Continuous Positive Airway Pressure Versus Research Articles

Continuous Positive Airway Pressure Versus Conventional Mechanical Ventilation in Management of Neonatal Meconium Aspiration syndrome

Continuous Positive Airway Pressure Versus Conventional Mechanical Ventilation in Management of Neonatal Meconium Aspiration syndrome

Preoperative Continuous Positive Airway Pressure Versus Incentive Spirometer in Morbidly Obese Patients Undergoing Bariatric Surgeries: Randomized Comparative Study

Preoperative Continuous Positive Airway Pressure Versus Incentive Spirometer in Morbidly Obese Patients Undergoing Bariatric Surgeries: Randomized Comparative Study

Continuous Positive Airway Pressure Versus Continuous Negative Pressure Around the Chest for Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease in the Intensive Care Unit: A Pilot Study

With chronic obstructive pulmonary disease (COPD) exacerbations, continuous positive airway pressure (CPAP) has been used to overcome the threshold load provided by intrinsic positive end expiratory pressure and decrease the inspiratory work of breathing. In this pilot study, we observed whether a continuous negative pressure (CNP) around the thorax and upper abdomen with a shell and wrap would provide a similar level of relief in dyspnoea. In eight patients with COPD in the intensive care unit receiving CPAP, CNP was alternated twice with CPAP (30 minutes each time). We measured heart rate, respiratory rate, blood pressure, arterial oxygen tension (PaO2), arterial carbon dioxide tension (PaCO2) pH and dyspnoea score, and asked each patient which system was more comfortable. Comparing CPAP with CNP, we found no significant difference in all measured parameters except PaCO2 which was lower with CNP. Seven out of eight patients found that CNP was more comfortable. The CNP was similar to CPAP except CNP was more comfortable.

Comparison of Bubble Continuous Positive Airway Pressure Versus Conventional Ventilation In Neonates with Respiratory Distress Syndrome

Aim: The use of positive airway pressure in babies with respiratory failure has been associated with significant reductions in respiratory failure, morbidity, and death. The two most popular CPAP techniques are bladder CPAP (B-CPAP) and ventilator-assisted CPAP (V-CPAP). We wanted to see if B-CPAP and V-CPAP have different survival rates and problems. Methods: This retrospective medical trial included 60 preterm babies between 1500- 2500 g who were hospitalized to Mayo Hospital's neonatal critical care unit for breathing difficulties between May 2019 and April 2020. Between May 2019 and April 2020, they were hospitalized for respiratory distress. The patients were allocated to therapy groups at random. To calculate and evaluate survival rates, a survival analysis was done. To compare rates of survival. The t-test for sample data was used to assess the length of supplemental oxygen, hospital stay, and cost of hospital stay. Results: At 24 hours, the predicted survival rates in the B-CPAP and V-CPAP subgroups were 100% and 78%, correspondingly. The comparable results after 48 hours were 100% and 72%. Furthermore, the V-CPAP group's hospitalization expenditures were considerably greater than the B-CPAP groups. Conclusion: Based on our findings, B-CPAP was helpful in treating newborns with breathing difficulties and reduced the hospitalization. In addition to the usual benefits, the lower cost of B-CPAP may be a factor for its widespread use when contrasted to V-CPAP. Keywords: Bubble Continuous Positive Airway Pressure, Versus Conventional Ventilation, Neonates With Respiratory.

