Application of CPAP in Pediatrics

I. Use of neonatal CPAP machine for severe pneumonia

Severe pneumonia is one of the common emergencies in the intensive care unit. Once bacteria invade the lungs, it can easily cause swelling of the bronchial mucosa, affect the generation of pulmonary surfactants, and lead to airway obstruction, resulting in respiratory failure and a series of complications.

When infants show early signs of breathing difficulties, the use of CPAP can relieve their hypoxemia and hypercapnia. A study randomly divided 90 infants with severe pneumonia into a treatment group and a control group (45 cases each). Infants in the treatment group were treated with nCPAP oxygen therapy, with an oxygen flow rate of 4-5 L/min, FiO2 of 0.4-0.6, PEEP of 2-6 cm H2O, and a usage time of 21-125 hours; the control group was treated with oxygen mask, with an oxygen flow rate of 4-5 L/min, FiO2 of 0.4-0.6, and a usage time of 36-203 hours.

The study observed dyspnea, respiratory distress, tachycardia, cyanosis, improvement of pulmonary signs, dynamic monitoring of blood gas analysis, and average length of hospital stay.

The results showed that infants in the treatment group were significantly better than those in the control group in correcting hypoxia, improving respiration, restoring heart rate, shortening the course of the disease, and the total effective rate was 93.3% in the treatment group and 60.0% in the control group. nCPAP treatment for severe pneumonia in children has significant efficacy and no obvious side effects. Marini and others found that the use of neonatal CPAP machine with an expiratory pressure of 5-10 cm H2O can reduce expiratory obstruction, improve oxygen supply to the body, and prevent further progression of severe pneumonia.

II. Use of neonatal CPAP machine for acute respiratory distress syndrome

ARDS is also one of the common critical emergencies in the pediatric intensive care unit, and it is more common in newborns. CPAP can effectively prevent alveolar collapse, allow unstable alveoli to reopen, increase the area of gas exchange in the alveoli, reduce the exudation of the alveoli caused by inflammation, and relieve mucosal edema of small bronchioles, thus shortening the distance of gas diffusion, increasing diffusion function, reducing pulmonary shunting, and increasing functional residual capacity of the lungs, ultimately improving the comprehensive metabolism, increasing the compliance of the lungs, and improving oxygenation.

Early use can maintain positive pressure in the alveoli, effectively prevent alveolar collapse, increase the area of diffusion, increase gas exchange, reduce PaCO2 in the alveoli, increase PaO2, and reduce PaCO2, thus improving the resistance, tidal volume, minute ventilation, and respiratory rate of the entire respiratory tract, maintaining regular autonomous breathing in infants, protecting the function of pulmonary surfactants, reducing the surface tension of the alveoli, and reducing the formation of hyaline membrane disease.