Continuous Positive Airway Pressure Interface Research Articles

Masks versus prongs as interfaces for nasal continuous positive airway pressure in preterm infants.

Nasal masks and nasal prongs are used as interfaces for providing continuous positive airway pressure (CPAP) for preterm infants with or at risk of respiratory distress, either as primary support after birth or as ongoing support after endotracheal extubation from mechanical ventilation. It is unclear which type of interface is associated with lower rates of CPAP treatment failure, nasal trauma, or mortality and other morbidity. To assess the benefits and harms of nasal masks versus nasal prongs for reducing CPAP treatment failure, nasal trauma, or mortality and other morbidity in newborn preterm infants with or at risk of respiratory distress. We used standard, extensive Cochrane search methods. The latest search date was October 2021. We included randomised controlled trials comparing masks versus prongs as interfaces for delivery of nasal CPAP in newborn preterm infants (less than 37 weeks' gestation) with or at risk of respiratory distress. We used standard Cochrane methods. Our primary outcomes were 1. treatment failure, 2. all-cause mortality, and 3. neurodevelopmental impairment. Our secondary outcomes were 4. pneumothorax, 5. moderate-severe nasal trauma, 6. bronchopulmonary dysplasia, 7. duration of CPAP use, 8. duration of oxygen supplementation, 9. duration of hospitalisation, 10. patent ductus arteriosus receiving medical or surgical treatment, 11. necrotising enterocolitis, 12. severe intraventricular haemorrhage, and 13. severe retinopathy of prematurity. We used the GRADE approach to assess the certainty of the evidence. We included 12 trials with 1604 infants. All trials were small (median number of participants 118). The trials occurred after 2001 in care facilities internationally, predominantly in India (eight trials). Most participants were preterm infants of 26 to 34 weeks' gestation who received nasal CPAP as the primary form of respiratory support after birth. The studied interfaces included commonly used commercially available masks and prongs. Lack of measures to blind caregivers or investigators was a potential source of performance and detection bias in all the trials. Meta-analyses suggested that use of masks compared with prongs may reduce CPAP treatment failure (risk ratio (RR) 0.72, 95% confidence interval (CI) 0.58 to 0.90; 8 trials, 919 infants; low certainty). The type of interface may not affect mortality prior to hospital discharge (RR 0.83, 95% CI 0.56 to 1.22; 7 trials, 814 infants; low certainty). There are no data on neurodevelopmental impairment. Meta-analyses suggest that the choice of interface may result in little or no difference in the risk of pneumothorax (RR 0.93, 95% CI 0.45 to 1.93; 5 trials, 625 infants; low certainty). Use of masks rather than prongs may reduce the risk of moderate-severe nasal injury (RR 0.55, 95% CI 0.44 to 0.71; 10 trials, 1058 infants; low certainty). The evidence is very uncertain about the effect on bronchopulmonary dysplasia (RR 0.69, 95% CI 0.46 to 1.03; 7 trials, 843 infants; very low certainty). The available trial data provide low-certainty evidence that use of masks compared with prongs as the nasal CPAP interface may reduce treatment failure and nasal injury, and may have little or no effect on mortality or the risk of pneumothorax in newborn preterm infants with or at risk of respiratory distress. The effect on bronchopulmonary dysplasia is very uncertain. Large, high-quality trials would be needed to provide evidence of sufficient validity and applicability to inform policy and practice.

CPAP setup by mail: we're not there yet.

CPAP setup by mail: we're not there yet.

0824 Can the interface utilized in continuous positive airway pressure therapy significantly alter the apnea-hypopnea index in certain patients with obstructive sleep apnea?

Abstract Introduction Multiple studies and analyses have demonstrated that use of an oronasal interface for delivery of continuous positive airway pressure (CPAP) therapy can lead not only to higher pressure requirements, but also a higher residual apnea hypopnea Index (AHI) in patients with obstructive sleep apnea (OSA). Report of Cases: We record a 75-year-old man with severe OSA, AHI of 38, and treated with CPAP 16 cm water. On routine follow up, the residual AHI was 2.9, but he reported mouth-venting with nasal mask and stretched out the chinstrap. He was transitioned to an oronasal interface, and on subsequent follow-up his AHI was 19.6. The decision was made to change back to a nasal mask with a better-fitting chinstrap, which reduced his AHI to 4. To verify that the AHI recorded by the CPAP device was physiologic, the patient later used CPAP while wearing a home sleep apnea test (HSAT) utilizing peripheral arterial tonometry for 2 nights. On the night he used a nasal mask with a chinstrap, the AHI recorded on the CPAP was 1.4 and 3.9 on the HSAT. The following night, he wore the oronasal interface and the recorded AHI on CPAP was 31.6 and 18.5 on the HSAT. Conclusion Although oronasal masks are commonly used as an interface for CPAP, there is significant evidence that nasal delivery systems are more effective at controlling AHI in some individuals. Many studies show that oronasal masks not only correspond to an increase in AHI but also are associated with higher pressure requirements and a lower adherence compared to nasal interfaces. Imaging has shown greater retropalatal airway expansion when using a nasal interface compared to an oronasal device. Oronasal devices may also push the tongue posteriorly and cause increased occlusion of the airway. The consistent finding of worsening OSA control in the setting of oronasal masks has led many to consider CPAP with a nasal interface to be the gold standard for treating OSA. The clinician should therefore be mindful of these considerations when initiating or altering a CPAP interface. Support (If Any)