Pressure Support Versus Continuous Positive Airway Pressure for Predicting Successful Liberation from Invasive Ventilation in Children: An Open Label, Randomized Non-Inferiority Trial

Pressure Support Versus Continuous Positive Airway Pressure for Predicting Successful Liberation from Invasive Ventilation in Children: An Open Label, Randomized Non-Inferiority Trial

Cost-Effectiveness Analysis of Nasal Continuous Positive Airway Pressure Versus Nasal High Flow Therapy as Primary Support for Infants Born Preterm

To compare the cost-effectiveness of 2 common "noninvasive" modes of respiratory support for infants born preterm. An economic evaluation was conducted as a component of a multicenter, randomized control trial from 2013 to 2015 enrolling infants born preterm at ≥28 weeks of gestation with respiratory distress, <24 hours old, who had not previously received endotracheal intubation and mechanical ventilation or surfactant. The economic evaluation was conducted from a healthcare sector perspective and the time horizon was from birth until death or first discharge. The cost-effectiveness of continuous positive airway pressure (CPAP) vs high-flow with "rescue" CPAP backup and high-flow without rescue CPAP backup (as sole primary support) were analyzed by using the hospital cost of inpatient stay in a tertiary center and the rates of endotracheal intubation and mechanical ventilation during admission. Hospital inpatient cost records for 435 infants enrolled in all Australian centers were obtained. With "rescue" CPAP backup, an incremental cost-effectiveness ratio was estimated of A$179 000 (US$123 000) per ventilation avoided if CPAP was used compared with high flow. Without rescue CPAP backup, cost per ventilation avoided was A$7000 (US$4800) if CPAP was used compared with high flow. As sole primary support, CPAP is highly likely to be cost-effective compared with high flow. Neonatal units choosing to use only one device should apply CPAP as primary respiratory support. Compared with high-flow with rescue CPAP backup, CPAP is unlikely to be cost-effective if willingness to pay per ventilation avoided is less than A$179 000 (US$123 000).

Non-Invasive Mechanical Ventilation Versus Continuous Positive Airway Pressure Relating to Cardiogenic Pulmonary Edema in an Intensive Care Unit

BackgroundTo compare the application of non-invasive ventilation (NIV) versus continuous positive airway pressure (CPAP) in the treatment of patients with cardiogenic pulmonary edema (CPE) admitted to an intensive care unit (ICU). MethodsIn a prospective, randomized, controlled study performed in an ICU, patients with CPE were assigned to NIV (n=56) or CPAP (n=54). Primary outcome was intubation rate. Secondary outcomes included duration of ventilation, length of ICU and hospital stay, improvement of gas exchange, complications, ICU and hospital mortality, and 28-day mortality. The outcomes were analyzed in hypercapnic patients (PaCO2>45mmHg) with no underlying chronic lung disease. ResultsBoth devices led to similar clinical and gas exchange improvement; however, in the first 60min of treatment a higher PaO2/FiO2 ratio was observed in the NIV group (205±112 in NIV vs. 150±84 in CPAP, P=.02). The rate of intubation was similar in both groups (9% in NIV vs. 9% in CPAP, P=1.0). There were no differences in duration of ventilation, ICU and length of hospital stay. There were no significant differences in ICU, hospital and 28-d mortality between groups. In the hypercapnic group, there were no differences between NIV and CPAP. ConclusionsEither NIV or CPAP are recommended in patients with CPE in the ICU. Outcomes in the hypercapnic group with no chronic lung disease were similar using NIV or CPAP.

Non-Invasive Mechanical Ventilation Versus Continuous Positive Airway Pressure Relating to Cardiogenic Pulmonary Edema in an Intensive Care Unit

BackgroundTo compare the application of non-invasive ventilation (NIV) versus continuous positive airway pressure (CPAP) in the treatment of patients with cardiogenic pulmonary edema (CPE) admitted to an intensive care unit (ICU). MethodsIn a prospective, randomized, controlled study performed in an ICU, patients with CPE were assigned to NIV (n=56) or CPAP (n=54). Primary outcome was intubation rate. Secondary outcomes included duration of ventilation, length of ICU and hospital stay, improvement of gas exchange, complications, ICU and hospital mortality, and 28-day mortality. The outcomes were analyzed in hypercapnic patients (PaCO2>45mmHg) with no underlying chronic lung disease. ResultsBoth devices led to similar clinical and gas exchange improvement; however, in the first 60min of treatment a higher PaO2/FiO2 ratio was observed in the NIV group (205±112 in NIV vs. 150±84 in CPAP, P=.02). The rate of intubation was similar in both groups (9% in NIV vs. 9% in CPAP, P=1.0). There were no differences in duration of ventilation, ICU and length of hospital stay. There were no significant differences in ICU, hospital and 28-d mortality between groups. In the hypercapnic group, there were no differences between NIV and CPAP. ConclusionsEither NIV or CPAP are recommended in patients with CPE in the ICU. Outcomes in the hypercapnic group with no chronic lung disease were similar using NIV or CPAP.

