Use Of Nasal Continuous Positive Airway Pressure Research Articles

Comparison of Two Methods for Weaning from Nasal Continuous Positive Airway Pressure via the Cyclic Use of High-Flow Nasal Cannula or Room Air in Preterm Infants.

Nasal continuous positive airway pressure (NCPAP) is extensively used for preterm infants experiencing respiratory distress syndrome (RDS). Weaning from NCPAP includes direct weaning or gradually extending room air exposure. However, a high-flow nasal cannula (HFNC) is an alternative weaning method. Therefore, this study evaluated the clinical outcomes of HFNC and progressively increasing room air duration as weaning strategies. This study enrolled 46 preterm infants with RDS receiving NCPAP support who underwent the cyclic use of NCPAP and HFNC weaning protocol as the HFNC group; a retrospective analysis included 87 preterm infants weaned from NCPAP by gradually extending room air duration as the room air group. Differences in clinical conditions, complications, and short-term outcomes between the weaning methods were compared. The mean post-menstrual age at initiating NCPAP weaning was lower in the room air group than in the HFNC group (mean ± SD, 35.2 ± 2.3 weeks vs. 33.2 ± 2.5 weeks, p < 0.001). Hospital stay duration and total respiratory therapy days were longer in the HFNC group (96 ± 38 days and 80 ± 37 days, respectively) than in the room air group (78 ± 28 days and 56 ± 25 days, respectively), with p-values of 0.006 and <0.001. In conclusion, employing HFNC for weaning from NCPAP resulted in longer hospital admissions and respiratory therapy days than the room air method. However, further studies with a larger sample size are warranted for a more comprehensive evaluation, given the limited number of enrolled patients.

Complications associated with incorrect use of nasal CPAP.

Nasal continuous positive airway pressure (nCPAP) is a safe, effective, non-invasive respiratory modality to deliver positive end expiratory pressure in neonates. Many studies have established its associated improved respiratory outcomes without increase in major morbidities associated with preterm neonates. In contrast, there is paucity in literature addressing complications such as nasal injury, abdominal distention, air leak syndromes (especially pneumothorax), hearing loss, heat and chemical burns, swallowing and aspiration of small components of the nasal interface and delay in escalation of respiratory support associated with the use of nCPAP, most frequently due to its incorrect use. This is a comprehensive review that seeks to address the different complications that are associated with the incorrect use of nCPAP highlighting that these are operator-related and not device-related.

Duration of positive airway pressure adherence: how much PAP is enough?

Duration of positive airway pressure adherence: how much PAP is enough?

Nasal continuous positive airway pressure levels for the prevention of morbidity and mortality in preterm infants.

Nasal continuous positive airway pressure levels for the prevention of morbidity and mortality in preterm infants.

Early objective adherence to hypoglossal nerve stimulation therapy.

To assess early adherence to therapy with hypoglossal nerve stimulation therapy. This is a prospective study of consecutive patients with moderate to severe obstructive sleep apnea who underwent implantation of hypoglossal nerve stimulation therapy within a single academic practice and attended a follow-up appointment after greater than 30 days of therapy use. Objective adherence data were extracted from an objective monitoring database and compared to patient characteristics. The study population was 79 participants who were 29.1% female with a mean age of 58.7 ± 12.8 years old, body mass index of 28.9 ± 3.4 kg/m2, and baseline apnea-hypopnea index of 33.8 ± 17.6 events/h. In the first 7 days after device activation, average use was 7.8 h/night, with 91.9% of nights with greater than 4 hours of therapy use and an average of 0.2 pauses in therapy per night. These figures remained stable after 30 days of use: 7.7 h/night, 91.0% of nights longer than 4 hours, and 0.3 pauses per night. Objective evidence of difficulty with acclimatization was associated with age less than 60 years (odds ratio 2.8, 95% confidence interval 1.1-7.1, P = .03) and a history of prior upper airway surgery (3.9, 1.2-11.9, P = .015). Insomnia was present in 31 patients and was not associated with objective evidence of difficulty tolerating therapy. Early adherence to hypoglossal nerve stimulation is excellent (92.4% >4 hours on >70% of nights), suggesting that the acclimatization period is straightforward in most. Younger age and a history of prior upper airway surgery appear to be associated with an increased risk of difficulty with acclimatization. Huyett P. Early objective adherence to hypoglossal nerve stimulation therapy. J Clin Sleep Med. 2022;18(2):631-636.

