Group No: 06

LITERATURE REVIEW

DEVELOPMENT OF A CONTINUOUS POSITIVE AIRWAY PRESSURE DEVICE

By 060558U H.G.D.B.S.Wimalarathna

Department of Mechanical Engineering University of Moratuwa Sri Lanka 09th November 2009

DECLARATION I hereby state that this report contains no material which has been accepted for the award of any other academic qualification in any University or equivalent institution in Sri Lanka or abroad, and that to the best of my knowledge and belief, contains no material previously published or written by any other person, except where due reference is made in the text of this report.

---------------------------H.G.D.B.S. Wimalarathna

Date: 09.11.2009

--------------------------Dr. Hans Gray Project Advisor

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Abstract
Respiratory Distress Syndrome (RDS) is one of most common respiratory diseases that caused to die many premature infants. The babies born prematurely have not yet started making surfactant. Surfactant is a substance that helps keeps lungs open when breathing. As a treatment for the RDS, the continuous positive airway pressure (CPAP) device is used. However, the CPAP devices are also used for diseases called Obstructive Sleep Apnea (OSA). Airway of some people becomes blocked or collapses, while they are sleeping. This airway collapse causes a blockage, which can cause breathing to stop briefly. When breathing stops for a short time, it is known as OSA. The objective of this literature survey is to collect the information relating to the project, which is about the background

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Abbreviations

CPAP - Continuous positive airway pressure FIO2 RDS OSA IRV - Inspired oxygen concentration - Respiratory distress syndrome - Obstructive Sleep Apnoea - Inspiratory Reserve Volume

PEEP - Positive End Expiratory Pressure

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Content

Abstract.................................................................................................................ii Abbreviations......................................................................................................iii Content.................................................................................................................iv List of Figures......................................................................................................vi List of Tables......................................................................................................vii 1.0INTRODUCTION...........................................................................................1
1.1 BACKGROUND OF THE PROBLEM...........................................................................1 1.2 OBJECTIVES OF THE PROJECT..................................................................................2

2.0 BASIC OF THE RESPIRATORY SYSTEM.................................................3
2.1 RESPIRATORY PROCESS............................................................................................3 2.1.1 INSPIRATION..........................................................................................................3 2.1.2 EXPIRATION...........................................................................................................4 2.2 BALANCE BETWEEN INSPIRATION AND EXPIRATION(Swan, 2006).................4 2.2.1 FUNCTION OF THE ALVEOLI.............................................................................5 2.3 PRESSURE CHANGE DURING VENTILATION........................................................5

3.0 INTRODUCTION TO CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) .................................................................................................................6
3.1 VENTILATION...............................................................................................................6 3.1.1 MECHANICAL VENTILATION ...........................................................................7 3.1.2 NEGATIVE PRESSURE VENTILATION..............................................................8 3.1.3 POSITIVE PRESSURE VENTILATION................................................................8 3.3 DESEASES THAT ARE USED CPAP TREATMENT..................................................8 Respiratory distress syndrome (RDS)................................................................................8 3.3.1 RESPIRATORY DISTRESS SYNDROM (RDS)....................................................9 iv

3.3.1.1 ROLE OF SURFACTANT................................................................................9 3.3.1.2 TREATMENT FOR RDS(Stevens, 2009)......................................................10 3.3.1.3 CAUSES FOR THE PREMATURE BIRTH(Stevens, 2009)..........................11 3.3.2 OBSTRUCTIVE SLEEP APNOEA.......................................................................12

4.0 WHAT IS CPAP WHY CPAP.....................................................................14
4.1 HOW DOES CPAP WORK...........................................................................................15 4.2 THE CHALLENGE OF CPAP......................................................................................15 4.3 IMPORTANT OF THE HUMIDIFICATION DURING CPAP....................................16 4.4 HOW TO CHOOSE CPAP MASK...............................................................................16 4.5 BENIFIT OF THE CPAP(Canadian Lung Association, 2009)......................................17 4.6 WHAT ARE THE RISK OF CPAP(AMERICAN THORACIC SOCIETY, 2005)......18

5.0 CONCLUSION.............................................................................................18 Reference............................................................................................................19

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List of Figures

Figure 1.1 : CPAP Treatment (Narendran et al., 2003)........................................1 Figure 2.2 : Inspiration (SWAN, J. 2006. Page 42)..............................................3 Figure 2.3 : Expiration (SWAN, J. 2006. page 43)..............................................4 Figure 2.4 : Alveoli (SWAN, J. 2006.page 30)....................................................5 Figure 2.5 : Pressure change during ventilation (Swan, 2006).............................5 Figure 3.6 : Mechanical Ventilation.....................................................................6 Figure 3.7 : CPAP Treatment for poor baby.........................................................9 Figure 3.8 : CPAP treatment for OSA ...............................................................13 Figure 4.9 : Babylog CPAP................................................................................14 Figure 4.10 : Nasal CPAP...................................................................................14 Figure 4.11 : The soft, steady jet of air from the CPAP machine (Canadian Lung Association, 2009).....................................................................................15 Figure 4.12 : Full-face mask...............................................................................17 Figure 4.13 : Mask with nasal pillows................................................................17 Figure 4.14 : Nasal mask....................................................................................17

