1 / 22

CPAP Workshop

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

plato-moore
Télécharger la présentation

CPAP Workshop

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

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

  2. 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. Dr. Gautam Ghosh

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

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

  5. Physiological effects Dr. Gautam Ghosh

  6. Various Modes of CPAP Dr. Gautam Ghosh

  7. 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 Dr. Gautam Ghosh

  8. 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. Dr. Gautam Ghosh

  9. CPAP Ranges Fi O2 controlled from 0.2 to 1.0 with CPAP. Dr. Gautam Ghosh

  10. Indications of CPAP • Respiratory distress, moderate /severe: retraction or grunt. • Recurrent apnea • P aO2 < 60 with FiO2 > 0.6 ( O2 hood). • Early : within 2 hrs of distress. • Late ; after FiO2 requirement > 0.6 Dr. Gautam Ghosh

  11. 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 Dr. Gautam Ghosh

  12. 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. Dr. Gautam Ghosh

  13. Optimum CPAP • Comfortable baby / pink / normal BP • No retraction / grunt • No cyanosis / normal CRT • CRT < 3 SEC • SpO2 > 90-93 % • ABG : PaO2 60-80 / PaCO2 40-45 /p H 7.30-7.40. • Diagnosis ; Xray Chest in supine : Post. Intercostal space 7-8 (if > 8 : reduce PEEP / IF < 5 : raise PEEP) Dr. Gautam Ghosh

  14. Failure of CPAP • Retraction / Grunt ++ • Apnea on CPAP • PaO2 < 50 in FiO2 > 0.8 ( nasal CPAP >8cm) • PaCO2 > 55 • Baby not tolerating CPAP. • Commonest cause : delay in starting Dr. Gautam Ghosh

  15. 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 15-30 min after each setting. Dr. Gautam Ghosh

  16. Practical Points in CPAP • Warm gases at 34—37* C & humidify. • Gas flow (21/2 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 Dr. Gautam Ghosh

  17. 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 ?? Dr. Gautam Ghosh

  18. 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 Dr. Gautam Ghosh

  19. 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. Dr. Gautam Ghosh

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

  21. Case 1 • 30wks, Uncontrolled APH, 30 yrs , 4th gravida, P 1+2, LUCS, 1 dose Dexa 12 hr before birth • BVm with 100% O2for resuscitation, APGAR 5/1, 8/5. 1280 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) Dr. Gautam Ghosh

  22. ABG tree Dr. Gautam Ghosh

More Related