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Infant Flow® LP Ncpap System

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Infant Flow® LP nCPAP system Clinical training workbook Table of contents Infant nasal CPAP ..............................................................................................1–6 CPAP overview .....................................................................................................1–3 CPAP modalities .......................................................................................................4 Variable flow technology ..........................................................................................5 Self assessment ........................................................................................................6 Infant Flow® SiPAP driver overview ............................................................... 7–16 Infant Flow LP system ...............................................................................................7 Infant Flow SiPAP configurations ..............................................................................8 Infant Flow SiPAP display screen ...............................................................................9 Infant Flow CPAP and circuit set-up ........................................................................10 Humidification and nCPAP ...................................................................................... 11 Airway temperature probe placement ................................................................... 11 Infant Flow SiPAP sensor calibration .......................................................................12 Infant Flow SiPAP set-up guide ......................................................................... 13–14 Respiratory abdominal sensor .................................................................................15 Self assessment ......................................................................................................16 Infant Flow SiPAP nCPAP driver ................................................................... 17–22 Modes of operation .......................................................................................... 17–18 BiPhasic mode strategy .....................................................................................19–20 SiPAP exercises and self assessment.................................................................. 21–22 Infant Flow LP generator assembly .............................................................23–27 Infant Flow LP generator ........................................................................................23 Initiating and maintaining Infant Flow LP interfaces ...................................................................................24–25 effective nCPAP therapy Infant Flow LP fixation devices ................................................................................26 is a critical step in helping Self assessment ......................................................................................................27 respiratory- compromised Infant Flow LP patient set-up...................................................................... 28–46 infants achieve successful Infant Flow LP interfaces ...................................................................................28–29 recovery and develop Fixation devices ......................................................................................................30 Headgear application .............................................................................................31 normal respiratory Generator assembly preparation .............................................................................32 function. When used Generator assembly and interface attachment to headgear .............................33–34 according to your facility’s Bonnet application .................................................................................................35 treatment protocols and Generator assembly and interface attachment to bonnet .................................36–37 with this training Bonnet application (alternative method 1) ..............................................................38 Bonnet application (alternative method 2) ..............................................................39 workbook, the Infant Flow Incorrect application of fixation device and generator assembly .......................40–41 LP nCPAP system can Incorrect application of generator assembly and interface ................................42–43 effectively deliver nCPAP Final inspection of nasal interface placement .........................................................44 therapy to help improve Self assessment and return demonstration ...................................................... 45–46 patient outcomes. Routine nCPAP care .......................................................................................47–49 Frequently asked questions .........................................................................50–54 Self assessment ......................................................................................................54 Glossary ..........................................................................................................55–56 References ............................................................................................................57 Infant nasal CPAP Introduction Worldwide each year, approximately 15 million (1 out of every 10) babies are born prematurely.1 Premature or low-birth weight (LBW) infants are at a high risk for respiratory problems due to underdeveloped lungs. Common neonatal respiratory conditions include apnea of prematurity, respiratory distress syndrome, transient tachypnea of the newborn (TTN), meconium aspiration syndrome, pulmonary edema and post-extubation support. These conditions are often associated with decreased pulmonary compliance and functional residual capacity (FRC).1,2 Several of these infants will require respiratory support. Respiratory distress syndrome (RDS) is a condition that strains normal respiration due to the lack of natural surfactant production. Approximately 50% of neonates born at 26 to 28 weeks gestation and 30% of neonates born at 30 to 31 weeks gestation develop RDS.2 CPAP overview What is surfactant? Surfactant is a phospholipid, which reduces surface tension compounds problems with premature infants. Given the to increase lung compliance. potential complications of intubation, many physicians opt for a less invasive approach for spontaneously breathing Artificial surfactant may be given to help reduce surface infants that utilizes continuous positive airway pressure tension, increase compliance and improve ventilation. (CPAP). As infants are preferential nose-breathers, nasal Without additional respiratory assistance, many infants have CPAP (nCPAP) is the preferred method for treatment difficulty establishing the adequate functional residual delivery. CPAP enhances alveolar recruitment decreasing capacity (FRC) required to maintain normal respiration. pulmonary vascular resistance and intrapulmonary shunting, Respiratory support stabilizes FRC and improves oxygenation. By increasing Several options are available to help the clinician provide surface area to alveolar gas exchange, CPAP decreases V/Q respiratory support to the neonatal patient. Historically, the mismatch. The goal of CPAP therapy is to maintain normal initial treatment for infants with respiratory problems was lung volumes and oxygenation, while enabling the infant 3,4 mechanical ventilation via an artificial airway. Intubation to breathe on their own. Physiologic effects of CPAP are presents a variety of challenges for any patient but represented in the organizational chart on page 2. 1 Physiologic effects of nasal CPAP in neonates3–4,10 Infant nasal CPAP Stretches lung Splint open airways and pleura Recruits alveoli and prevents Increases pharyngeal Stabilizes chest wall Stimulates the Stimulates lung alveoli collapse cross section and diaphragm J receptors and HIBR growth Improves Reduces central Increases FRC Conserves Maintains airway Reduces upper breathing pattern and and lung volumes surfactant patency airway resistance and decreases WOB obstructive apnea Improves V/Q ratio Decreases Decreases and increases obstructive apnea intrapulmonary oxygenation shunting Decreases WOB Improves V/Q ratio Nasal (nCPAP) is associated with improved respiratory mechanics and decreased chronic lung disease (CLD) rate. What is nasal CPAP (nCPAP)? Advantages of CPAP nCPAP is the application of positive pressure to • Increases FRC the airways of a spontaneously breathing infant • Maintains and increases lung volume throughout the respiratory cycle. nCPAP is a continuous • Improves lung compliance flow of gas administered through nasal prongs inserted • Reduces work of breathing (WOB) and in the nares or by a nasal mask placed around the airway resistance perimeter of the nose. The positive pressure, usually • Provides a noninvasive procedure 4 cmH2O to 8 cmH2O, acts as a splint, which can help • Allows small airways to develop prevent alveoli collapse. • Promotes the use of natural surfactant • Promotes easy application BiPhasic CPAP alternates between two levels of CPAP • Provides cost effectiveness at a set time interval. The infant can breathe at both • Helps prevent extubation failure in some infants CPAP settings. The BiPhasic mode helps increase the • Stabilizes the airway diaphragm and chest wall infant’s tidal volume and may stimulate the respiratory • Decreases incidence of chronic
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