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List of Tables

Table 1 : Ventilation (SWAN, J. 2006. page 46)..................................................7 Table 2 : comparisons over two time periods(Narendran et al., 2003)......10

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1.0 INTRODUCTION Babies, who have born early 32 weeks, are called premature babies. After they are born, babies must breathe continuously to get oxygen. In a premature baby, the part of the central nervous system (Brain and Spinal cord), that controls breathing is not yet mature enough to allow nonstop breathing. When they are first born, many of these premature infants must get help breathing because their lungs are too immature to allow them to breathe on their own. Continuous positive airway pressure (CPAP) devises are used to help keeps a preemie’s lungs open. Therefore, he/she can breathe; however, the CPAP device does not provide breaths for the baby, so the baby breathes on his own.

Figure 1.1 : CPAP Treatment (Narendran et al., 2003)

1.1 BACKGROUND OF THE PROBLEM Continuous positive airway pressure (CPAP) treatment commonly used to treat breathing disorders of premature infants, including respiratory distress syndrome (RDS) and for patient who has Obstructive sleep apnoea. CPAP device continuously provides pressurised air or a mixture of air and oxygen to the entrance of a patient’s airway via an endotracheal tube (flexible plastic tube that is put in the mouth or nose) at a pressure elevated above
gm atmospheric pressure typically in range of 2.2 - 7.35 H m . The positive pressure causes the

gas to flow into the lungs with less effort and prevent the undesirable contracting in alveoli .The alveoli are tiny air sacs within the lungs where the exchange of oxygen and carbon dioxide takes place. 1

Over the years, many companies have developed several CPAP machines, which have the ability to supply the required air mixture at a predetermined pressure and an oxygen percentage. However, due to their high cost (In local market existing devices cost take around two million rupees). Therefore, they are in under affordable and are available only in a few of the main hospitals. In addition, the existing devices have been designed to operate by wall-mounted air and oxygen supplies, therefore these devices have to be kept inside an ICU. If the device were portable, enough so that it could use in an ambulance, the therapy could be followed while the patient is being carried. Besides, it could be used in normal wards making the ICU vacant for another patient Therefore, there is a higher demand for a low cost and portable CPAP device that can be used in the hospitals in Sri Lanka. The project's goal is to develop a prototype of a low-cost neonatal CPAP for poor countries that are more affordable to buy own, more easy to use and locally maintainable. 1.2 OBJECTIVES OF THE PROJECT

Design a low cost CPAP device with the following capabilities • • • • • Mix oxygen and air to a given ratio as determined by a physician Ability to set the flow rate of the mixture up to a limit of 15 litres per minute Supply the mixture at a pressure of 3 to 5 water centimetres Give warning if actual flow rate or pressure is outside set limits, the machine should also stop flow if these values can cause harm to the patient Has the ability to record the operating parameters over time

The device should be portable enough to be carried in an ambulance

In this literature review report, include concepts and information mainly relating to the medical background of the project. However, in first few topics gave you a brief introduction about the human respiratory system, which may be useful to understand the clearly medical terms and knowledge that are described throughout the report.

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2.0 BASIC OF THE RESPIRATORY SYSTEM The respiratory system main function is to admittance gases to all body cells; however, respiratory system facilitates removal of the carbon dioxide. The respiratory system is a group of organs and tissues. The main parts of this system are the airways, the lungs and linked blood vessels, and the muscles that enable breathing. Oxygen is essential for cells, which use this essential substance to release the energy needed for cellular activities. In addition to supplying oxygen, the respiratory system aids in removing of carbon dioxide, preventing the toxic build-up of this waste product in body tissues (A group of connected cells). “Day-in and day-out, without the prompt of conscious thought, the respiratory system carries out its life-sustaining activities.”(Swan, 2006) 2.1 RESPIRATORY PROCESS There are two parts in respiratory process. Which are called Inspiration (inhaling) and expiration (exhaling). During inspiration, the diaphragm contracts (Figure2.1), moves downward, and causes the thoracic cavity volume to increase. When the diaphragm relaxes the thoracic volume, decreases and the lungs partially deflate. This process is called expiration. 2.1.1 INSPIRATION In inspiration, air is moved into the lungs. The rib cage and the diaphragm (Figure 2.1) control their movements. The diaphragm contracts, this would cause to increase the volume of the thorax and lungs (West, 2008). Therefore, it is caused to decrease in pressure of lungs and air will get into the lungs.