Development of a smart-fit system for CPAP interface selection.

Continuous Positive Airway Pressure (CPAP) therapy is commonly prescribed for longstanding, acute cases of Obstructive Sleep Apnea (OSA) during which patients must wear a tight-fitting breathing mask overnight for the duration of the treatment. Because this condition frequently leads to the permanent use of CPAP masks, interface selection is a crucial factor influencing the treatment quality and effectiveness. Masks/interface selection is normally performed on a trial an error basis with clinicians informing their selection based on OSA-related factors with basic fitting feedback from patients. However, it is not uncommon for patients to abandon the treatment or request additional consultations due to ill-fitting CPAP mask with the main sources of discomfort being perceived air leakage and mask/strap overtightening leading to skin damage. This work introduces a novel system (Smart-Fit), for CPAP interface selection using advanced digital technologies, such as Reverse Engineering and Computational Modeling (Finite Element Analysis) which are paired to evaluate and determine the best fitting interface for each clinical case. The model simplifies the number of 3D facial landmarks to 12 and established that a 2 mm scan resolution is enough for accurate scans. The Von Mises stress map in ANSYS serves as an indicator of potential high-pressure areas, triggering the need for a chance of mask size. Current results indicate the Smart Fit System can enable a “best fit CPAP interface” to be selected considering individual’s physical characteristics and existing CPAP interface configurations. The development of the Smart Fit System is an evolution compared to traditional CPAP interface selection approach, which optimizes the CPAP interface selection process.

In Vitro Performance of an Investigational Vibrating-Membrane Nebulizer with Surfactant under Simulated, Non-Invasive Neonatal Ventilation Conditions: Influence of Continuous Positive Airway Pressure Interface and Nebulizer Positioning on the Lung Dose

Non-invasive delivery of nebulized surfactant has been a long-pursued goal in neonatology. Our aim was to evaluate the performance of an investigational vibrating-membrane nebulizer in a realistic non-invasive neonatal ventilation circuit with different configurations. Surfactant (aerosols were generated with a nebulizer in a set-up composed of a continuous positive airway pressure (CPAP) generator with a humidifier, a cast of the upper airway of a preterm infant (PrINT), and a breath simulator with a neonatal breathing pattern. The lung dose (LD), defined as the amount of surfactant collected in a filter placed at the distal end of the PrINT cast, was determined after placing the nebulizer at different locations of the circuit and using either infant nasal mask or nasal prongs as CPAP interfaces. The LD after delivering a range of nominal surfactant doses (100–600 mg/kg) was also investigated. Surfactant aerosol particle size distribution was determined by laser diffraction. Irrespective of the CPAP interface used, about 14% of the nominal dose (200 mg/kg) reached the LD filter. However, placing the nebulizer between the Y-piece and the CPAP interface significantly increased the LD compared with placing it 7 cm before the Y-piece, in the inspiratory limb. (14% ± 2.8 vs. 2.3% ± 0.8, nominal dose of 200 mg/kg). The customized eFlow Neos showed a constant aerosol generation rate and a mass median diameter of 2.7 μm after delivering high surfactant doses (600 mg/kg). The customized eFlow Neos nebulizer showed a constant performance even after nebulizing high doses of undiluted surfactant. Placing the nebulizer between the Y-piece and the CPAP interface achieves the highest LD under non-invasive ventilation conditions.