Pregnancy in a Woman with a Congenital Type of Nemaline Myopathy

<i>Introduction</i>: Congenital nemaline myopathy is a genetically heterogeneous disease caused by gene defects in a number of genes: nebulin (2q21-22) alpha-tropomysin (1q21-23), alpha-actin (1q42) and others. Nemaline myopathy can be inherited as an autosomal recessive or dominant trait. <i>Case report</i>: We present a case of the first pregnancy in a woman with a congenital type of nemaline myopathy, with a severe pulmonary involvement, in the Czech Republic. <i>Course of pregnancy</i>: The woman got spontaneously pregnant less than two months after a respiratory failure, when she had to be tracheostomized, remained dependent on portable ventilator support. The patient strictly refused artificial abortion recommended to her. Until the 22^nd gestational week she was stabilized in terms of ventilation and received health care at home. Subsequently, she was repeatedly admitted to the hospital for lung infection to ICU of the Department of Intensive Care. The fetus was developing proportionately, without signs of muscle hypotonia, but after the 23^rd g.w. was diagnosed with slightly progressive polyhydramnios. <i>Childbirth</i>: It was decided to schedule termination of the pregnancy by a caesarean section for the 30^th g.w., during the interval of the patient´s relatively satisfactory clinical respiratory and mental stabilization. A boy was born (1120g) and was transferred to the NICU. The newborn required artificial pulmonary ventilation, from the 3^rd day he was extubated, with intermittent use of nasal CPAP until the 9^th day. <i>Results</i>: The baby prospered, tolerated food and showed no signs of muscle hypotonia. A postoperative course of the mother went without any complications. On the 8^th postoperative day she was discharged from the hospital, ventilator-dependent and with tracheostomy in place. <i>Conclusion</i>: Pregnancy in women with a congenital type of nemaline myopathy with a severe lung involvement is a challenge for physicians. Based on the course of pregnancy it is necessary to decide when its termination will be safe for both the mother and the fetus. The care of the patient requires a multidisciplinary approach.

One Stage Multilevel Surgery for the Treatment of Obstructive Sleep Apnea Syndrome

Obstructive sleep apnea syndrome (OSAS) is a very frequent and increasingly recognized major health problem [1]. OSAS may result in cardiovascular diseases, quality of life deficits and performance deficits from loss of alertness [2-5]. Nasal continuous positive airway pressure (CPAP) is considered the gold standard for the primary treatment of moderate to severe OSAS [6]. However, the therapeutic use of nasal CPAP is seriously limited by low long-term compliance [7]. The surgical approach is still the most common OSAS treatment method and varieties of surgical techniques have been well-described in managing OSAS. Uvulopalatopharyngoplasty (UPPP) and radio frequency-induced thermotherapy (RFITT) of the soft palate have been widely used for the treatment of velopharyngeal obstruction in OSAS [8,9].

