghosh Practical Points in CPAP Warm gases at 34—37* C & humidify. Gas flow (2 1/2 times minute ventilation) at 5-8 L/M minimum Look for nasal or oral blocks by secretion Oro-gastric suction is a must Stabilize the head with a cap and string Change CPAP circuit/prong every 3 days Asepsis. Sedation ?? Feed : oro-gastric 10 ml/kg EBM

17 Dr. Gautam Ghosh CPAP & RDS Prevent atelectasis/ preserve surfactant / avoid IMV Early better than late / no role in prophylactic CPAP INSURE : intubate / surfactant /extubate / CPAP with early signs( a/A o2 <0.36) Surfactant by CPAP ; future ??

18 Dr. Gautam Ghosh CPAP & Other disease CPAP after extubaion : Nasal better than ET tube CPAP / SNIPP (synchronised nasal intermittent positive pressure ventilation) MAS : better in atelectatic than over- inflated lung

19 Dr. Gautam Ghosh Complications of CPAP PAL : tends to occur when O2requirements are decreasing & compliance improving Excess PEEP : V /Q mismatch due to excess flow in under-ventilated lungs.

20 Dr. Gautam Ghosh Future With chance of cost of surfactant coming down in future, CPAP may be a better alternative in RDS. Noninvasive ventilation

21 Dr. Gautam Ghosh Case 1 30wks, Uncontrolled APH, 30 yrs, 4 th gravida, P 1+2, LUCS, 1 dose Dexa 12 hr before birth BVm with 100% O2for resuscitation, APGAR 5/1, 8/ gms female Cord blood PCV 56%, Sepsis screen –ve, gastric aspirate shake test –ve. 1hr: tachypnea, retractions, Spo2 82% Put on O2 hood (Fio2 0.5)

22 Dr. Gautam Ghosh ABG tree ABGCORD1 HR (hood) 6HR (CPAP) 14HR (IMV?) p H Pa CO PaO HCO SpO

Download ppt "Dr. Gautam Ghosh CPAP Workshop Dr. Gautam Ghosh Dr. Chandan Roy Dr. Ashok Modi Dr. Debjani Gupta Dr. Amit Roy."

Similar presentations

Ads by Google