Arterial Blood Gases Response to Incentive Spirometry Versus Continuous Positive Airway Pressure breathing After Coronary Artery Bypass Graft Surgery

Background: Postoperative respiratory complications such as hypoxemia and atelectasis remain important causes of mortality after CABG. Objective: The aim of this study was to compare the changes in arterial blood gases after the use of incentive spirometry (IS) with continuous positive airway pressure (CPAP) during intensive care unit period, after coronary artery bypass graft (CABG) also to provide an idea about which of them is more effective method following coronary artery bypass surgery in intensive care unit. Methods: 30 volunteer patients’ (22 males and 8 females) who had coronary artery bypass surgery participated in this study and they were randomly selected from surgical department at intensive care unit (ICU) in National Heart Institute, Egypt, their ages ranged from 45 to 55 years. Participants were randomly assigned between two equal groups. Group 1 received incentive spirometry breathing training in addition to routine chest physiotherapy following CABG, while Group 2 received CPAP in addition to routine chest physiotherapy program following CABG. Results: The results obtained in this study indicated that, there was statistical significant increase PaO2 and decrease in PaCO2 after two hours of using incentive spirometry, which indicated long term effect of incentive spirometry. While there was no statistical significant improvement in arterial blood gases after two hours of using CPAP which indicated short term effect of CPAP (p<0.05). Conclusion: Incentive spirometry is superior to continuous positive airway pressure breathing to long term improve arterial blood gases following coronary artery bypass graft surgery.

Continuous Positive Airway Pressure Versus Oxygen Therapy in the Cardiac Surgical Ward: A Randomized Trial

Noninvasive ventilation (NIV) is a common technique to manage patients with acute respiratory failure in the intensive care unit. However, use of NIV in general wards is less well described. The authors' aim was to demonstrate efficacy of NIV, applied in a cardiac surgery ward, in improving oxygenation in patients who developed hypoxemic acute respiratory failure after being discharged from the intensive care unit. Randomized, open-label trial. University hospital. Sixty-four patients with hypoxemia (PaO2/FIO2 ratio between 100 and 250) admitted to the main ward after cardiac surgery. Patients were randomized to receive standard treatment (oxygen, early mobilization, a program of breathing exercises and diuretics) or continuous positive airway pressure in addition to standard treatment. Continuous positive airway pressure was administered 3 times a day for 2 consecutive days. Every cycle lasted 1 to 3 hours. All patients completed their 1-year follow-up. Data were analyzed according to the intention-to-treat principle. The primary endpoint was the number of patients with PaO2/FIO2<200 48 hours after randomization. Continuous positive airway pressure use was associated with a statistically significant reduction in the number of patients with PaO2/FIO2<200 (4/33 [12%] v 14/31 [45%], p = 0.003). One patient in the control group died at the 30-day follow-up. Among patients with acute respiratory failure following cardiac surgery, administration of continuous positive airway pressure in the main ward was associated with improved respiratory outcome. This was the first study that was performed in the main ward of post-surgical patients with acute respiratory failure.

