Infant CPAP therapy

Continuous positive airway pressure (CPAP) therapy is a well-established mode of noninvasive respiratory support for spontaneously breathing patients.

Bubble CPAP System

Designed to provide consistent pressure to infants up to 10 kg. This system includes circuits, a pressure relief manifold and a Bubble CPAP generator.

View Bubble CPAP System

FlexiTrunk™ nasal CPAP interface

An integrated solution that includes all the components for delivering CPAP: nasal masks, nasal prongs, bonnets, and headgear. Provides a complete system when combined with a Bubble CPAP generator.

View FlexiTrunk Interface

How does CPAP work?

CPAP therapy delivers a mixture of heated, humidified air and oxygen and generates a continuous distending pressure throughout the respiratory cycle by means of a sealed interface.^1,2

CPAP can be used in both the acute and recovery phases of respiratory distress syndrome (RDS) and is well established to improve the work of breathing.^5,6

Selecting an appropriately-sized interface is important for achieving an adequate seal. Short bi-nasal prongs or a nasal mask are the most common types of interfaces for CPAP delivery.³

Bubble CPAP is a type of CPAP therapy commonly used for younger patients.⁴ During bubble CPAP, an underwater seal is created by submerging the expiratory tube in water to varying degrees. Gas exiting the expiratory tube produces bubbles, the bursting of which generates pressure oscillations, which may improve gas exchange and carbon dioxide (CO₂) elimination compared with other modes of CPAP delivery.^1,4

• Bubble CPAP generates pressure oscillations
• Promotes airway hydration

Bubble CPAP generates pressure oscillations

Pressure oscillations generated during bubble CPAP therapy produce vibrations that are similar to those produced by high-frequency ventilation, and which may improve gas exchange and CO₂ elimination.⁴

Studies have demonstrated these pressure oscillations may be transmitted down the airways and into the lungs.^4,17

Fig 1. Graphical representation of bubble CPAP generated pressure oscillations. The pressure vs. time plot shows how pressure oscillations vary over time (green line) alongside the resulting mean airway/nasopharyngeal (NP) pressure (blue line).

Promotes airway hydration

During CPAP therapy, continuous distending pressure is generated throughout the respiratory cycle, and a heated and humidified mixture of air and oxygen is delivered.

Heated and humidified gas is an important aspect of delivering CPAP therapy, assisting with the natural defense mechanisms, maintaining airway mucosa and promoting conservation of energy for growth and development.^23,24

CPAP: Neonates and Infants — Clinical Paper Summaries

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Gupta S and Donn SM. Seminars in Fetal and Neonatal Medicine - Continuous positive airway pressure: Physiology and comparison of devices. Semin. Fetal Neonatal Med. 21, 204–11 (2016). View abstract
Courtney SE and Barrington KJ. Continuous positive airway pressure and noninvasive ventilation. Clin. Perinatol. 34, 73–92, vi (2007). View abstract
Sweet DG et al. European consensus guidelines on the management of respiratory distress syndrome – 2019 update. Neonatology 115, 432–50 (2019). View abstract
Lee KS, Dunn MS, Fenwick M and Shennan AT. A comparison of underwater bubble continuous positive airway pressure with ventilator-derived continuous positive airway pressure in premature neonates ready for extubation. Biol. Neonate 73, 69–75 (1998). View abstract
Chan V and Greenough A. Randomized trial of methods of extubation in acute and chronic respiratory distress. Archives of Disease in Childhood. 68, 570–2 (1993). View abstract
Morley, S. L. Non-invasive ventilation in paediatric critical care. Paediatr. Respir. Rev. 20, 24–31 (2016). View abstract
Magnenant E et al. Dynamic behavior of respiratory system during nasal continuous positive airway pressure in spontaneously breathing premature newborn infants. Pediatr. Pulmonol. 37, 485–91 (2004). View abstract
Bhutani VK. Development of the Respiratory System. In: Manual of Neonatal Respiratory Care 3–15 (Springer US, 2012). doi:10.1007/978-1-4614-2155-9_1. View abstract
Saunders RA, Milner AD and Hopkin IE. The effects of continuous positive airway pressure on lung mechanics and lung volumes in the neonate. Biol. Neonate 29, 178–86 (1976). View abstract
Milner AD, Saunders RA and Hopkin IE. Effects of continuous distending pressure on lung volumes and lung mechanics in the immediate neonatal period. Biol. Neonate 31, 111–15 (1977). View abstract
Diblasi RM. Nasal continuous positive airway pressure (CPAP) for the respiratory care of the newborn infant. Respir. Care 54, 1209–35 (2009). View abstract
Higgins RD, Richter SE and Davis JM. Nasal continuous positive airway pressure facilitates extubation of very low-birth-weight neonates. Pediatrics 88, 999–1003 (1991). View abstract
Finer NN et al. Early CPAP versus surfactant in extremely preterm infants. N. Engl. J. Med. 362, 1970–79 (2010). View abstract
Tooley J and Dyke M. Randomized study of nasal continuous positive airway pressure in the preterm infant with respiratory distress syndrome. Acta Paediatr. 92, 1170–74 (2003). View abstract
De Paoli AG. Nasal CPAP for neonates: what do we know in 2003? Archives of Disease in Childhood. – Fetal Neonatal Ed. 88, 168F–172F (2003). View abstract
Morley C and Davis P. Continuous positive airway pressure: current controversies. Curr. Opin. Pediatr. 16, 141–45 (2004). View abstract
Hough JL et al. Effect of body position on ventilation distribution in preterm infants on continuous positive airway pressure. Pediatr. Crit. Care Med. 13, 446–51 (2012). View abstract
Avery ME et al. Is chronic lung disease in low-birth-weight infants preventable? A survey of eight centers. Pediatrics 79, 26–30 (1987). View abstract
Gregory GA, Kitterman JA, Phibbs RH, Tooley WH and Hamilton WK. Treatment of the idiopathic respiratory-distress syndrome with continuous positive airway pressure. N. Engl. J. Med. 284, 1333–40 (1971). View abstract
Morley CJ et al. Nasal CPAP or intubation at birth for very preterm infants. N. Engl. J. Med. 358, 700–8 (2008). View abstract
Thukral A, Sankar MJ, Chandrasekaran A, Agarwal R and Paul VK. Efficacy and safety of CPAP in low- and middle-income countries. J. Perinatol. 36 Suppl. 1, S21–8 (2016). View abstract
De Paoli AG, Davis PG, Faber B and Morley CJ. Devices and pressure sources for administration of nasal continuous positive airway pressure (NCPAP) in preterm neonates. Cochrane Database Syst. Rev. CD002977 (2008). View abstract
Pollett HF and Reid WD. Prevention of obstruction of nasopharyngeal CPAP tubes by adequate humidification of inspired gases. Can. Anaesth. Soc. J. 1977 Sep;24(5):615–17 (1977). View abstract
de Klerk A. In: Physiology of Humidification in Critically Ill Neonates. Springer Berlin Heidelberg (2012). View abstract

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