Randomised In Vitro Study Investigating PEEP-Stability During Application of CPAP With Binasal Prongs and Face Masks

Face masks and binasal prongs are commonly used interfaces for applying continuous positive airway pressure (CPAP) in neonatology. We aimed to assess CPAP stability in a randomised controlled in vitro study.

In a simulated resuscitation scenario of a 1000-g preterm infant with respiratory distress, 20 operators (10 with/without neonatology experience) aimed to maintain a CPAP of 5 cmH₂O as precisely as possible using face masks or binasal prongs in random order. The primary outcome was the minimum-achieved CPAP at the Y-piece (P_Ymin). Secondary outcomes included time to target CPAP, CPAP stability and the impact of operator experience.

Binasal prongs enabled more consistent maintenance of the target CPAP of 5 cmH₂O than face masks (median [IQR]: P_Ymin: binasal prongs, 3.74 cmH₂O [3.54-3.88]) vs. 3.20 cmH₂O (2.72-3.73), with no significant deviation from the target CPAP. Target CPAP was achieved significantly faster with face masks (2.89 s [1.67-5.64] vs. 6.49 s [4.76-13.62] [p < 0.05]). No significant differences were observed on the basis of operator experience (p > 0.05).

Binasal prongs allow more accurate CPAP maintenance than face masks regardless of the operator's experience, although current clinical studies offer limited evidence on the superiority of nasal interfaces compared with that of face masks.