scholarly journals Custom-Fit Three-Dimensional-Printed BiPAP Mask to Improve Compliance in Patients Requiring Long-Term Noninvasive Ventilatory Support

2018 ◽  
Vol 12 (3) ◽  
Author(s):  
Ying Ying Wu ◽  
Deepshikha Acharya ◽  
Camilla Xu ◽  
Boyle Cheng ◽  
Sandeep Rana ◽  
...  
Keyword(s):  
Computer Aided Design ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Neuromuscular Disorders ◽  
Ventilatory Support ◽  
Three Dimensional ◽  
Respiratory Muscles ◽  
Number Of Patients ◽  
Improve Compliance ◽  
Rigid Interface

Noninvasive ventilator support using bi-level positive airway pressure/continuous positive airway pressure (BiPAP/CPAP) is commonly utilized for chronic medical conditions like sleep apnea and neuromuscular disorders like amyotrophic lateral sclerosis (ALS) that lead to weakness of respiratory muscles. Generic masks come in standard sizes and are often perceived by patients as being uncomfortable, ill-fitting, and leaky. A significant number of patients are unable to tolerate the masks and eventually stop using their devices. The goal of this project is to develop custom-fit masks to increase comfort, decrease air leakage, and thereby improve patient compliance. A single-patient case study of a patient with variant ALS was performed to evaluate the custom-fit masks. His high nose bridge and overbite of lower jaw caused poor fit with generic masks, and he was noncompliant with his machine. Using desktop Stereolithography three-dimensional (3D) printing and magnetic resonance imaging (MRI) data, a generic mask was extended with a rigid interface such that it was complementary to the patient's unique facial contours. Patient or clinicians interactively select a desired mask shape using a newly developed computer program. Subsequently, a compliant silicone layer was applied to the rigid interface. Ten different custom-fit mask designs were made using computer-aided design software. Patient evaluated the comfort, extent of leakage, and satisfaction of each mask via a questionnaire. All custom-fit masks were rated higher than the standard mask except for two. Our results suggest that modifying generic masks with a 3D-printed custom-fit interface is a promising strategy to improve compliance with BiPAP/CPAP machines.

Bronchomalacia in the Neonate

1985 ◽  
Vol 94 (5) ◽  
pp. 466-469 ◽  
Author(s):  
James C. Denneny
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Neuromuscular Disorders ◽  
Ventilatory Support ◽  
Neuromuscular Disorder ◽  
Operative Intervention ◽  
Respiratory Assistance

Congenital bronchomalacia is a disease typically associated with infants between 1 and 12 months of age; cases in children less than 1 month of age are rare. Bronchomalacia is commonly associated with tracheomalacia and rarely warrants operative intervention. Three cases of bronchomalacia are presented, including two unusual cases of bronchomalacia associated with neuromuscular disorder, one complicated by hypotonia. These patients required ventilatory support in the form of continuous positive airway pressure to prevent lobar collapse. Following tracheobronchial and neuromuscular maturation, these infants were able to be weaned from respiratory assistance without further sequelae. Bronchomalacia is discussed, the literature reviewed, and the standard therapies presented. The results indicate a possible relationship between neuromuscular disorders and respiratory collapse.

scholarly journals The frequency of nasal injury in newborns due to the use of continuous positive airway pressure with prongs

2009 ◽  
Vol 17 (4) ◽  
pp. 489-494 ◽  
Author(s):  
Renata Medeiros do Nascimento ◽  
Anne Laura Costa Ferreira ◽  
Ana Cláudia Ferreira Pinheiro Coutinho ◽  
Regina Célia Sales Santos Veríssimo
Keyword(s):  
Risk Factor ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Ventilatory Support ◽  
Convenience Sample ◽  
Nasal Injury

Continuous positive airway pressure (CPAP) with prongs is the ventilatory support most used in newborns. Nasal injuries are complications that may arise due to the prolonged use of this device. This study aimed to determine the frequency of nasal injuries in newborns through the use of continuous positive airway pressure with prongs. A convenience sample composed of hospitalized newborns using prongs for more than two days was used. Data were collected through a structured form. Lesions were observed in all newborns, which were classified as: mild (79.6%), moderate (19.7%) and severe (0.7%). The conclusion is that the use of prongs for more than two days represents a risk factor for the lesions to develop.

scholarly journals The role of Continuous Positive Airway Pressure (CPAP) in Delaying or Avoiding Mechanical Ventilation in COVID-19 Respiratory Failure: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Allan Cameron ◽  
Sharif Fattah ◽  
Laura Knox ◽  
Pauline Grose
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Support ◽  
Royal Infirmary ◽  
High Dependency ◽  
Number Of Patients

