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CPAP (Continuous Positive Airway Pressure) Bedside Application in the Newborn
PK Rajiv
1:
Applied Physiology
PHYSIOLOGICAL PRINCIPLES
Ventilation (V)
Perfusion (Q)
Basic Understanding of Various Lung Units in Disease States
Alveoli are Optimally Distended ‘Normal Lung Under Ideal Conditions’
ALVEOLI IS ATELECTATIC
ALVEOLAR OVERDISTENTION
CONCEPTUAL MODELS OF APPLIED PHYSIOLOGY
ANATOMICAL CONSIDERATIONS
PHYSIOLOGICAL CONSIDERATIONS
Airway Resistance
Lung Compliance
Pressure Volume Loop in Hyaline Membrane Disease (HMD)
Relationship of Lung Condition with Pressure-Volume Loop
2:
Effects of CPAP
INTRODUCTION
LONG-TERM IMPLICATION
Cardiovascular Stability
Sequence of Events in Excessive CPAP
Renal System
Gastrointestinal Tract
Central Nervous System
3:
Clinical Assessment of Respiratory Distress
CLINICAL ASSESSMENT FOR RESPIRATORY DISTRESS SYNDROME (RDS)
4:
Indications and Contraindications of CPAP
SPECIFIC INDICATIONS FOR CPAP
Conditions Responsive to CPAP
PHYSICAL CRITERIA TO APPLY CPAP*
Rationale for CPAP in Various Conditions
Aims of Management
Time of Application
Early CPAP
Early CPAP in RDS—Advantages
Prophylactic CPAP
Contraindications for CPAP
Failure of CPAP
5:
CPAP Protocol
GUIDELINES FOR CPAP
AIMS OF CPAP
GUIDELINES IN ATELECTATIC DISORDERS
Initial Setting
CPAP for * Preterm RDS (Fig. 5.1)
6:
Optimum CPAP
OPTIMUM CPAP
ROAD TO OPTIMUM CPAP
Measures to Maintain Optimum CPAP
Success with CPAP
Steps in the Management of CPAP after Optimization (Fig. 6.1)
Special Monitoring Parameters
7:
Failure of CPAP
CAUSES
8:
Weaning from CPAP
RESPIRATORY DISTRESS SYNDROME (RDS)
Steps of Weaning in Respiratory Distress Syndrome (RDS)
PRE-EXTUBATION PROTOCOL
General Considerations
Steps to Extubation
CPAP MANAGEMENT ACCORDING TO BIRTH WEIGHT
Eligibility Criteria for Extubation
Exclusion Criteria
Criteria for Extubation of ELBW Infant
Sequential Weaning
Abrupt Weaning
Suggested Weaning Protocol
9:
Complications of CPAP
PULMONARY COMPLICATIONS
PNEUMOTHORAX
Cardiovascular Complications
Gastrointestinal Complications
Renal Complications
Central Nervous System Complications
Local Complications
HAZARDS AND COMPLICATIONS ASSOCIATED WITH EQUIPMENT
10:
CPAP and X-rays
INTRODUCTION
Chest X-ray Showing Deflation (Posterior Intercostal Space of < 7 Spaces) (Fig. 10.5)
CXR Showing Adequate Chest Expansion (Fig. 10.7)
Chest X-ray Showing Overexpansion (Posterior ICS of > 9 Spaces/Flattening of Diaphragm) (Fig. 10.9)
DISEASE PROFILES
Hyaline Membrane Disease and CPAP (Figs. 10.11 to 10.14)
Pneumonia and CPAP (Figs. 10.15 to 10.17)
Meconium Aspiration Syndrome and CPAP (Figs. 10.18 to 10.21)
CLINICAL CLUES ON CO2 (FIG. 10.22 AND FLOW CHART 10.1)
11:
Blood Gas Analysis
ACID-BASE STATUS
Respiratory Disorders (Table 11.1)
Metabolic Disorders (Table 11.2)
Compensation in Acid-base Disturbances
BASIC QUESTIONS IN ANALYSIS OF ARTERIAL BLOOD GAS (ABG)
Interpretation (Tables 11.4 and 11.5)
Blood Gas Classifications
Error in Blood Gas Measurements
CO2 Permissive Hypercapnea
pH
Important Trends in Arterial Blood Gas (ABG)
12:
Strategies in Specific Disorders
RESPIRATORY DISTRESS SYNDROME (RDS)
