John Stephen C, Barnett Joseph D, Habben Nickolas D, Le Hoa T, Cheng Eric, John Sunil P, Gustafson Peter A
University of Michigan Medical School, Ann Arbor, Michigan.
Western Michigan University, Kalamazoo, Michigan.
Respir Care. 2017 Sep;62(9):1131-1136. doi: 10.4187/respcare.05443. Epub 2017 May 30.
Neonatal respiratory distress results in > 1 million annual deaths worldwide. Bubble CPAP is a simple, effective, and widely used therapy for infants in respiratory distress. In low-resource settings, more advanced respiratory support is limited by cost, technical expertise, and sporadic electricity. We sought to develop a safe, inexpensive, and simple solution to provide further respiratory support for these infants.
A standard bubble CPAP system was modified to provide 2 levels of positive airway pressure (bi-level positive airway pressure) by attaching a novel device. To demonstrate reliability, the system was run with continuous pressure monitoring on full-term and preterm neonatal mannikins with pressure targets of 8/5 cm HO and 15/5 cm HO to simulate 2 different modes of noninvasive ventilation (NIV).
At a ventilation rate set between 30 and 45 cycles/min, by adjusting the leak rate of the device, the following mean pressures ± SD were demonstrated: term mannikin low-pressure NIV, 7.9 ± 0.2/5.3 ± 0.2 cm HO; term mannikin high-pressure NIV, 15.1 ± 0.1/6.1 ± 0.1 cm HO; preterm mannikin low-pressure NIV, 7.9 ± 0.2/5.3 ± 0.2 cm HO; preterm mannikin high-pressure NIV, 16.5 ± 0.4/5.1 ± 0.1 cm HO.
The modified bubble CPAP system reliably provided alternating pressures similar to bi-level positive airway pressure modes of respiratory support in neonatal mannikins. The dual-pressure technology is a simple, single connection add-on that can readily be applied to existing bubble CPAP systems.
新生儿呼吸窘迫在全球每年导致超过100万人死亡。气泡持续气道正压通气（bubble CPAP）是一种用于呼吸窘迫婴儿的简单、有效且广泛应用的治疗方法。在资源匮乏地区，更先进的呼吸支持受到成本、技术专长和间歇性电力的限制。我们试图开发一种安全、廉价且简单的解决方案，为这些婴儿提供进一步的呼吸支持。
通过连接一种新型装置，对标准气泡CPAP系统进行改良，以提供两种水平的气道正压（双水平气道正压）。为证明其可靠性，该系统在足月和早产新生儿模型上进行连续压力监测运行，压力目标分别为8/5 cm HO和15/5 cm HO，以模拟两种不同模式的无创通气（NIV）。
在设定为30至45次/分钟的通气频率下，通过调整该装置的漏气率，得到以下平均压力±标准差：足月模型低压NIV，7.9±0.2/5.3±0.2 cm HO；足月模型高压NIV，15.1±0.1/6.1±0.1 cm HO；早产模型低压NIV，7.9±0.2/5.3±0.2 cm HO；早产模型高压NIV，16.5±0.4/5.1±0.1 cm HO。
改良后的气泡CPAP系统在新生儿模型中可靠地提供了类似于双水平气道正压通气模式的交替压力。双压力技术是一种简单的单连接附加装置，可轻松应用于现有的气泡CPAP系统。
