Optimum levels of CPAP for tracheal extubation of newborn infants

doi:10.1016/S0022-3476(76)80942-0

The Journal of Pediatrics

Volume 89, Issue 1, July 1976, Pages 109-112

https://doi.org/10.1016/S0022-3476(76)80942-0 Get rights and content

Arterial oxygen tension and functional residual capacity were studied in 16 intubated, spontaneously breathing newborn infants recovering from respiratory disease. Studies were made at 2 cm H₂O continuous positive airway pressure, at zero end expiratory pressure, and following extubation. The study showed that Pa_O₂ and FRC at 2 cm H₂O CPAP were the same as observed following extubation, but that both values were significantly lower at ZEEP.

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Randomized, controlled trial of nasopharyngeal continuous positive airway pressure in the extubation of very low birth weight infants
1994, The Journal of Pediatrics
We conducted a prospective, randomized controlled trial to determine whether extubation of very low birth weight infants was facilitated by the use of nasopharyngeal continuous positive airway pressure (CPAP). Eligible infants included patients weighing 600 to 1500 gm at birth who required tracheal intubation within 48 hours of birth and who met specific predetermined criteria for extubation by day 14 of life. We also sought to determine whether varying the duration of nasopharyngeal CPAP influenced the likelihood of successful extubation. Infants underwent random assignment to receive nasopharyngeal CPAP until resolution of lung disease (n = 40), 6 hours of nasopharyngeal CPAP (n = 42), or oxygen supplementation delivered by hood (n = 42). Extubation failure was predefined as a requirement for ≥80% oxygen, pH ≤7.20, severe apnea, or predefined clinical deterioration, and extubation success was predefined as the ability to remain free of a requirement for mechanical ventilation for 7 days and a 66% reduction in the need for supplemental oxygen. Each group was similar with regard to race, sex, and birth weight. Extubation was successful in 62%, 61%, and 60% of infants. After stratification by birth weight, there were no significant differences in the rates of successful extubation among the treatment groups. We conclude that nasopharyngeal CPAP does not improve the likelihood of successful extubation of very low birth weight infants who are ready for extubation within the first 2 weeks of life. (J Pediatr 1994;124:455-60)
Influence of glottic mechanism on pulmonary function after acute lung injury
1990, Chest
We measured arterial gas tensions, respiratory timing, and intratracheal pressure in 12 rabbits to investigate the consequences of translaryngeal intubation with normal and subsequently injured lungs. Data were collected before, during, and after intubation. Intubation in normal rabbits precipitated no untoward effects on gas exchange or respiratory phase timing. However, there was significant elevation of subglottic pressure during expiration following extubation. Central venous injection of oleic acid (0.08 ml/kg) induced an acute lung injury that after 24 h was characterized by reduced PaO₂ and dynamic lung-thorax compliance and tachypnea. Intubation in animals with acute lung injury was associated with a significant decline in arterial oxygenation, tachypnea, and increased Pco₂. Expiratory tracheal pressure and expiratory time were greater and PaCO₂ and respiratory rate were lower following extubation. We conclude that translaryngeal intubation following acute lung injury exacerbates already compromised pulmonary function by preventing a compensatory expiratory braking maneuver by the glottic apparatus.
The effect of external expiratory resistance on lung volume and pulmonary function in the neonate
1980, The Journal of Pediatrics
To investigate the acute physiologic effects of external expiratory resistance on lung function in extubated neonates recovering from respiratory disease, lung mechanics, respiratory patterns, and function residual capacity were measured in ten neonates during a control period and immediately after application of an external expiratory resistance of 30 cm H₂O/l/second via a face mask. Following application of EER, mean FRC increased by 40.8% (P<0.05). The work of breathing was significantly increased after the EER was applied; there was also a significant increase in measured expiratory resistance and a decrease in inspiratory-expiratory time ratio. The change in lung volume was rapid, requiring less than five seconds for the new end-expiratory level to be reached. Dynamic lung compliance, inspiratory resistance, and respiratory rate did not change during any phase of the study. The application of external expiratory resistance may have potential therapeutic value by increasing lung volume in infants recovering from respiratory disease.

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⁺: Supported in part by United States Public Health Service Grant 5 2 1 GN-00215-16 from the National Institutes of Health.

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Optimum levels of CPAP for tracheal extubation of newborn infants+

J Pediatr

The significance of grunting in hyaline membrane disease

Pediatrics

Newborn housestaff manual

Lung volume in newborn infants after cardiovascular surgery

Treatment of the idiopathic respiratory distress syndrome with continuous positive airway pressure

N Engl J Med