Analysis of retinopathy of prematurity screening in Tianjin, China

AIM: To analyze the findings of retinopathy of prematurity (ROP) exam in Tianjin, and study the impact of pulmonary surfactant Curosurf and nasal continuous positive airway pressure (NCPAP) in ROP. METHODS: A multicenter retrospective review. 2894 preterm infants (1592 males, 1302 females) from several hospitals in Tianjin were screened from January 2009 to December 2013. Demographic information, ophthalmic outcomes and possible systemic risk factors were recorded. Gestation age, birth weight, oxygen supplementation, Curosurf and NCPAP were used to estimate risk factors for ROP. RESULTS: ROP was found in 448 eyes of 224 patients (7.7%). Among which, severe ROP developed in 98 eyes of 49 patients (21.9%). There was significant statistical difference in RDS, NCPAP, and Curosurf usage between control and ROP groups (P=0.000). Multiple logistic regression analyses of ROP indicated that lower birth weight, younger gestational age, and oxygen supplementation were the risk factors leading to ROP. As the usage rate of Curosurf and NCPAP increased year by year, the usage of oxygen supplementation gradually decreased, the incidence of ROP was also on the decline. CONCLUSION: Low birth weight, young gestational age and oxygen supplementation are associated with ROP. The use of Curosurf and NCPAP may be the factor that reduces the occurrence of ROP.

Nasal Pressure Injuries Due to Nasal Continuous Positive Airway Pressure Treatment in Newborns: A Prospective Observational Study.

The purpose of this study was to calculate incidence, severity, and risk factors of nasal pressure injuries due to nasal continuous positive airway pressure (NCPAP) treatment in newborns. A prospective observational study. Newborns admitted between March 2017 and February 2018 to the neonatal intensive care unit of the First Affiliated Hospital of Xiamen University, Xiamen, China. All newborns' noses were examined during NCPAP application. Every NCPAP-related nasal pressure injury including occurrence date, injury severity, outcomes, and pressure injury treatment methods was recorded. These data were collected twice a week by a research nurse. Nasal pressure injuries were classified using the National Pressure Ulcer Advisory Panel/European Pressure Ulcer Advisory Panel pressure injury classification system. During the study period, 429 newborns received NCPAP treatment via nasal prongs. Nasal pressure injuries were observed in 149 (34.7%); 99 (66.44%) were classified as Stage 1, 48 (32.31%) were Stage 2, and 2 (1.25%) cases were classified as deep tissue injury. The risk of nasal pressure injury was significantly higher when gestational age was less than 32 weeks (odds ratio [OR], 3.728; 95% confidence interval [CI], 1.18-11.77; P ≤ .025) and in those who received NCPAP treatment for more than 6 days (OR, 0.262; 95% CI, 0.087-0.787; P ≤ .017). The mean interval between the application of NCPAP and onset of nasal pressure injury was 4.72 days (SD, 4.78; range, 0-30 days). Nasal pressure injuries are a prevalent complication of NCPAP use, especially in preterm newborns. Our results identified a gestational age of less than 32 weeks and longer use of NCPAP are important factors associated with nasal pressure injuries. Methods to prevent the development of injuries such as the use of a prophylactic dressing along and replacement of binasal prongs with nasal masks are advocated.

Randomized Control Trial: Heated Humidity High Flow Nasal Cannula in Comparison with NCPAP in the Management of RDS in Extreme Low Birth Infants in Immediate Post Extubation Period