Predictors of oronasal breathing among obstructive sleep apnea patients and controls

Oronasal breathing may adversely impact obstructive sleep apnea (OSA) patients either by increasing upper airway collapsibility or by influencing continuous positive airway pressure (CPAP) treatment outcomes. Predicting a preferential breathing route would be helpful to guide CPAP interface prescription. We hypothesized that anthropometric measurements but not self-reported oronasal breathing are predictors of objectively measured oronasal breathing. Seventeen OSA patients and nine healthy subjects underwent overnight polysomnography with an oronasal mask with two sealed compartments attached to independent pneumotacographs. Subjects answered questionnaires about nasal symptoms and perceived breathing route. Oronasal breathing was more common (P = <0.001) among OSA patients than controls while awake (62 ± 44 vs. 5 ± 6%) and during sleep (59 ± 39 vs. 25 ± 21%, respectively). Oronasal breathing was associated with OSA severity (P = 0.009), age (P = 0.005), body mass index (P = 0.044), and neck circumference (P = 0.004). There was no agreement between objective measurement and self-reported breathing route among OSA patients while awake (κ = -0.12) and asleep (κ = -0.02). The breathing route remained unchanged after 92% of obstructive apneas. These results suggest that oronasal breathing is more common among OSA patients than controls during both wakefulness and sleep and is associated with OSA severity and anthropometric measures. Self-reporting is not a reliable predictor of oronasal breathing and should not be considered an indication for oronasal CPAP.NEW & NOTEWORTHY Continuous positive airway pressure (CPAP) interface choice for obstructive sleep apnea (OSA) patients is often guided by nasal symptoms and self-reported breathing route. We showed that oronasal breathing can be predicted by anthropometric measurements and OSA severity but not by self-reported oronasal breathing. Self-reported breathing and nasal symptoms should not be considered for CPAP interface choice.

A comparative study of outcomes of nasal prongs and nasal mask as CPAP interface in preterm neonates: A randomized control trial

Background: Nasal prongs are a common method of providing CPAP to newborn babies. They are the cause of mild to severe trauma to the nose and nasal septum and may result in CPAP failure. Nasal masks are now being used to try and mitigate the trauma.These are form fitting masks placed over the nose and are thought to cause less trauma than nasal prongs. Methods: A study was conducted on preterm neonates (28–34-week gestation) with respiratory distress within 24 h of life, admitted in a tertiary care center, Meerut. Babies were randomized and divided into two groups while being put on bubble continuous positive airway pressure (CPAP), using either nasal prongs (Group A) or nasal masks (Group B). The data generated were collected and analyzed for mean duration of CPAP, duration of hospital stay, CPAP failure, retinopathy of prematurity, necrotizing enterocolitis, patent ductus arteriosus, and nasal trauma among both groups. Results: Eighty neonates were analyzed in the study, of which the mean duration of CPAP was 4.53 days in Group A and 5.20 days in Group B; the mean duration of hospital stay was 21.36 days in Group A and 24.58 days in Group B; CPAP failure was observed in 21.95% cases in Group A and 23.07% cases in Group B; and nasal trauma was seen in 46.34% cases in Group A and 43.58% in Group B. Statistical analysis showed no significant difference among both groups. Conclusion: The outcomes of nasal mask as interface are as effective as nasal prongs in preterm infants on CPAP therapy.

Assessment of resistance of nasal continuous positive airway pressure interfaces

ObjectiveTo compare the resistance of interfaces used for the delivery of nasal continuous positive airway pressure (CPAP) in neonates, as measured by the generated system pressure at fixed gas flows,...

Impact of the type of mask on the effectiveness of and adherence to continuous positive airway pressure treatment for obstructive sleep apnea.

Continuous positive airway pressure (CPAP) is the gold standard for the treatment of obstructive sleep apnea (OSA). Although CPAP was originally applied with a nasal mask, various interfaces are currently available. This study reviews theoretical concepts and questions the premise that all types of interfaces produce similar results. We revised the evidence in the literature about the impact that the type of CPAP interface has on the effectiveness of and adherence to OSA treatment. We searched the PubMed database using the search terms "CPAP", "mask", and "obstructive sleep apnea". Although we identified 91 studies, only 12 described the impact of the type of CPAP interface on treatment effectiveness (n = 6) or adherence (n = 6). Despite conflicting results, we found no consistent evidence that nasal pillows and oral masks alter OSA treatment effectiveness or adherence. In contrast, most studies showed that oronasal masks are less effective and are more often associated with lower adherence and higher CPAP abandonment than are nasal masks. We concluded that oronasal masks can compromise CPAP OSA treatment adherence and effectiveness. Further studies are needed in order to understand the exact mechanisms involved in this effect.

Nocturnal Diaphoresis Secondary to Mild Obstructive Sleep Apnea in a Patient with a History of Two Malignancies

Numerous medical disorders, including obstructive sleep apnea, may cause nocturnal diaphoresis. Previous work has associated severe obstructive sleep apnea with nocturnal diaphoresis. This case report is of import as our patient with severe nocturnal diaphoresis manifested only mild sleep apnea, and, for years, his nocturnal diaphoresis was ascribed to other causes, i.e., first prostate cancer and then follicular B-cell lymphoma. Additionally, it was the nocturnal diaphoresis and not more common symptoms of obstructive sleep apnea, such as snoring, that led to the definitive diagnosis of his sleep apnea and then to treatment with a gratifying resolution of his onerous symptom.

