| Unpredictability of delivered bubble nasal continuous positive airway pressure: role of bias flow magnitude and nares-prong air leaks. | |
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MedLine Citation:
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PMID: 17622958 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Nasal continuous-positive-airway-pressure (NCPAP) is popular for infant respiratory support. We compared delivered to intended intra-prong, proximal-airway, and distal-airway pressures using ventilator (V-NCPAP) and bubble (B-NCPAP) devices. Measurements were repeated at five flows (4, 6, 8, 10, and 12 L/min) and three NCPAP (4, 6, and 8 cm H2O) under no, small, and large nares-prong interface leak conditions. With no-leak, delivered B-NCPAP was systematically greater than intended levels at all pressure sites. The corresponding V-NCPAP flow-dependence was none-to-minimal. Prong and intra-airway B-NCPAP overshoots were also observed with small-leak, while only prong B-NCPAP showed a flow-dependent overshoot for large-leak. Leaks did not affect intra-prong V-NCPAP but resulted in progressively lower than desired, flow-independent intra-airway V-NCPAP. We conclude that the self-adjusting capability of ventilators allows closely matched actual versus intended V-NCPAP. Alternatively, for the range of flows used clinically, intra-prong and intra-airway B-NCPAP are systematically higher at increasing flows than operator-intended levels, even when appreciable nares-prong leak is present. Additionally, the oscillations (noise) characterizing B-NCPAP are substantially attenuated between the proximal and distal airways; therefore, it is unlikely that B-NCPAP engenders ventilation or lung recruitment via this phenomenon. Tubing submersion depth for setting the level of B-NCPAP is highly inaccurate, and operators should instead rely on intra-prong pressure measurement. |
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Authors:
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Doron J Kahn; Sherry E Courtney; Andrew M Steele; Robert H Habib |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Pediatric research Volume: 62 ISSN: 0031-3998 ISO Abbreviation: Pediatr. Res. Publication Date: 2007 Sep |
Date Detail:
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Created Date: 2007-12-05 Completed Date: 2008-01-25 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0100714 Medline TA: Pediatr Res Country: United States |
Other Details:
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Languages: eng Pagination: 343-7 Citation Subset: IM |
Affiliation:
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Department of Neonatal-Perinatal Medicine, Schneider Children's Hospital, NSLIJHS, New Hyde Park, New York 11040, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Continuous Positive Airway Pressure*
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instrumentation,
methods Humans Infant Masks Models, Biological |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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