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Preventing Continuous Positive Airway Pressure Failure

Clyde J. Wright, Laurie G. Sherlock, Rakesh Sahni, Richard A. Polin
2018 Clinics of Perinatology  
Synopsis Routine use of continuous positive airway pressure (CPAP) to support preterm infants with respiratory distress is an evidenced based strategy to decrease the incidence of bronchopulmonary dysplasia (BPD). However, rates of CPAP failure remain unacceptably high (50-60%) in very premature neonates (< 26 weeks' gestation), who are at high risk for developing BPD. Here, using the GRADE framework to assess the quality of available evidence, we review strategies aimed at decreasing CPAP
more » ... ecreasing CPAP failure, starting with delivery room interventions and followed through to system-based efforts in the NICU. Despite best efforts, some very premature neonates will fail CPAP. Correctly identifying those neonates early will allow targeted interventions including surfactant and mechanical ventilation. We review predictors of CPAP failure in this vulnerable population. Keywords CPAP (continuous positive airway pressure); nCPAP (nasal CPAP); BPD (bronchopulmonary dysplasia); ventilatory-induced lung injury; SLI (sustained lung inflation); INSURE (INtubate, SURfactant, Extubate); RCT (randomized controlled trial); mechanical ventilation; IFD (infant flow driver)
doi:10.1016/j.clp.2018.01.011 pmid:29747887 pmcid:PMC5953203 fatcat:3mtaihctavaz5gwoebyo2riwkq