A Comparison of two nasal continuous positive airway pressure interfaces – a randomized crossover study

In spite of widespread use of nasal CPAP there are comparatively few studies to guide the choice of nasal prongs. To determine whether the Fisher & Paykel Healthcare (FPH) neonatal continuous positive airway pressure (CPAP) interface was effective in providing bubble CPAP when compared to the Hudson prong interface. The study was a randomized cross-over study of twenty newborn infants 500 g or more requiring CPAP for respiratory support at birth. Infants were randomized to either the Fisher & Paykel Healthcare or Hudson CPAP interface for twenty four hours. Crossover between interfaces occurred after subsequent twenty four hour periods. The primary outcome was the provision of desired CPAP pressures, defined as provision of CPAP within ± one cm H2O of set pressure. The percentage time CPAP was within ± one cm H2O of set pressure was 66.5% for the Hudson and 71.8% for the FPH interface (p = 0.66). Oxygen saturations for the Hudson interface were in target range for a median of 97.8% of the time, and, with the FPH interface, for a median of 98.2% of the time (p = 0.76). Clinically significant differences in primary or secondary outcomes between the two groups were not detected. The nasal CPAP interfaces studied were equally effective in achieving desired bubble CPAP pressures and target saturations.

CPAP interface: satisfaction and side effects

This study aimed to evaluate the care receiver's satisfaction with the continuous positive airway pressure (CPAP) interfaces. A questionnaire with visual analog scales was sent to all our CPAP patients (0 = absolutely unsatisfied, 100 = very satisfied). From the ResMed ResScan program, we obtained the CPAP daily use and air leak values. We received 730 answers (70 % of participants); females comprised 22 %. A total of 391 patients had ResMed interfaces, 227 had Respironics, 87 had Fisher & Paykel (F&P), and 25 patients had other interfaces. Interfaces were nasal for 79 %, nasal pillows for 9 %, oronasal for 9 %, and unidentified for 3 % of cases. The mean ± SD satisfaction rate was 68 ± 25. No statistically significant differences were found regarding the type or brand of interface, previous interface experience, or the age or gender of the patient. Users of ResMed interfaces had significantly (p < 0.01) fewer cases of disturbing leaks than did users of Respironics or F&P interfaces (60 vs. 70 and 72 %, respectively). The ResMed Ultra Mirage interface had the fewest cases of disturbing leaks. Values for the measured median leaks were a mean of 5.9 ± 7.2 l/min, and those for the maximum leaks were 39.3 ± 22.2 l/min with no differences between brands. The users of F&P interfaces experienced significantly (p < 0.01) more comfort and used the CPAP device significantly (p < 0.007) more than did users of ResMed or Respironics interfaces (88 % of cases vs. 65 and 57 % and 6.2 ± 2.6 vs. 5.3 ± 2.8 or 5.8 ± 2.8 h/day, respectively). The majority of patients consider the use of the CPAP interface disturbing even though the satisfaction rate is good with no differences between brands.

Treatment of complex sleep apnea syndrome: A retrospective comparative review

Background and purpose Some patients with obstructive sleep apnea syndrome (OSAS) develop problematic central apneas or Cheyne-Stokes pattern with acute application of continuous positive airway pressure (CPAP), herein called complex sleep apnea syndrome (CompSAS). This response makes it difficult to be certain that CPAP will be a successful treatment strategy. We sought to compare treatments between patients with CompSAS vs. OSAS and hypothesized that CompSAS patients would find CPAP less effective and have more problems with adherence than patients with OSAS. Patients and methods We performed a retrospective review of patients studied in our sleep disorders center over 1 month. Results There were 133 patients with OSAS (mean age=57.6±12.2 years; males=63.9%) and 34 with CompSAS (mean age=54.4±16 years; males=82.35%). CPAP was prescribed in 93.7 and 87.9% of OSAS and CompSAS patients, respectively ( P=0.284), with no significant difference in required CPAP pressures ( P=0.112). There was no difference in prescription frequency of alternative therapies. Mean time to the first follow-up was shorter in CompSAS patients (46.2±47.3 vs. 53.8±36.8 days; P=0.022). CPAP compliance in OSAS and CompSAS patients (5.1±1.6 vs. 6.1±1.5 h, P=0.156) and improvement in Epworth Sleepiness Scale (ESS) (−4.6±4.8 vs. −5.9±6.9, P=0.483) was similar. However, interface problems were more common in CompSAS patients, especially air hunger/dyspnea (0.8 vs. 8.8%) and inadvertent mask removal (2.6 vs. 17.7%) (all P<0.050). Conclusion CompSAS patients have more CPAP interface problems and require more follow-up than OSAS patients but with intervention may have similar treatment results compared to patients with OSAS.