Nasal Bubble Continuous Positive Airway Pressure (CPAP) in neonates is a gentle and non-invasive ventilation respiratory intervention for newborns designed with wide-bore tubing and a low-resistance interface, that is associated with the least damage to the developing premature lung, the least incidence of chronic lung disease and the best long-term pulmonary outcomes among preterm infants. Infant CPAP is used for basic neonatal resuscitation of a newborn baby at birth. It is proven to be safe, effective and can help to avoid intubation and mechanical ventilation when used immediately after birth.
The bubble CPAP for neonates comprises a humidified and blended gas source, an interface that connects the breathing circuit to the infant’s airway through the nasal cannula for neonatal babies, and a tube submerged in a bottle of water. As the gas exits the tube, when carrying out resuscitation for newborns, it creates bubbles that produce small airway pressure oscillations. When these oscillations reach the neonate’s lungs, the result is overall improved lung compliance and better gas exchange
Bubble continuous positive airway pressure (CPAP) is appealing due to the low cost and simple structure. It is also associated with a decreased incidence of bronchopulmonary dysplasia (BPD) compared to mechanical ventilation.
There are three major components in a bubble CPAP system which included an air oxygen blender mixer connecting with compressed air and oxygen source to supply an appropriate concentration level of gas from 21%-100% FiO2 and flow up to 10LPM. Meanwhile, a respiratory humidifier is optional to keep the gas humidified and warm at a constant temperature. A bubble generator is compulsory by creating pressure by placing the expiratory tube into the water container, which designated pressure will be determined by the depth of the tube immersed. A nasal tube and nasal prong can be chosen for nasal interface and make sure it applied to the infant without air and pressure leakage during the resuscitation of the newborn baby.
Choose the right size of the nasal interface according to the infant's weight when carrying out resuscitation in newborn baby.
Adjust the CPAP gauge to the pressure setting of 5-7 cm/H2O or as ordered.
Adjust the oxygen flow to 5-8 L/min, occlude the prongs and observe the bubble chamber for bubbles (make sure combi-stop in place). Bubbling should be constant but not excessive.
Too much space between prongs and nares will allow movement and cause trauma. Too little space between prongs and nares will cause blanching around the nostrils indicating too much pressure.
CPAP delivery must be maintained at ALL times whenever the infant is handled.