Nasal Bilevel Versus Continuous Positive Airway Pressure in Preterm Infants: A Randomized Controlled Trial

Objective: We designed a study with a primary objective of comparing the effectiveness of nasal continuous positive airway pressure (nCPAP) versus bi-level CPAP (BiPAP) as the primary mode of non-invasive ventilation in preterm newborns. The primary outcome was need for invasive ventilation in the first 120 hours of life. The secondary objective was to compare these two groups regarding duration of non-invasive ventilation, use of surfactant, incidence of pneumothorax, bronchopulmonary dysplasia (BPD), peri and intraventricular haemorrhage (PIVH), necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), sepsis, length of hospitalisation and mortality. Methods: Prospective, multicentre clinical trial enrolling 220 neonates born at 27 to 32+6 weeks of gestation randomly assigned at birth for either CPAP or BiPAP. Results: One hundred and nine neonates received NCPAP and 111 BiPAP. Invasive ventilation was needed in 18.3% in the CPAP group and 14.4% in the BiPAP group. This difference was not statistically significant. However, when stratifying the groups regarding gestational age (GA), we found a tendency favouring BiPAP in subgroup of 30 to 32+6 weeks. There was no difference regarding the secondary outcomes, except for an increase in NEC in the CPAP group. Multivariate analysis demonstrated a significant association between absence of premature rupture of membranes and the need of invasive ventilation within the first 120 hours of life, independently on the assigned mode of non invasive ventilation. Conclusion: BiPAP and CPAP are both effective and safe as a primary mode of ventilation in preterms between 27 and 32+6 weeks without important complications. In a subgroup of 30 to 32+6 weeks of gestation a better outcome using BiPAP was observed.

Bi-level Versus Continuous Positive Airway Pressure in Acute Cardiogenic Pulmonary Edema: A Randomized Control Trial

This study was to compare the efficacy of continuous, bi-level positive airway pressure (CPAP, Bi-PAP) and oxygen therapy on detailed observation of time-course change in blood gases, physiological parameters and rate of endotracheal intubation in patient with acute cardiogenic pulmonary edema (ACPE). Sixty-six patients with ACPE were randomly assigned to receive standard oxygen (O²) therapy (n=23), CPAP (n=21), and Bi-PAP (n=22). Blood gases (PaCO², PaO², SaO², pH, and HCO³), and physiological parameters (HR, RR, SBP, and DBP) were collected at baseline (T0), immediately after 60 minutes (T60), and after 30 minutes of discontinuation (T90). A significant improvements (p<0.05) in PaCO², PaO², SaO² and vital signs were observed immediately after CPAP and Bi-PAP when compared to O² therapy. After 30 minutes of disconnection, Bi-PAP revealed significant improvement (p<0.05) in PaO², SaO², and respiratory rate. No differences on intubation and death rate detected among treatment groups. Both methods of noninvasive ventilations are effective treatment for ACPE. However, Bi-PAP should be considered as first line of treatment due to faster and continuous improvement in oxygenation and respiratory rate.

Extubation Success in Premature Infants With Respiratory Distress Syndrome Treated With Bi-Level Nasal Continuous Positive Airway Pressure Versus Nasal Intermittent Positive Pressure Ventilation

The Journal of Perinatal & Neonatal Nursing: October/December 2013 - Volume 27 - Issue 4 - p E3-E4 doi: 10.1097/JPN.0000000000000002

Extubation Success in Premature Infants With Respiratory Distress Syndrome Treated With Bi-Level Nasal Continuous Positive Airway Pressure Versus Nasal Intermittent Positive Pressure Ventilation

Infants born prematurely with respiratory distress syndrome are at high risk for complications from mechanical ventilation. Strategies are needed to minimize their days on the ventilator. The purpose of this study was to compare extubation success rates in infants treated with 2 different types of continuous positive airway pressure devices. A retrospective cohort study design was used. Data were retrieved from electronic medical records for patients in a large, metropolitan, level III neonatal intensive care unit. A sample of 194 premature infants with respiratory distress syndrome was selected, 124 of whom were treated with nasal intermittent positive pressure ventilation and 70 with bi-level variable flow nasal continuous positive airway pressure (bi-level nasal continuous positive airway pressure). Infants in both groups had high extubation success rates (79% of nasal intermittent positive pressure ventilation group and 77% of bi-level nasal continuous positive airway pressure group). Although infants in the bi-level nasal continuous positive airway pressure group were extubated sooner, there was no difference in duration of oxygen therapy between the 2 groups. Promoting early extubation and extubation success is a vital strategy to reduce complications of mechanical ventilation that adversely affect premature infants with respiratory distress syndrome.