Background: Respiratory failure in neonates remains a difficult challenge and is associated with high morbidity and mortality. Current practice reflects the belief that limited exposure to invasive mechanical ventilation and careful use of oxygen support, results in less lung injury and improved long term pulmonary outcomes in preterm infants. Respiratory Distress Syndrome (RDS) is a common cause of respiratory failure in preterm infants and occurs in most preterm infants less than 28 weeks gestation. Standard of care involves surfactant administration and providing respiratory support. Objective: To compare the primary outcome, failure of extubation defined by the need for re-intubation and mechanical ventilation within 5 days of initial extubation and secondary outcomes, morbidities and mortality after using of heated humidity high flow nasal cannula (HHHFNC) and Nasal Continuous Positive Airway Pressure (NCPAP) in the immediate post-extubation period for preterm infants between 24 and 28 weeks gestation with respiratory distress syndrome. Methods: 60 preterm infants with gestational ages between 24 and 28 weeks were randomized in this study to either HHHFNC or NCPAP. The primary outcome measured was failed extubation defined by the need for reintubation and mechanical ventilation within 5 days of initial extubation after receiving at least 2 doses of surfactant. Secondary outcome measures included: 1. Duration of respiratory support using HHHFNC/NCPAP. 2. Duration of oxygen requirement. 3. Incidence of complications i.e. Nasal breakdown, Sepsis, Intraventricular hemorrhage, Retinopathy of prematurity and Patent Ductus Arteriosis. Preterm infants who remained intubated for more than 24 hours were excluded from the study. Results: 17.2% of neonates placed on HHHFNC failed extubation and required re-intubation within 5 days of initial extubation compared with 20.8% of neonates placed on NCPAP (p value 1.000). Mean duration of respiratory support using HHHFNC was 37.45 days compared with 40.04 days using NCPAP (p value 0.66). Duration of oxygen requirement for infants placed on HHHFNC was 49.41 days compared with 43.75 days for infants placed on NCPAP (p value 0.58). 25% of infants placed on NCPAP suffered nasal trauma, 12.5% developed sepsis, 12.5% had grades III and IV IVH, 41.67% were reported to have a PDA and 41.67% were reported to have varying stages of ROP. No nasal trauma was reported for infants placed on HHHFNC, 3.5% developed sepsis, 13.79% had grades III and IV IVH, 31.03% were reported to have a PDA and 24.14% were reported to have varying stages of ROP. Conclusion: HHHFNC use is comparable to the use of NCPAP in the immediate post-extubation period for preterm infants between 24 and 28 weeks gestations with Respiratory Distress Syndrome without an increased risk for co-morbid conditions.

Quality Improvement of Nasal Continuous Positive Airway Pressure Therapy in Neonatal Intensive Care Unit

Nasal continuous positive airway pressure (NCPAP) therapy is widely used in neonates, but the clinical practice varies. However, nursing practice differs among individuals, and an inappropriate application method may delay the respiratory therapy, influence the beneficial effect of NCPAP, and increase complications. We introduced a quality improvement project to expedite the application of NCPAP therapy and decrease the incidence of nasal trauma. A new strategy of mobile NCPAP cart with prepacked fixation kits and a written protocol was implemented from April 2006. All medical staff answered a questionnaire to assess their basic knowledge before and after intensive training. The records of the patients who were treated with NCPAP from October 2005 to November 2006 were reviewed. Fifty-nine medical staff were involved in the project, and their mean score for the questionnaire improved from 69.2 points to 98.3 points after training. From October 2005 to November 2006, 113 infants were recruited in total and 82 of them were admitted after the protocol was implemented. The NCPAP cart dramatically shortened the preparation time (from 520seconds to 72seconds) and the application time (from 468seconds to 200seconds). The use of the nursing protocol significantly decreased the incidence of nasal trauma in the study population (45.2% vs. 19.6%, p=0.006), but not in infants with a birth weight of < 1000g. Risk factors for nasal skin trauma included lower gestational age and birth weight, longer duration of NCPAP use, and lack of standardized nursing care. The mobile NCPAP cart with prepacked fixation kits is a practical way of expediting the initiation of NCPAP therapy. The written nursing protocol decreased the incidence of nasal trauma in infants, except for those with an extremely low birth weight.

Somatic arousal and sleepiness/fatigue among patients with sleep-disordered breathing.

