Brief clinical and laboratory observationPharyngeal pressures in nasal CPAP
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Cited by (23)
Respiratory distress syndrome in preterm neonates in the era of precision medicine: A modern critical care-based approach
2021, Pediatrics and NeonatologyCitation Excerpt :CPAP is better transmitted if delivered through nasal mask in the first days of life and this seems also to reduce the risk of local skin injury.53,54 However, we have to acknowledge that nasal CPAP unavoidably has relevant leaks up to around 40% with mouth opening,55 irrespective of the nasal interface used56–59 and the same applies for more complex techniques of non-invasive respiratory failure.60 As the optimal CPAP level to be provided in preterm neonates with RDS is not known, we also ignore if active mouth closure may be beneficial.
Less invasive surfactant administration: a word of caution
2020, The Lancet Child and Adolescent HealthCitation Excerpt :The absence of substantial pressure leaks, and the presence of a patent airway, are also essential, because leaks, upper airway obstruction, or both, can impair pressure transmission. Pressure leaks often occur in vivo (40–50% of delivered pressure is lost) when a neonate's mouth is open,8–10 and are independent from the type of CPAP.11 Similar pressure leaks have been measured during the use of different types of non-invasive ventilation, such as biphasic positive airway pressure, neurally adjusted ventilator assistance, and nasal high-frequency oscillatory ventilation.12
The Montreux definition of neonatal ARDS: biological and clinical background behind the description of a new entity
2017, The Lancet Respiratory MedicineCitation Excerpt :For neonates treated with non-invasive respiratory support, accurate mean airway pressure calculation is difficult. Estimations of the applied mean airway pressure should only be made when the airway leak has been minimised, which can be achieved by closure of the mouth with gentle pressure on the jaw and use of interfaces of appropriate size.64,65 Blood gas values from indwelling arterial lines should be used to calculate oxygenation index.
Effects of flow rate and airleak at the nares and mouth opening on positive distending pressure delivery using commercially available high-flow nasal cannula systems: A lung model study
2011, Pediatric Critical Care MedicineCitation Excerpt :Total airleak in infants receiving nasal CPAP depends on prong size, nares size, configuration of the nasal passages, and leak at mouth. Chilton and Brooks (15) described a reduction from set pressure to delivered pressure of approximately 50% when nasal CPAPs were sampled in the pharyngeal area of infants with open mouth, suggesting significant airleak with consequent reduction in delivered distending pressures when the mouth is open. De Paoli (16) et al described a similar observation in 11 preterm infants receiving bubble CPAP.
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Dr. Chilton supported in part by a grant from the American Lung Association of Colorado.