Bubble CPAP

<h2 id="history">History</h2>
In the early 1970s, Gregory et al. demonstrated that providing CPAP using an anesthesia bag improved oxygenation in preterm infants with respiratory distress syndrome.<a class="footnote-ref" id="fnref:6" href="#fn:6">6</a> Subsequently, <a href="/facts/Jen-Tien_Wung/lVVdVMP7">Jen-Tien Wung</a> at Children's Hospital of New York, <a href="/facts/Columbia_University/Hlf1gw53">Columbia University</a> developed the bubble CPAP system using short nasal prongs.<a class="footnote-ref" id="fnref:7" href="#fn:7">7</a> 
In 1987 Avery et al. reported large differences in the risk-adjusted incidence of BPD in a comparison of 12 academic neonatal intensive care units in the United States.<a class="footnote-ref" id="fnref:8" href="#fn:8">8</a> This study first identified the Columbia approach of using bubble CPAP in the delivery room as a possible strategy to reduce the incidence of BPD as compared to mechanical ventilation.<a class="footnote-ref" id="fnref:9" href="#fn:9">9</a> During the <a href="/facts/Influenza_A_virus_subtype_H1N1/MRzPcTQ4">H1N1 influenza</a> outbreak in 2009, Dr. Aarti Kinikar made a "homemade" bubble CPAP machine in order to transition neonates off of ventilators so that ventilators could be used to help other patients.<a class="footnote-ref" id="fnref:10" href="#fn:10">10</a> Over the pandemic's course, "Kinikar used bubble CPAP to support the breathing of hundreds of children at her hospital."<a class="footnote-ref" id="fnref:11" href="#fn:11">11</a>

<h2 id="components">Components</h2>
The bubble CPAP system consists of three major components:<a class="footnote-ref" id="fnref:12" href="#fn:12">12</a>
1. Gas source: An oxygen blender connected to a source of oxygen and compressed air is used to supply an appropriate concentration of inspired oxygen (<a href="/facts/FiO2/l47JYnne">FiO2</a>). The humidified blended oxygen is then circulated through corrugated tubing.
2. Pressure generator: Pressure in the bubble CPAP system is created by placing the distal expiratory tubing in water. Designated pressure is determined by the depth of tubing immersed.
3. Patient interface: Nasal prongs are used as the nasal interface between the circuit and the infant's airway. Short and wide nasal prongs allow for a low resistance to air flow. It is important that the nasal interface be applied to the infant without air leakage while taking measures to prevent nasal trauma.

<h2 id="nursing-care">Nursing care</h2>
The successful application of bubble CPAP requires elaborate nursing care.<a class="footnote-ref" id="fnref:13" href="#fn:13">13</a> There is a learning curve to the implementation of the bubble CPAP respiratory approach that requires a team effort.<a class="footnote-ref" id="fnref:14" href="#fn:14">14</a> Respiratory therapists are important members of the team.

<ol><li>The system has to be snugly fitted and stationed on the infant's head. The nasal prongs can be secured by putting on an appropriate sized hat which rests on the lower part of the infant's ears and across the forehead.<a class="footnote-ref" id="fnref:15" href="#fn:15">15</a> The tubing can be fastened with the help of safety pins and rubber bands.<a class="footnote-ref" id="fnref:16" href="#fn:16">16</a></li>
<li>Nasal prongs must be properly placed to prevent air leak. Application of a <a href="/facts/Velcro/WGbzgeEE">Velcro</a> mustache placed over a piece of hydrocolloid dressing on the <a href="/facts/Philtrum/5UY3DaJ1">philtrum</a> can prevent accidental incarceration of the prong on the nasal septum.<a class="footnote-ref" id="fnref:17" href="#fn:17">17</a></li>
<li>Gentle nasal suctioning is important to maintain clear airways.</li>
<li>Frequent decompression of the infant's stomach with an oro-gastric tube is necessary to promote comfort, and to prevent a distended stomach from splinting the diaphragm and compromising respiration.<a class="footnote-ref" id="fnref:18" href="#fn:18">18</a></li></ol>