In a large clinical sample, we tested the hypothesis that levels of sleepiness and fatigue among upper airway resistance syndrome (UARS) patients are correlated with levels of somatic arousal (SA; reflecting the sympathetic nervous system component of the stress response). We also tested the correlations of post-treatment change in these three parameters, and we extended the investigation to obstructive sleep apnea/hypopnea (OSA/H) patients. From 5years of patient data, we obtained scores on the body sensation questionnaire (BSQ), measuring the level of SA, the fatigue severity scale (FSS), and Epworth sleepiness scale (ESS) for 152 consecutive UARS patients and 150 consecutive OSA/H patients. For each group, we correlated the FSS and ESS scores with the BSQ scores. Among the 45 UARS patients and 49 OSA/H patients treated with nasal CPAP who provided post-treatment data, we correlated change in FSS and ESS scores with change in BSQ scores. Scores on the BSQ, FSS, and ESS for UARS patients and OSA/H patients were comparable. In both UARS and OSA/H patients, both the FSS and ESS scores were positively correlated with the BSQ score. Nasal CPAP use decreased all three questionnaire scores in both patient groups. In the pooled data, changes in FSS were significantly correlated with changes in BSQ. Our findings confirm our preliminary observations that sleepiness and fatigue among UARS patients are correlated with their level of SA and suggest that the same is true for OSA/H patients. The decrease of SA following treatment suggests that SDB is a cause of SA among patients with UARS and OSA/H.

The use of nasal CPAP at the Charlotte Maxeke Johannesburg Academic Hospital

Background . Nasal continuous positive airway pressure (NCPAP) is well established as a treatment for hyaline membrane disease (HMD) and other respiratory diagnoses in neonates. NCPAP is an affordable intervention that reduces the number of neonatal admissions to the intensive care unit (ICU) for ventilation. At the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) we have been using NCPAP since April 2006. Objectives. To review the use of early NCPAP in our hospital setting. Methods. This was a retrospective, descriptive study of all neonates ≥750 g admitted to CMJAH between 1 January 2013 and 31 July 2014, who received NCPAP within 72 hours of birth. The characteristics and the survival of all infants who received NCPAP were described using univariate analysis. Results. The NCPAP group ( n =481) of neonates <1 500 g was significantly associated with surfactant use ( p <0.0005), bronchopulmonary dysplasia ( p <0.0005) and late sepsis ( p <0.0005). The survival to day 7 and to discharge of infants treated with NCPAP was significantly decreased ( p <0.0005). NCPAP alone (without ventilation) improved the survival to discharge ( p =0.001). The survival was 95.4% in the ≥1 500 g infants, compared with 87.6% in the very low birth weight infants and 55.2% in the extremely low birth weight infants. Conclusion. NCPAP is an effective intervention for HMD; it is both cost-effective and easy to use in a resource-limited setting, and reduces the morbidity and mortality associated with ICU admission.

ABSTRACT 387

Background and aims: Asthma is very common in pediatric admissions and its confusing with acute bronchiolitis in infants because of the similarity of signs and symptoms. Treatment of acute bronchiolitis may include the use of nasal CPAP. Aims: To describe the occurance of neck and upper chedt emphysema post nasal cpap use in an infant. Methods: Case report of subcutaneous emphysema post nCPAP in asthmatic infant and resolution aftrr discontinue CPAP and starting intravenous and continuous salbutamol nebulization. Results: The use of nCPAP in asthmatic infants may lead to air leak syndrome such as subcutaneous emphysema. Proper history taking revealed the history of recurrent wheezy chest responding to asthma therapy and when asthma treatment optimized the clinical condition improved and emphysema resolved. Conclusions: The use of nasal CPAP in asthmatic infant may lead to subcutaneous emphysema.

Allergic contact dermatitis due to use of a continous positive airway pressure mask - A rare case report

Nasal continuous positive airway pressure (CPAP) is commonly used to treat various respiratory conditions including obstructive sleep apnea (OSA). It is now the treatment of choice for patients with sleep apnea syndrome (SAS). Several side effects related to the use of nasal CPAP are described in the literature. Mask interface related issues can be an important determinant of adherence to continuous positive airway pressure (CPAP) therapy and the side effects can cause patients to discontinue this effective therapy. We report a case of 72 year old man who used nasal CPAP for 6 months for the treatment of OSA and developed allergic contact dermatitis (ACD) from a CPAP nasal mask.

