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CPAP review

Olie Chowdhury1, Catherine J Wedderburn, Donovan Duffy

  • 1Division of Asthma, Allergy & Lung Biology, MRC-Asthma UK Centre in Allergic Mechanisms of Asthma, King's College, London, UK.

European Journal of Pediatrics
|December 17, 2011
PubMed

Insights

Continuous positive airway pressure (CPAP) effectively prevents re-intubation in premature infants when delivered via short nasal prongs. Early CPAP use and specific pressure levels reduce extubation failure, but optimal generation methods require further study.

Area of Science:

  • Neonatal respiratory support
  • Pediatric critical care

Background:

  • Continuous positive airway pressure (CPAP) is a cornerstone of respiratory support in neonatal intensive care units.
  • It is utilized both as an initial treatment and post-extubation following mechanical ventilation, especially for prematurely born infants.

Purpose of the Study:

  • To review the evidence for CPAP use in prematurely born infants.
  • To evaluate different methods of CPAP delivery and their impact on clinical outcomes.
  • To assess the association between CPAP and bronchopulmonary dysplasia (BPD).

Main Methods:

  • Meta-analysis of randomized trials comparing CPAP delivery methods.
  • Review of observational studies on early CPAP versus ventilation.
  • Analysis of randomized trials examining CPAP levels and weaning strategies.

Main Results:

  • Delivery of CPAP via short nasal prongs is most effective in preventing re-intubation.
  • CPAP use reduces extubation failure, particularly with levels ≥5 cm H2O.
  • Evidence for high-flow nasal cannulae in premature infants is insufficient; early CPAP's link to lower BPD incidence requires further confirmation.

Conclusions:

  • Short nasal prongs are recommended for CPAP delivery to prevent re-intubation.
  • CPAP is effective in reducing extubation failure in premature infants.
  • Further research is needed to optimize CPAP generation and weaning strategies to minimize complications like BPD and nasal injury.

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