The basics of neonatal CPAP

If you work for a smaller hospital and rarely see bad baby's and yet are asked to set up CPAP on one, you ought to know what you're doing. We usually stabilize the baby and then ship the baby to a regional neonatal intensive care unit.

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:

1. 5–6 CWP good place to start
2. 2. 7 – 8 CWP if FiO2 needs greater than60%, or signs increased SOB
3. If SpO2 greater than target range, down FiO2 by 5–20, then allow 4 minutes for stabilization between each change.
4. If SpO2 less than target range, up FiO2 by 5–20, then wait 4 min for stabilizing between changes
5. 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:

1. PaO2 less than 50-60 and FiO2 greater than 60
2. Infant needs increased level of respiratory support but does not yet need intubation and positive pressure breaths
3. Infant experiencing increased frequency or severity of apnea, yet episodes not severe enough to warrent intubation
4. Infant has increased work of breathing and/or increasing oxygen requirements (Retractions, grunting, etc.)
5. Infant has mild CO2 retention and mild acidosis
6. Infant has atelectasis on x-ray
7. Infant has trancheobronchomalacia
8. Respiratory Distress Syndrome
9. Meconium Aspiration
10. Apnea of Prematurity
11. Patent Ductus Arteriosis

(Information obtained from STABLE program.

Contraindications for setting up CPAP on neonate:

1. Infants with rapidly progressing respiratory failure
2. Infants with increasing CO2, decreasing pH, and progressive hypoxemia
3. Diaphragmatic hernia
4. Tracheosophageal fistula
5. Choanal atresia
6. Cleft palate
7. Cardiovascular instability and poor heart function
8. poor respiratory drive
9. no respiratory drive

(Information obtained from STABLE program)

Pulmonary effects of CPAP:

1. Decreases respiratory rate, tidal volume and minute ventilation
2. Increases FRC
3. Decreasees lung compliance and dynamic compliance
4. Decreases total aireway resistance
5. Protective effect on surfactant

(Information obtained from this slide presentation Thrathip Kolatat MD)