Abstract Background - During the winter of 2020-2021, the second wave of the COVID19 pandemic in the United Kingdom caused increased demand for intensive care unit (ICU) beds, and in particular, for invasive mechanical ventilation (IMV). To alleviate some of this pressure, some centres offered non-invasive continuous positive airway pressure (CPAP), delivered on specialised COVID high dependency units (cHDUs). However, this practice was based largely on anecdotal reports, and it is not clear from the literature how effective CPAP is at delaying or preventing IMV. Methods - This was a retrospective observational cohort study of consecutive patients admitted to a specialised cHDU at Glasgow Royal Infirmary between November 2020 and February 2021. Each patient had a continuous record of the level of respiratory support required, and was followed up to hospital discharge or death. We examined patient outcomes according to age, sex and maximum level of respiratory support, using logistic regression and time-to-event analysis. The number of patients who could not be oxygenated by standard oxygen facemask but could be oxygenated by CPAP was counted and compared to the number of patients admitted to ICU for IMV over the same period.Results - There were 152 admissions to cHDU over the study period. Of these, 125 received CPAP treatment. Of the patients who received support in cHDU, the overall mortality rate was 37.9% (95% CI 30.3% - 46.1%)). Odds of mortality were closely correlated with increasing age and oxygen requirement. Of the 152 patients, 44 patients (28.8%, 95% CI 22.0 – 36.9%) went on to require IMV in ICU. This represents 77.2% of the 57 COVID-19 admissions to ICU during the same period. However, there were also 41 patients who received levels of respiratory support on cHDU which would normally necessitate ICU admission but who never went to ICU, potentially reducing ICU admissions by 41.8% (95% CI 32.1 – 52.2%).Conclusion - Providing respiratory support in cHDU reduced the number of potential ICU admissions by 41.8%, as well as delaying IMV for over 75% of ICU admissions. This represents a significant sparing of ICU capacity at a time when IMV beds were in high demand.

Discrepancy in the physical dimensions of nose and continuous positive airway pressure (CPAP) interface: a possible reason for high rates of nasal injury in Indian neonates

2020 ◽  
Vol 7 (1) ◽  
pp. 33-39
Author(s):  
Jagjit Singh Dalal ◽  
Sanketh Kumar Ajmera ◽  
Kanika Prajapat ◽  
Tanushree Sahoo ◽  
Chander Prakash Yadav ◽  
...  
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Neonatal Intensive Care ◽  
Positive Airway Pressure ◽  
Three Dimensional ◽  
Cross Sectional Study ◽  
High Rate ◽  
Cross Sectional ◽  
Weight Category ◽  
Nasal Injury

BackgroundProperly fitting continuous positive airway pressure (CPAP) interface is critical to the efficacy and safety of nasal CPAP therapy in preterm. Unfortunately, there is a perception that CPAP interfaces being used in Indian neonatal intensive care units do not fit well and cause a high rate of nasal injury.ObjectivesTo determine the nasal anthropometric dimensions in preterm (<35 weeks) Indian neonates and compare them with those of commercially available CPAP interfaces.MethodsIn this cross-sectional study, relevant anterior nasal parameters were measured by three dimensional imaging in 32 preterm newborn (26+0–34+6 weeks) and compared with commercially available 17 short binasal CPAP prongs of multiple sizes made by five manufacturers. Dimensions for best-suited interfaces were generated for Indian neonates.ResultsThe mean (SD) gestation and birth weight of enrolled neonates were 30.6 (3.0) weeks and 1338 (575) g, respectively. The inter prong distance was narrower than the upper bound of the 95% CI of the columellar width in Hudson type CPAP interfaces in <1250 g weight category with discrepancy in measurement varying from 0.2 to 0.5 mm and 0.9–1.4 mm at midpoint and base of columella, respectively. Similarly, the lower bound of 95% CI of the distance between the lateral walls of the nostrils was narrower than the width of the prongs by 1–3 mm.ConclusionsThere is mismatch between nasal prongs and nose dimension of Indian neonates resulting in possible erosion of columella and distension of nostrils.

Respiratory therapy techniques

2011 ◽  
Author(s):  
Carl Waldmann ◽  
Neil Soni ◽  
Andrew Rhodes
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Prone Position ◽  
High Frequency ◽  
Airway Pressure ◽  
Oxygen Therapy ◽  
Positive Airway Pressure ◽  
Ventilatory Support ◽  
High Frequency Ventilation ◽  
Frequency Ventilation ◽  
Positive Airway Pressure Ventilation

Oxygen therapy 2Ventilatory support: indications 6IPPV—description of ventilators 8IPPV—modes of ventilation 10IPPV—adjusting the ventilator 12IPPV—barotrauma 14IPPV—weaning techniques 16High-frequency ventilation 18Positive end-respiratory pressure 22Continuous positive airway pressure ventilation (CPAP) 24Recruitment manoeuvres 26Prone position ventilation 28...

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