Early nasal continuous positive airway pressure compared with mechanical ventilation in very-low-birth-weight neonates

ObjectivesTo determine whether prophylactic nasal continuous positive airway pressure (CPAP) applied soon after birth, regardless of the respiratory status, in very-low-birth-weight (VLBW) neonates reduces the use of mechanical ventilation and its hazards.BackgroundUsing nasal CPAP early in VLBW neonates is highly beneficial and associated with lower complications compared with mechanical ventilation.Patients and methodsThis prospective clinical trial was performed on 40 preterm neonates less than 37 weeks old and with body weight greater than 1000 g and less than 1500 g, who were admitted to the neonatal intensive care unit of Shibin El-Kom teaching hospital because of VLBW. Patients were randomly allocated into the following treatment groups. Group I included 20 preterm neonates supported by nasal CPAP immediately after birth regardless of their respiratory status. Group II included 20 preterm neonates receiving routine neonatal care. Survival analysis was applied to estimate and compare survival rates, the duration of oxygen therapy, and the hospital stay using the independent sample t-test.ResultsRegarding the initial and the final arterial blood gases in the CPAP group, there was a statistically significant difference with respect to the PO 2 . In contrast, there were no statistically significant differences in the initial and the final arterial blood gases in the non-CPAP group.There was a statistically significant difference between the CPAP group and the non-CPAP group with regard to the whole duration of stay in the neonatal intensive care unit (the duration was 19.60 ± 3.44 and 32.10 ± 12.28, respectively) and the whole duration of ventilation (the duration was 4.0 ± 5.32 and 24.70 ± 13.0, respectively).ConclusionThe use of nasal CPAP was associated with a lower duration of stay, a lower incidence of complications (pneumothorax, bronchopulmonary dysplasia, pulmonary hemorrhage, and sepsis), and a decreased need for mechanical ventilation.

Assessment of regional lung ventilation by electrical impedance tomography in a patient with unilateral bronchial stenosis and a history of tuberculosis

Bronchial stenosis can impair regional lung ventilation by causing abnormal, asymmetric airflow limitation. Electrical impedance tomography (EIT) is an imaging technique that allows the assessment of regional lung ventilation and therefore complements the functional assessment of the lungs. We report the case of a patient with left unilateral bronchial stenosis and a history of tuberculosis, in whom regional lung ventilation was assessed by EIT. The EIT results were compared with those obtained by ventilation/perfusion radionuclide imaging. The patient was using nasal continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea syndrome. Therefore, we studied the effects of postural changes and of the use of nasal CPAP. The EIT revealed heterogeneous distribution of regional lung ventilation, the ventilation being higher in the right lung, and this distribution was influenced by postural changes and CPAP use. The EIT assessment of regional lung ventilation produced results similar to those obtained with the radionuclide imaging technique and had the advantage of providing a dynamic evaluation without radiation exposure.

Infants with severe respiratory syncytial virus needed less ventilator time with nasal continuous airways pressure then invasive mechanical ventilation

Nasal continuous positive airway pressure (NCPAP) has been proposed as an early first-line support for infants with severe respiratory syncytial virus (RSV) infection. We hypothesised that infants <6months with severe RSV would require shorter ventilator support on NCPAP than invasive mechanical ventilation (IMV). Retrospective cohort analysis of infants admitted to two paediatric intensive care units, one primarily using NCPAP and one exclusively using IMV, between January 2008 and February 2010. We studied 133 (NCPAP n=89, IMV n=46) consecutively admitted infants. On admission, disease severity [i.e. Paediatric RISk of Mortality (PRISM) II score (NCPAP 5.1±2.8 vs. IMV 12.2±6.0, p<0.001) and SpO2 /Fi O2 ratio (NCPAP 309±81 vs. IMV 135±98, p<0.001)] was higher in the IMV group. NCPAP remained independently associated with shorter ventilatory support (hazard ratio 2.3, 95% CI 1.1-4.7, p=0.022) after adjusting for PRISM II score, PCO2 , SpO2 /Fi O2 ratio, bronchopulmonary dysplasia and occurrence of clinically suspected secondary bacterial pneumonia. Nasal continuous positive airway pressure was independently associated with a shorter duration of ventilatory support. Differences in baseline disease severity mandate a randomised trial before the routine use of NCPAP can be recommended.