Oral Appliance Versus Continuous Positive Airway Pressure in Obstructive Sleep Apnea Syndrome: A 2-Year Follow-up

Oral appliance therapy has emerged as an important alternative to continuous positive airway pressure (CPAP) in treating patients with obstructive sleep apnea syndrome (OSAS). In this study we report about the subjective and objective treatment outcome of oral appliance therapy and CPAP in patients with OSAS. Cohort study of a previously conducted randomized clinical trial. University Medical Center, Groningen, The Netherlands. One hundred three patients with OSAS. CPAP and oral appliance therapy (Thornton Adjustable Positioner type-1, Airway Management, Inc., Dallas, TX, USA). Objective (polysomnography) and subjective (Epworth Sleepiness Scale, Functional Outcomes of Sleep Questionnaire, Medical Outcomes Study 36-item Short Form Health Survey [SF-36]) parameters were assessed after 1 and 2 years of treatment. Treatment was considered successful when the apnea-hypopnea index (AHI) was < 5 or showed substantial reduction, defined as reduction in the index of at least 50% from the baseline value to a value of < 20 in a patient without OSAS symptoms while undergoing therapy. Regarding the proportions of successful treatments, no significant difference was found between oral appliance therapy and CPAP in treating mild to severe OSAS in a 2-year follow-up. More patients (not significant) dropped out under oral appliance therapy (47%) compared with CPAP (33%). Both therapies showed substantial improvements in polysomnographic and neurobehavioral outcomes. However, CPAP was more effective in lowering the AHI and showed higher oxyhemoglobin saturation levels compared to oral appliance therapy (P < 0.05). Oral appliance therapy should be considered as a viable treatment alternative to continuous positive airway pressure (CPAP) in patients with mild to moderate obstructive sleep apnea syndrome (OSAS). In patients with severe OSAS, CPAP remains the treatment of first choice. The original randomized clinical trial, of which this study is a 2-year follow-up, is registered at ISRCTN.org; identifier: ISRCTN18174167; trial name: Management of the obstructive sleep apnea-hypopnea syndrome: oral appliance versus continuous positive airway pressure therapy; URL: http://www.controlled-trials.com/ISRCTN18174167.

G170 Randomised Controlled Trial of Synchronised Intermittent Positive Airway Pressure (SiPAP™) Versus Continuous Positive Airway Pressure (CPAP) as a Primary Mode of Respiratory Support in Preterm Infants with Respiratory Distress Syndrome

BackgroundMinimising exposure to factors contributing to chronic respiratory morbidity is a priority in preterm care. CPAP is established but alternatives are gaining popularity despite limited evaluation. SiPAP has not previously...

A Randomized Controlled Trial of Post-extubation Bubble Continuous Positive Airway Pressure Versus Infant Flow Driver Continuous Positive Airway Pressure in Preterm Infants with Respiratory Distress Syndrome

A Randomized Controlled Trial of Post-extubation Bubble Continuous Positive Airway Pressure Versus Infant Flow Driver Continuous Positive Airway Pressure in Preterm Infants with Respiratory Distress Syndrome

A Randomized Controlled Trial of Post-extubation Bubble Continuous Positive Airway Pressure Versus Infant Flow Driver Continuous Positive Airway Pressure in Preterm Infants with Respiratory Distress Syndrome

