What is nasal CPAP (nCPAP)?
nCPAP is the application of positive pressure to
the airways of a spontaneously breathing infant
throughout the respiratory cycle. nCPAP is a continuous
flow of gas administered through nasal prongs inserted
in the nares or by a nasal mask placed around the
perimeter of the nose. The positive pressure, usually
4 cmH
2
O to 8 cmH
2
O, acts as a splint, which can help
prevent alveoli collapse.
BiPhasic CPAP alternates between two levels of CPAP
at a set time interval. The infant can breathe at both
CPAP settings. The BiPhasic mode helps increase the
infant’s tidal volume and may stimulate the respiratory
drive center.
Advantages of CPAP
• Increases FRC
• Maintains and increases lung volume
• Improves lung compliance
• Reduces work of breathing (WOB) and
airway resistance
• Provides a noninvasive procedure
• Allows small airways to develop
• Promotes the use of natural surfactant
• Promotes easy application
• Provides cost effectiveness
• Helps prevent extubation failure in some infants
• Stabilizes the airway diaphragm and chest wall
• Decreases incidence of chronic lung disease (CLD)
2
Nasal (nCPAP) is associated with improved respiratory mechanics and decreased chronic lung disease (CLD) rate.
Physiologic effects of nasal CPAP in neonates
3–4,10
Infant nasal CPAP
Splint open airways
Stretches lung
and pleura
Stimulates lung
growth
Stimulates the
J receptors and HIBR
Stabilizes chest wall
and diaphragm
Increases pharyngeal
cross section
Recruits alveoli
and prevents
alveoli collapse
Increases FRC
and lung volumes
Improves V/Q ratio
and increases
oxygenation
Decreases WOB
Decreases
obstructive apnea
Decreases
intrapulmonary
shunting
Improves
V/Q ratio
Conserves
surfactant
Maintains airway
patency
Reduces upper
airway resistance
Improves
breathing pattern
and decreases WOB
Reduces central
and
obstructive apnea
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