AMMARI, Amer; KASHLAN, Fawaz; EZZEDEEN, Faisal; AL-ZAHRANI, Atyah; KAWAS, John; MAJEED-SAIDAN, M.A. Bubble nasal CPAP manual. Riyadh AL-Kharj Hospital Programme Neonatal intensive care, 2005
PREFACE Respiratory Distress Syndrome (RDS) is due to a deficiency of pulmonary surfactant. Seventy one % of very low birth weight infants had RDS, and 35% of them still required oxygen at 36 weeks adjusted age (Vermont Oxford Network 2001). Along with significant mortality, RDS is associated with significant morbidity and high costs to society. Pulmonary surfactant lines the surface of the alveoli in the lung, thereby reducing surface tension and preventing alveolar collapse. Surfactant deficiency results in progressive atelectasis of the alveoli, decreased pulmonary compliance, increased work of breathing, respiratory failure, and lung injury. The earlier the gestational age, at which birth occurs, the higher the risk that severe respiratory distress syndrome will develop. Historically, conventional therapy for this disorder has consisted of continuous positive airway pressure (CPAP) or mechanical ventilation, along with appropriate supportive care. In the past decade, surfactant replacement has led to significant improvements in survival, particularly for infants less than 1000 grams. However, attempts to treat RDS may lead to lung injury, and secondary complications including bronchopulmonary dysplasia (BPD) and chronic lung 2 disease (CLD). This lung injury is thought to result from the effect of mechanical injury due to assisted ventilation, oxygen toxicity, and lung inflammation among other factors. The following materials comprise the bubble nasal CPAP Manual. This manual provides a training tool in the administration of nasal CPAP using a bubble bottle system, following guidelines established at The Children’s Hospital of New York at New York Presbyterian Medical Center (Columbia-Presbyterian Medical Center).