Baby-A: Moderate RDS with Failure of CPAP
APNEA OF PREMATURITY
CPAP—4 to 5 cm of H2O
Baby-B: Apnea of Prematurity
APPROACH TO MECONIUM ASPIRATION (MAS)
Tracheobronchomalacia
POSTEXTUBATION MANAGEMENT
BABY-C: Congenital Pneumonia
13:
Case Scenarios
CASE 1
CASE 2 (FIG. 13.3)
CASE 3
Evaluated for Extubation Failure
14:
CPAP Devices
CONCEPTUAL MODELS OF OPERATION
VENTILATOR CPAP
Components of CPAP
Type of Pressure Generation System
Patient Interface System
METHODS OF GENERATING CPAP
Continuous Flow CPAP Systems
Ventilator Derived CPAP
Dameca Benveniste Valve (Jet assembly)
Bubble CPAP and Water Seal CPAP
Variable Flow CPAP Systems
Principles of Variable Flow Device
Variable Flow CPAP System (Infant Flow Driver)
Advantages
CPAP PRESSURE STABILITY
CONCLUSION
SiPAP
Indications
Mechanism of SiPAP with Infant Flow Driver
Advantages of SiPAP
SiPAP Controls
Typical Starting SiPAP Settings
Effects of SiPAP Setting
METHODS OF DELIVERING CPAP (Table 14.1)
Nasal Prongs (NCPAP)
Advantages
Disadvantages
Types and Brands
Nasal vs Nasopharyngeal CPAP
Nasopharyngeal Prongs (Npcpap)
Advantages
Disadvantages
Nasal Cannulae
Disadvantages
Vapotherm
Advantages
Nasal Masks
Face Masks
Advantage
Disadvantages
Delivery room CPAP
INSURE (INTUBATION SURFACTANT EXTUBATION)
Steps in INSURE Procedure
FUTURE DIRECTIONS
Aerosolized Surfactant and Cpap
Current Information
Nitric Oxide and Cpap
NO Biosynthesis
Vascular Effects of NO
15:
Setting-up CPAP
BASIC PRINCIPLES
Equipment
Manpower
Preliminary Steps in CPAP
BUBBLE CPAP SYSTEM
16:
Troubleshooting
INTRODUCTION
BABY INTERPHASE
NASAL PRONG INTERFACE (FIG. 16.1)
Hudson Interface
Hudson Interface Nasal Prongs Size
NASAL PRONGS
Hudson's Prongs
Nasopharyngeal Prongs
Mechanics of Nasopharyngeal prongs
17:
CPAP in Developing Countries
INDIGENOUS CPAP MACHINES
Companies
IMPLICATIONS IN DEVELOPING COUNTRIES
RECOMMENDATIONS FROM THE 3 MONTHS STRUCTURED TRAINING PROGRAM IN VENTILATION (Dr PK Rajiv 2009)
Implications in Developing Countries
Complications
Early Referral to Tertiary Center
Transport Facilities
IMPLICATIONS FOR PRACTICE IN DEVELOPING COUNTRIES
Choice of Prongs
Choice of CPAP Devices
Role of Prophylactic (or) Early in Delivery Room / NICU
Role of Surfactant with CPAP
18:
Certain Dictums in CPAP Management
INTRODUCTION
KEY CONCEPTS
The Application of CPAP is an Art
THE IMPACT OF CPAP IN NEONATAL RESPIRATORY CARE
Amrita Institute of Medical Sciences (AIMS) Study
Abstract of the Study
Historical Landmark in India (Fig. 18.1)
CONCLUSION
19:
Product Information
ARGYLE PRONGS FOR CPAP (FIG. 19.1)
HUDSON's PRONGS FOR CPAP (FIG. 19.2)
Advantages
Appropriate Size of Hudson's Prongs
NASAL PRONG COMPARISON
Comparing the Tolerance and Efficacy of Delivering CPAP by Two Different Sets of Nasal Prongs
PRODUCT INFORMATION OF CPAP
Pressure Manifold
MR290 Humidification Chamber (Fig. 19.4)
Circuit (Fig. 19.5)
CPAP Generator (Fig. 19.6)
Patient Interface (Fig. 19.7)
INDIGENOUS CPAP SYSTEM
Product Information
Indian Products
20:
Columbia Protocols
INTRODUCTION
Protocol I
ACTION ORIENTED MONITORING ON CPAP, COLUMBIA
Protocol II
Suggested Reading
INDEX
TOC
Index
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