To help us stabilize the patient, we often use CPAP.
That in mind, here's the advice I received from our regional intensive care unit on setting up CPAP on neonates:
Setting up CPAP for a neonate:
- 5–6 CWP good place to start
- 2. 7 – 8 CWP if FiO2 needs greater than60%, or signs increased SOB
- If SpO2 greater than target range, down FiO2 by 5–20, then allow 4 minutes for stabilization between each change.
- If SpO2 less than target range, up FiO2 by 5–20, then wait 4 min for stabilizing between changes
- Continue assuring AW patent, HR greater than 100, & infant not apneic.
(For a printable cheat sheet with this information and more, click here. )
It's also important to know when to use CPAP and when not to.
Indications for setting up CPAP on neonate:
- PaO2 less than 50-60 and FiO2 greater than 60
- Infant needs increased level of respiratory support but does not yet need intubation and positive pressure breaths
- Infant experiencing increased frequency or severity of apnea, yet episodes not severe enough to warrent intubation
- Infant has increased work of breathing and/or increasing oxygen requirements (Retractions, grunting, etc.)
- Infant has mild CO2 retention and mild acidosis
- Infant has atelectasis on x-ray
- Infant has trancheobronchomalacia
- Respiratory Distress Syndrome
- Meconium Aspiration
- Apnea of Prematurity
- Patent Ductus Arteriosis
(Information obtained from STABLE program.
Contraindications for setting up CPAP on neonate:
- Infants with rapidly progressing respiratory failure
- Infants with increasing CO2, decreasing pH, and progressive hypoxemia
- Diaphragmatic hernia
- Tracheosophageal fistula
- Choanal atresia
- Cleft palate
- Cardiovascular instability and poor heart function
- poor respiratory drive
- no respiratory drive
(Information obtained from STABLE program)
Pulmonary effects of CPAP:
- Decreases respiratory rate, tidal volume and minute ventilation
- Increases FRC
- Decreasees lung compliance and dynamic compliance
- Decreases total aireway resistance
- Protective effect on surfactant
(Information obtained from this slide presentation Thrathip Kolatat MD)