High-Flow Nasal Cannulae in Very Preterm Infants after Extubation

BackgroundThe use of high-flow nasal cannulae is an increasingly popular alternative to nasal continuous positive airway pressure (CPAP) for noninvasive respiratory support of very preterm infants (gestational age, <32 weeks) after extubation. However, data on the efficacy or safety of such cannulae in this population are lacking.MethodsIn this multicenter, randomized, noninferiority trial, we assigned 303 very preterm infants to receive treatment with either high-flow nasal cannulae (5 to 6 liters per minute) or nasal CPAP (7 cm of water) after extubation. The primary outcome was treatment failure within 7 days. Noninferiority was determined by calculating the absolute difference in the risk of the primary outcome; the margin of noninferiority was 20 percentage points. Infants in whom treatment with high-flow nasal cannulae failed could be treated with nasal CPAP; infants in whom nasal CPAP failed were reintubated.ResultsThe use of high-flow nasal cannulae was noninferior to the use of nasal CPAP, with treatment failure occurring in 52 of 152 infants (34.2%) in the nasal-cannulae group and in 39 of 151 infants (25.8%) in the CPAP group (risk difference, 8.4 percentage points; 95% confidence interval, −1.9 to 18.7). Almost half the infants in whom treatment with high-flow nasal cannulae failed were successfully treated with CPAP without reintubation. The incidence of nasal trauma was significantly lower in the nasal-cannulae group than in the CPAP group (P=0.01), but there were no significant differences in rates of serious adverse events or other complications.ConclusionsAlthough the result for the primary outcome was close to the margin of noninferiority, the efficacy of high-flow nasal cannulae was similar to that of CPAP as respiratory support for very preterm infants after extubation. (Funded by the National Health and Medical Research Council; Australian New Zealand Clinical Trials Network number, ACTRN12610000166077.)

An Integrative Review of Skin Breakdown in the Preterm Infant Associated with Nasal Continuous Positive Airway Pressure

To identify factors associated with skin injury during nasal continuous positive airway pressure (NCPAP) and describe differences in frequency, severity, and type of skin injuries when comparing nasal interfaces used during NCPAP in the preterm infant. Scientific databases were searched using provided key terms and yielded 113 articles. Forty-six articles were included in this integrative review: six case studies, 22 with identified aim of examining skin and nasal injury during NCPAP; 18 included skin care considerations during NCPAP. Studies were categorized into four themes: types of nasal injuries; associated risk factors that increase incidence of injury; differences between NCPAP devices and/or nasal interface and corresponding rate and severity of nasal injury; and recommended prevention strategies to reduce iatrogenic cutaneous injury. Skin injury was a common theme during neonatal NCPAP with skin breakdown rates of 20% to 60%. Increased skin injury risk was associated with smaller infant size, gestational age, and duration of therapy. Nursing care strategies to improve skin integrity during NCPAP had little supportive evidence. Nursing practice is varied with reportedly little standardized care during NCPAP therapy. Recommendations for specific care strategies to reduce skin injury during NCPAP were supported by limited experimental studies. Risk factors during NCPAP include nasal injury and trauma secondary to tight-fitting nasal interfaces necessary to provide continuous distending pressure for respiratory stability. Identifying strategies to reduce skin breakdown will support noninvasive treatment success, reduce reintubation rates, reduce sepsis, reduce patient discomfort, and improve developmental outcomes during NCPAP use.