How does bubble CPAP therapy work?

According to the National Heart, Lung, and Blood Institute, 10% of newborns delivered prematurely in the United States each year suffer respiratory distress syndrome (RDS) (NHLBI).

 Additionally, the chance of developing RDS increases with the time of birth. For instance, a baby born before 29 weeks of pregnancy has a 60% probability of developing RDS, whereas a baby born at full term has almost no chance.

Some infants still develop bronchopulmonary dysplasia despite mechanical breathing with continuous positive airway pressure (CPAP), helping to prevent the collapse of alveoli in the lungs and maybe increase survival rates (BPD).

According to a BMJ study, nasal bubble CPAP is a noninvasive method superior to intubation for lowering BPD.

One of the most critical developments in the history of neonatology was the discovery of surfactants. Surfactant undoubtedly saved the lives of premature children who would have otherwise been deemed nonviable.

The prevention of chronic lung disease (CLD) did not advance, and it became evident that mechanical ventilation significantly reduces the assistance surfactant offers to premature lungs.

Even after accounting for birth weight, race, and sex distributions in the centres, there are still significant differences in the incidence of CLD between institutions. Since biological variables were unable to account for the broad variation, respiratory treatment was seen as being essential to either causing or preventing CLD.

How does it work?

The bubble CPAP device is straightforward; it consists of a breathing circuit with an expiratory limb submerged in water in a container to produce the required pressure and an inspiratory limb providing a heated humidified gas mixture to the baby.

Gas flow produces underwater bubbles that cause the water level to fluctuate, affecting how much pressure is applied to the patient. As a result, the patient using b-CPAP experiences fluctuating pressure instead of steady pressure. This oscillation effect could increase the volume recruitment effectiveness of b-CPAP.

Multiple physiological benefits of CPAP exist. It lessens respiratory efforts in premature newborns who breathe independently by stenting the airway and the diaphragm.

It keeps alveoli inflated, raises the lung’s functional residual capacity, and perfectly balances ventilation and perfusion.

 CPAP reduces volutrauma and subsequent biotrauma compared to mechanical ventilation and tracheal intubation. When used on animals repeatedly, CPAP creates a favourable strain that promotes lung growth.

To compare the effectiveness of early nasal CPAP to mechanical ventilation, numerous randomised controlled trials were launched.

These studies did not specifically call for the use of b-CPAP; instead, they employed any CPAP and did not provide information on competency-based training to ensure its proper application.

Despite these concerns, research showed that it was possible to provide CPAP to premature infants as early as 24–25 weeks of gestation without changing mortality or CLD.

Early use of CPAP had a marginal advantage over prophylactic surfactant with intubation for the composite outcome of survival without CLD when these trials were taken as a whole in a recent meta-analysis.

These results contradict reports of a significant decline in CLD in newborn facilities using b-CPAP.

The decreased CLD in b-CPAP units may be due to two things. The first factor is the type of nasal prongs and CPAP.

The caregiver’s ability to employ b-CPAP at the bedside is the second factor. B-CPAP strategy is a comprehensive therapy package, necessitating defined practice standards and a training procedure.