Acta anaesth. scand. 1978, 22, 367-370
Treatment of Respiratory Insufficiency in Infants Using Nasal CPAP and a Gas Jet J. KAMPER and A. BRENDSTRUP Departments of Paediatrics and Anaesthesia, Glostrup Hospital, University of Copenhagen, Denmark
A light-weight system for continuous positive airway pressure (CPAP) based on a nasal vestibular cannula and a miniature gas jet has been tried out in 29 newborns with severe idiopathic respiratory distress syndrome (IRDS) and nine infants suffering from respiratory insufficiency caused by lower respiratory tract infections. In infants with IRDS, a permanent effect was achieved in 20% when the birth weight was below 1501 g, and in 74% when the birth weight was higher. T h e infants with lower respiratory tract infections all recovered without further ventilatory support. Significant complications occurred in only two infants, both of whom developed pneumothorax. The system forms a simple and safe alternative to existing nasal CPAP systems suitable for use in newborns as well as older infants with lung diseases resulting in alveolar collapse.
Received 27 September, accepted for publication 17 Nouember 1977
Continuous positive airway pressure (CPAP) (PAPEet al. 1976), while some of the methods has become a well established therapy in involving a neck seal have been shown to conditions leading to alveolar collapse. It increase the pressure in intracranial venous was introduced to neonatology by GREGORYsinuses, with the possible risk of haemorrhage et al. (1971) and is at present the most and hydrocephalus (VERTet al. 1973). CPAP via a twin nasal cannula seems to be effective and the safest treatment of idiopathic respiratory distress syndrome (IRDS). Orig- a comparatively safe and simple method et al. 1973, CALIUMI-PELLEinally CPAP was delivered by way of a (KATTWINKEL GRINI et al. 1974, RISEMRERG et al. 1974, tracheal tube. This involved the risks of tube et al. 1976). We dislocation and obstruction, laryngotracheal WUNGet al. 1975, SCHMID et al. 1976) and infection. report here our experience with this techlesions (CHOFFAT A number of less invasive CPAP techniques nique in a modification based on the miniahave therefore been tried : nasopharyngeal ture paediatric gas jet described by BEN( 1968). catheter (NOVOGRODER et al. 1973), face VENISTE & PEDERSEN & HALL1973), head chamber mask (RHODES (GREGORY et al. 1971), and face chamber MATERIAL AND M E T H O D (AHLSTROM et al. 1976). An effect analogous to CPAP has also been produced by means of In the years 1974-76, we treated 38 small infants with nasal CPAP. The clinical and therapeutiral data are a continuous negative pressure around the presented in Table 1. & VIDYASAGAR 1972). thorax (CHERNICK Some of these methods appear unnecessarily IRDS complicated, while others carry their own T h e largest group (29 newborns) had IRDS, chararterized by inspiratory retractions, tachypnoea (respirarisks. For example, the use of a face mask tory frequency > 6 0 min -'), grunting, impaired oxyheld in place by a ribbon behind the neck has genation and a typical opaque chest radiograph. At tlie been connected with cerebellar haemorrhage start of CPAP they presented one or more of the fol-
368
J. KAMPER AND A. BRENDSTRUP
CPAP were 68 (47-90)mmHg and 7.25 (7.09-7.38), respectively. Two infants had initial treatmcnt with mcchanical ventilation through a nasotracheal tube.
Fig. 1. Twin nasal cannula with attached jet device for CPAP. lowing symptoms in spite of a F I 2~0.6: ~ 1) universal cyanosis; 2) repeated shorter or; 3) one longer spell of apnoea; 4) Pao2
Treatment of Respiratory Insufficiency in Infants Using Nasal CPAP and a Gas Jet J. KAMPER and A. BRENDSTRUP Departments of Paediatrics and Anaesthesia, Glostrup Hospital, University of Copenhagen, Denmark
A light-weight system for continuous positive airway pressure (CPAP) based on a nasal vestibular cannula and a miniature gas jet has been tried out in 29 newborns with severe idiopathic respiratory distress syndrome (IRDS) and nine infants suffering from respiratory insufficiency caused by lower respiratory tract infections. In infants with IRDS, a permanent effect was achieved in 20% when the birth weight was below 1501 g, and in 74% when the birth weight was higher. T h e infants with lower respiratory tract infections all recovered without further ventilatory support. Significant complications occurred in only two infants, both of whom developed pneumothorax. The system forms a simple and safe alternative to existing nasal CPAP systems suitable for use in newborns as well as older infants with lung diseases resulting in alveolar collapse.
Received 27 September, accepted for publication 17 Nouember 1977
Continuous positive airway pressure (CPAP) (PAPEet al. 1976), while some of the methods has become a well established therapy in involving a neck seal have been shown to conditions leading to alveolar collapse. It increase the pressure in intracranial venous was introduced to neonatology by GREGORYsinuses, with the possible risk of haemorrhage et al. (1971) and is at present the most and hydrocephalus (VERTet al. 1973). CPAP via a twin nasal cannula seems to be effective and the safest treatment of idiopathic respiratory distress syndrome (IRDS). Orig- a comparatively safe and simple method et al. 1973, CALIUMI-PELLEinally CPAP was delivered by way of a (KATTWINKEL GRINI et al. 1974, RISEMRERG et al. 1974, tracheal tube. This involved the risks of tube et al. 1976). We dislocation and obstruction, laryngotracheal WUNGet al. 1975, SCHMID et al. 1976) and infection. report here our experience with this techlesions (CHOFFAT A number of less invasive CPAP techniques nique in a modification based on the miniahave therefore been tried : nasopharyngeal ture paediatric gas jet described by BEN( 1968). catheter (NOVOGRODER et al. 1973), face VENISTE & PEDERSEN & HALL1973), head chamber mask (RHODES (GREGORY et al. 1971), and face chamber MATERIAL AND M E T H O D (AHLSTROM et al. 1976). An effect analogous to CPAP has also been produced by means of In the years 1974-76, we treated 38 small infants with nasal CPAP. The clinical and therapeutiral data are a continuous negative pressure around the presented in Table 1. & VIDYASAGAR 1972). thorax (CHERNICK Some of these methods appear unnecessarily IRDS complicated, while others carry their own T h e largest group (29 newborns) had IRDS, chararterized by inspiratory retractions, tachypnoea (respirarisks. For example, the use of a face mask tory frequency > 6 0 min -'), grunting, impaired oxyheld in place by a ribbon behind the neck has genation and a typical opaque chest radiograph. At tlie been connected with cerebellar haemorrhage start of CPAP they presented one or more of the fol-
368
J. KAMPER AND A. BRENDSTRUP
CPAP were 68 (47-90)mmHg and 7.25 (7.09-7.38), respectively. Two infants had initial treatmcnt with mcchanical ventilation through a nasotracheal tube.
Fig. 1. Twin nasal cannula with attached jet device for CPAP. lowing symptoms in spite of a F I 2~0.6: ~ 1) universal cyanosis; 2) repeated shorter or; 3) one longer spell of apnoea; 4) Pao2
