title: Strategies for the prevention of continuous positive airway pressure failure.
abstract: Progress in neonatal intensive care is closely linked to improvements in the management of respiratory failure in preterm infants. Current modalities of respiratory support range from the more benign continuous positive airway pressure (CPAP) to various modes of mechanical ventilation. Data from recent randomized control trials suggest that the use of nasal (n)CPAP as the initial mode of respiratory support in critically ill very low birth weight infants is associated with a lower incidence of chronic lung disease. The practice of early initiation of nasal-prong CPAP in all spontaneously breathing infants at Columbia University has resulted in very low rates of chronic lung disease for decades. Many institutions have attempted to replicate the practices and results at Columbia University. However, success rates with nCPAP are highly variable, which may in part be attributable to how well it is utilized. With recent renewed interest in non-invasive respiratory support, particularly bubble nCPAP, it is essential to evaluate strategies for the prevention of CPAP failure. This review discusses strategies that address these issues and shares the practical aspects for replicating success with bubble nCPAP. In addition, it reviews desirable features, major components, and physiological consequences of various bubble CPAP systems along with clinical experience of CPAP use.
authors.affiliation: Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Sahni
authors.affiliation: NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Schiaratura
authors.affiliation: Columbia University College of Physicians and Surgeons, New York, NY, USA. Electronic address: rap32@cumc.columbia.edu.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Polin
mesh_terms: D045422:Continuous Positive Airway Pressure / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*; D017211:Treatment Failure
keywords: Infant; Nasal continuous positive airway pressure; Newborn; Preterm; Respiratory distress syndrome