To compare the efficacy and safety of bubble continuous positive airway pressure (CPAP) and Infant Flow Driver (IFD) CPAP for the post-extubation management of preterm infants with respiratory distress syndrome (RDS). A total of 140 preterm infants at 24 to 29 weeks' gestation or with a birth weight of 600 to 1500 g who were ventilated at birth for RDS were randomized to receive either IFD CPAP (a variable-flow device) or bubble CPAP (a continuous-flow device). A standardized protocol was used for extubation and CPAP. No crossover was allowed. The primary outcome was successful extubation maintained for at least 72 hours. Secondary outcomes included successful extubation maintained for 7 days, total duration of CPAP support, chronic lung disease, and complications of prematurity. Seventy-one infants were randomized to bubble CPAP, and 69 were randomized to IFD CPAP. Mean gestational age and birth weight were similar in the 2 groups, as were the proportions of infants who achieved successful extubation for 72 hours and for 7 days. However, the median duration of CPAP support was 50% shorter in the infants on bubble CPAP. Moreover, in the subset of infants who were ventilated for less than 14 days, the infants on bubble CPAP had a significantly lower extubation failure rate. There was no difference in the incidence of chronic lung disease or other complications between the 2 study groups. Bubble CPAP is as effective as IFD CPAP in the post-extubation management of infants with RDS; however, in infants ventilated for < or = 14 days, bubble CPAP is associated with a significantly higher rate of successful extubation. Bubble CPAP also is associated with a significantly reduced duration of CPAP support.

A Randomized Controlled Trial of Post-extubation Bubble Continuous Positive Airway Pressure Versus Infant Flow Driver Continuous Positive Airway Pressure in Preterm Infants with Respiratory Distress Syndrome

A Randomized Controlled Trial of Post-extubation Bubble Continuous Positive Airway Pressure Versus Infant Flow Driver Continuous Positive Airway Pressure in Preterm Infants with Respiratory Distress Syndrome

Continuous Positive Airway Pressure Versus Bilevel Noninvasive Ventilation in Acute Cardiogenic Pulmonary Edema: A Randomized Multicenter Trial

Patients with acute cardiogenic pulmonary edema may develop respiratory failure. Noninvasive respiratory support should be initiated rapidly to avoid tracheal intubation. The aim of this study is to compare the efficacy of continuous positive airway pressure (CPAP) delivered by the Boussignac CPAP device and bilevel positive airway pressure (bilevel PAP) in patients with acute respiratory failure caused by acute cardiogenic pulmonary edema. This prospective multicenter randomized study was conducted in 3 emergency departments. Patients were assigned to Boussignac CPAP through a facemask or to bilevel PAP, in addition to standard therapy. The main outcome was a combined criterion (tracheal intubation, death, or acute myocardial infarction). Complications, durations of ventilation, and hospitalization were also assessed. After 1 hour of ventilation and at the end of the ventilation period, clinical parameters of respiratory distress and blood gas exchange significantly improved in each treatment arm. No significant differences were observed between the Boussignac CPAP and bilevel PAP arms for the combined criterion (5% versus 12%, respectively; odds ratio [OR] 0.4; 95% confidence interval [CI] 0.0 to 1.9) and also for severe complications (9% versus 6%; OR 1.5; 95% CI 0.3 to 9.9), duration of ventilation (median for both groups 2 hours; interquartile range [IQR] 1.2 to 3.0 hours), duration of hospitalization (CPAP 8.5 [IQR 6 to 14] days; bilevel PAP 10 [IQR 7 to 16] days), or intrahospital mortality (8% versus 14%; OR 1.8 [IQR 0.4 to 8.8]). Similar results were obtained among hypercapnic patients (PaCO2 >45 mm Hg). Whatever the ventilation support used, the combined criterion and severe complications were more frequently observed among hypercapnic patients. Both Boussignac CPAP and bilevel PAP appeared effective in rapidly improving respiratory distress even in hypercapnic patients, but they were not different in terms of patient outcome.