<h2 id="references">References</h2>

<ol>
<li id="fn:1">Morley CJ, Lau R, De Paoli A, Davis PG (July 2005). "Nasal continuous positive airway pressure: does bubbling improve gas exchange?". Archives of Disease in Childhood. Fetal and Neonatal Edition. 90 (4): F343-4. doi:10.1136/adc.2004.062588. PMC 1721902. PMID 16036895. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1721902" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1721902</a> <a href="#fnref:1" class="footnote-back-ref">↩</a></li>
<li id="fn:2">Sahni R (February 2010). "Bubble CPAP: can we predict success or failure?". Indian Pediatrics. 47 (2): 129–30. doi:10.1007/s13312-010-0019-0. PMID 20228427. <a href="https://doi.org/10.1007%2Fs13312-010-0019-0" target="_blank">https://doi.org/10.1007%2Fs13312-010-0019-0</a> <a href="#fnref:2" class="footnote-back-ref">↩</a></li>
<li id="fn:3">Dada S, Ashworth H, Sobitschka A, Raguveer V, Sharma R, Hamilton RL, Burke T (2021-06-11). "Experiences with implementation of continuous positive airway pressure for neonates and infants in low-resource settings: A scoping review". PLOS ONE. 16 (6): e0252718. Bibcode:2021PLoSO..1652718D. doi:10.1371/journal.pone.0252718. PMC 8195417. PMID 34115776. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8195417" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8195417</a> <a href="#fnref:3" class="footnote-back-ref">↩</a></li>
<li id="fn:4">Polin RA, Sahni R (October 2002). "Newer experience with CPAP". Seminars in Neonatology. 7 (5): 379–89. doi:10.1053/siny.2002.0132. PMID 12464500. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:4" class="footnote-back-ref">↩</a></li>
<li id="fn:5">Sahni R (February 2010). "Bubble CPAP: can we predict success or failure?". Indian Pediatrics. 47 (2): 129–30. doi:10.1007/s13312-010-0019-0. PMID 20228427. <a href="https://doi.org/10.1007%2Fs13312-010-0019-0" target="_blank">https://doi.org/10.1007%2Fs13312-010-0019-0</a> <a href="#fnref:5" class="footnote-back-ref">↩</a></li>
<li id="fn:6">Gregory GA, Kitterman JA, Phibbs RH, Tooley WH, Hamilton WK (June 1971). "Treatment of the idiopathic respiratory-distress syndrome with continuous positive airway pressure". The New England Journal of Medicine. 284 (24): 1333–40. doi:10.1056/NEJM197106172842401. PMID 4930602. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:6" class="footnote-back-ref">↩</a></li>
<li id="fn:7">Chan SY, Chan CK, Hou SM, Ng C (2007). "The Use of Bubble CPAP in Premature Infants: Local experience" (PDF). Hong Kong Journal of Paediatrics. 12 (2): 86–92. doi:10.1016/S1561-5413(08)60006-X. <a href="http://www.hkjpaed.org/pdf/2007;12;86-92.pdf" target="_blank">http://www.hkjpaed.org/pdf/2007;12;86-92.pdf</a> <a href="#fnref:7" class="footnote-back-ref">↩</a></li>
<li id="fn:8">Avery ME, Tooley WH, Keller JB, Hurd SS, Bryan MH, Cotton RB, et al. (January 1987). "Is chronic lung disease in low birth weight infants preventable? A survey of eight centers". Pediatrics. 79 (1): 26–30. doi:10.1542/peds.79.1.26. PMID 3797169. S2CID 21853784. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:8" class="footnote-back-ref">↩</a></li>
