CPAP Maintenance and
monitoring
Maintenance and Monitoring
▪ Flow
̶ Bubble minimal bubbling (2 to 7 liters/min)
̶ Ventilator 6 to 8 cms of water
▪ FiO2 (21% to 60 %) : SpO2 90% - 95s%
▪ CPAP (4 to 7 cms) : Recessions / CXR and SpO2
CPAP and FiO2: Proportionality
CPAP 5 cms FiO2 50%
CPAP 6 cms FiO2 60%
CPAP 7 cms FiO2 70 to 100%
CPAP 4 cms FiO2 25 to 40%
CPAP
▪ CPAP of < 4 cm H2O never given!
▪ CPAP of 4-7 cm H2O is a good range
̶ Advantages many, disadvantages few!
▪ CPAP of > 7 cm H2O is a bad range
̶ Advantages some, disadvantages galore!
Warming and Humidification
▪ Temperature of inspiratory gases at 37o C
▪ Relative humidity of 100%
▪ No condensation in the inspiratory circuit
▪ Some condensation in the expiratory limb
Humidifier
37o c
37o c 39o c 37o c
Monitoring
▪ Patient
– HR, RR, SAS Score, SpO2, Air entry and bubbling
– CFT, Blood pressure, AF, Urine output, Abd girth
▪ Machine
– CPAP pressure, FiO2 and Flow
– Water in humidifier, Bubble chamber
– Condensation in circuit
▪ Interface
– Nasal injury, Cap size, Prong size, Secretions
CXR
Adequacy of CPAP
Satisfactory cardiorespiratory status
▪ Comfortable baby
▪ Minimal retraction, no grunt
Bubbling
▪ Normal capillary refill, BP Breath sounds
▪ Normal saturations: 90% - 94%
▪ Normal ABG
(PaO2 60-80, PaCO2 40-60, pH 7.35-7.45, BE±2)
Weaning
▪ Decrease FiO2 and then CPAP
▪ Every 1 cm decrease in CPAP, aim 10% in FiO2
▪ CPAP : 5cm & FiO2 50%, maintain CPAP till FiO2 is 30%
▪ Decrease CPAP to 4 cm
▪ The disease process has improved
▪ If CPAP 4 cm & FiO2 < 30% & clinically well (no RD,
SpO2 > 90% & Normal ABG) : Remove CPAP
Procedure after the CPAP
▪ Oral and Nasal suction / Saline nebulization if
secretions
▪ Watch for apneas, tachypnea, retractions and
bradycardia
▪ Frequent change in positions
Failure of CPAP
▪ Continuing retractions, grunt
▪ Recurrent apneas
▪ SpO2 <90 %/ PaO2 < 50 : PEEP > 7 & FiO2 >60%
▪ PaCO2 > 55, Poor respiratory efforts
▪ Baby not tolerating CPAP
Reasons for Failure
▪ Failure of the CPAP system
▪ Worsening of baby
̶ Respiratory
̶ Cardiovascular
̶ Neurological
Summary
▪ Titration
̶ Flow Bubbling
̶ FiO2 SpO2
̶ CPAP Recessions/CXR
▪ Proportionality of FiO2 and CPAP
▪ Systematic evaluation: Failure of CPAP
