Published online October 31, 2008
PEDIATRICS Vol. 122 No. 5 November 2008, pp. 1009-1013 (doi:10.1542/peds.2007-3416)
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ARTICLE

Effects of Flow Amplitudes on Intraprong Pressures During Bubble Versus Ventilator-Generated Nasal Continuous Positive Airway Pressure in Premature Infants

Doron J. Kahn, MDa, Robert H. Habib, PhDb,c and Sherry E. Courtney, MD, MSa

a Department of Neonatal-Perinatal Medicine, Schneider Children's Hospital, North Shore Long Island Jewish Health System, New Hyde Park, New York
b Department of Pediatrics, Mercy Children's Hospital at St Vincent Mercy Medical Center, Toledo, Ohio
c Department of Pediatrics, University of Toledo College of Medicine, Toledo, Ohio

OBJECTIVES. The goal were to characterize the flow dependence of bubble nasal continuous positive airway pressure delivery in a cohort of preterm infants and to compare the actual (delivered) intraprong continuous positive airway pressure with the intended (set) nasal continuous positive airway pressure for both ventilator-generated nasal continuous positive airway pressure and bubble nasal continuous positive airway pressure delivery. A range of set values and constant flow rates were studied in the same preterm infants.

METHODS. For 12 premature infants of <1500 g (birth weight: 1140 ± 267 g; gestational age: 28.5 ± 1.9 weeks; study age: 12.9 ± 8 days; all mean ± SD), intraprong pressures were measured at 3 increasing flow settings, repeated for set nasal continuous positive airway pressures (or desired immersion depths) of 4 and 6 cmH2O. Next, intraprong pressures were measured at bubble nasal continuous positive airway pressure expiratory tubing submersion depths and ventilator-generated nasal continuous positive airway pressure set expiratory pressures of 2, 3, 4, 5, and 7 cmH2O while the flow rate was held constant.

RESULTS. Actual (delivered) intraprong pressure during bubble nasal continuous positive airway pressure delivery was highly flow dependent and increased as the flow rate increased. During ventilator-generated nasal continuous positive airway pressure delivery, actual pressure at the nasal prongs closely approximated the pressure set at the ventilator. During bubble nasal continuous positive airway pressure delivery at constant flow rate, the average delivered prong pressure was 1.3 cmH2O (range: 0.5–2.2 cmH2O) higher than that set through submersion of the expiratory tubing, and the relative difference between the set and actual pressures increased at lesser immersion depths.

CONCLUSIONS. Prong pressure during bubble nasal continuous positive airway pressure delivery is highly variable and depends on the interaction of submersion depth and flow amplitudes.

Key Words: nasal continuous positive airway pressure • bubble nasal continuous positive airway pressure • ventilator-generated nasal continuous positive airway pressure • ventilation

Abbreviations: NCPAP—nasal continuous positive airway pressure • B-NCPAP—bubble nasal continuous positive airway pressure • V-NCPAP—ventilator-generated nasal continuous positive airway pressure • CPAP—continuous positive airway pressure

Accepted Feb 19, 2008.


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