<li id="fn:9">Narendran V, Donovan EF, Hoath SB, Akinbi HT, Steichen JJ, Jobe AH (Apr–May 2003). "Early bubble CPAP and outcomes in ELBW preterm infants". Journal of Perinatology. 23 (3): 195–9. doi:10.1038/sj.jp.7210904. PMID 12732855. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:9" class="footnote-back-ref">↩</a></li>
<li id="fn:10">Fink, Sheri. Five Days at Memorial : Life and Death in a Storm-Ravaged Hospital. Atlantic Books, 2013. <a href="#fnref:10" class="footnote-back-ref">↩</a></li>
<li id="fn:11">Fink, Sheri. Five Days at Memorial : Life and Death in a Storm-Ravaged Hospital. Atlantic Books, 2013. <a href="#fnref:11" class="footnote-back-ref">↩</a></li>
<li id="fn:12">Won A, Suarez-Rebling D, Baker AL, Burke TF, Nelson BD (August 2019). "Bubble CPAP devices for infants and children in resource-limited settings: review of the literature". Paediatrics and International Child Health. 39 (3): 168–176. doi:10.1080/20469047.2018.1534389. PMID 30375281. S2CID 53113380. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:12" class="footnote-back-ref">↩</a></li>
<li id="fn:13">Chan SY, Chan CK, Hou SM, Ng C (2007). "The Use of Bubble CPAP in Premature Infants: Local experience" (PDF). Hong Kong Journal of Paediatrics. 12 (2): 86–92. doi:10.1016/S1561-5413(08)60006-X. <a href="http://www.hkjpaed.org/pdf/2007;12;86-92.pdf" target="_blank">http://www.hkjpaed.org/pdf/2007;12;86-92.pdf</a> <a href="#fnref:13" class="footnote-back-ref">↩</a></li>
<li id="fn:14">Sahni R (February 2010). "Bubble CPAP: can we predict success or failure?". Indian Pediatrics. 47 (2): 129–30. doi:10.1007/s13312-010-0019-0. PMID 20228427. <a href="https://doi.org/10.1007%2Fs13312-010-0019-0" target="_blank">https://doi.org/10.1007%2Fs13312-010-0019-0</a> <a href="#fnref:14" class="footnote-back-ref">↩</a></li>
<li id="fn:15">Chan SY, Chan CK, Hou SM, Ng C (2007). "The Use of Bubble CPAP in Premature Infants: Local experience" (PDF). Hong Kong Journal of Paediatrics. 12 (2): 86–92. doi:10.1016/S1561-5413(08)60006-X. <a href="http://www.hkjpaed.org/pdf/2007;12;86-92.pdf" target="_blank">http://www.hkjpaed.org/pdf/2007;12;86-92.pdf</a> <a href="#fnref:15" class="footnote-back-ref">↩</a></li>
<li id="fn:16">"Averting Newborn Deaths: Blending Oxygen and Bubble CPAP". Vayu Global Health Innovations. <a href="https://vayuinnovations.org/vayu-bcpap/" target="_blank">https://vayuinnovations.org/vayu-bcpap/</a> <a href="#fnref:16" class="footnote-back-ref">↩</a></li>
<li id="fn:17">Chan SY, Chan CK, Hou SM, Ng C (2007). "The Use of Bubble CPAP in Premature Infants: Local experience" (PDF). Hong Kong Journal of Paediatrics. 12 (2): 86–92. doi:10.1016/S1561-5413(08)60006-X. <a href="http://www.hkjpaed.org/pdf/2007;12;86-92.pdf" target="_blank">http://www.hkjpaed.org/pdf/2007;12;86-92.pdf</a> <a href="#fnref:17" class="footnote-back-ref">↩</a></li>
<li id="fn:18">Chan SY, Chan CK, Hou SM, Ng C (2007). "The Use of Bubble CPAP in Premature Infants: Local experience" (PDF). Hong Kong Journal of Paediatrics. 12 (2): 86–92. doi:10.1016/S1561-5413(08)60006-X. <a href="http://www.hkjpaed.org/pdf/2007;12;86-92.pdf" target="_blank">http://www.hkjpaed.org/pdf/2007;12;86-92.pdf</a> <a href="#fnref:18" class="footnote-back-ref">↩</a></li>
</ol>

Bubble CPAP open-in-new

Bubble CPAP