Figure 2.2 : Inspiration (SWAN, J. 2006. Page 42)

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Inhalation is initiated by the diaphragm and supported by the external intercostals muscles. Normal human resting respirations are 10 to 18 breaths per minute, with a time-period of 2 seconds.(West, 2008) 2.1.2 EXPIRATION Exhalation is generally a passive process. The lungs have a natural elasticity, so the diaphragm get relaxes due to elasticity of the muscle tissue and of the lung stroma causes recoil that returns the lungs to their volume before inspiration (Figure 2.2). They recoil from the stretch of inhalation; airflows back out until the pressures in the chest and the atmosphere reach equilibrium. (West, 2008)

Figure 2.3 : Expiration (SWAN, J. 2006. page 43) 2.2 BALANCE BETWEEN INSPIRATION AND EXPIRATION(Swan, 2006) The tendency of the lungs to expand, called distension, is due to the pulling action applied by the pleural membranes (any thin layer of connective tissue coating individual cells and organs of the body). Expansion is also facilitated by the action of surfactant in preventing the collapse of the alveoli. This distension is force responsible for inspiration. The opposite tendency is called elasticity or recoil, and is the process by which the lungs return to their size before inspiration (Figure 2.1 & Figure 2.2). Recoil is due to the elastic stroma (the connective tissue that provides the framework of an organ) of the lungs and the series elastic elements of the respiratory muscles, particularly the diaphragm.

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The diaphragm is a dome-shaped muscle located below your lungs. It separates the chest cavity from the abdominal cavity. The diaphragm is the main muscle used for breathing. 2.2.1 FUNCTION OF THE ALVEOLI Alveoli are thin-walled chambers surrounded by capillaries for gas transport

(Figure2.3).There are about 300 million alveoli in the human lung, each about 1/3mm in diameter (if they are spheres).” In elastic fibers, part of the stroma of the lungs, provide support and elasticity (recoil) for the lungs.(Swan, 2006)

Figure 2.4 : Alveoli (SWAN, J. 2006.page 30)

2.3 PRESSURE CHANGE DURING VENTILATION During inspiration, the pressure inside the lungs (the intrapulmonary pressure) decreases
- 1 to - 3 H m gm

compared to the atmosphere (Gauge Pressure). However, this variation can compared to the atmosphere. (Swan, 2006)

vary with the depth of inspiration. During expiration, the intrapulmonary pressure increases
+1 to +3 H m gm

5 Figure 2.5 : Pressure change during ventilation (Swan, 2006)

3.0 INTRODUCTION TO CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) In modern, mechanical ventilation, systems are used to ventilate patient that have different kind of respiratory diseases. CPAP machines also one type of ventilation technique fall under the positive pressure ventilators. Continuous positive airway pressure devices help to breathe, which patient has respiratory diseases and need help to breathe. CPAP provides backpressure to prevent lungs from collapsing. Mainly CPAP are used to help the patient that suffered diseases called Respiratory Distress Syndrome (RDS) and Obstructive Sleep Apnoea (OSA).Here RDS occurs only in babies that caused by premature born. Ventilators

Positive Pressure Ventilation

Negative Pressure Ventilation

RDS CPAP Treatment OSA Figure 3.6 : Mechanical Ventilation 3.1 VENTILATION Ventilation is involved of two parts; inspiration and expiration. Each of these can be described as being either quiet, the process at rest, or forced, the process when active such as when exercising. If the volume of the gas increases, its pressure will decrease. If the volume decreases, its pressure will increase (Boyle's Law). (Swan, 2006) The movement of air in ventilation occurs because of the pressure gradient produced when the volume of the lungs increases or decreases. The following table describes the events, which produce this pressure gradient at different respiratory condition. Which mean either at normal or forced breathing conditions.

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Table 1 : Ventilation (SWAN, J. 2006. page 46) Inspiration Restful Diaphragm contracts volumes of thorax and lungs increase, pressures decrease: air flows inward along pressure gradient Forced Expiration Diaphragm relaxes, volumes of thorax and lungs decrease, pressures increase: air flows outward along pressure gradient

Additional muscles help to increase the Additional muscles aid in decreasing the volume of the thorax and lungs: scalene, volume of the thorax or in pushing the pectoral is minor, sternocleidomastoid diaphragm upward. (is a paired muscle in the superficial layers of the anterior portion of the neck. It acts to flex and rotate the head.)

3.1.1 MECHANICAL VENTILATION Mechanical ventilation is a life support treatment. A mechanical ventilator is a machine that helps people breathe when they are not able to breathe enough on their own. The mechanical ventilator is also called a ventilator, respirator, or breathing machine Ventilator machine generates a controlled flow of gas into a patient’s airways. Oxygen and air are received from cylinders or wall outlets, the gas is pressure reduced and blended according to the prescribed inspired oxygen tension (FiO2), accumulated in a receptacle within the machine, and delivered to the patient using one of many available modes of ventilation. Mechanical ventilation is often a life-saving intervention, but carries many potential complications including pneumothorax, airway injury, alveolar damage, and ventilatorassociated pneumonia(Ohio State University Medical, 2008). For this reason the pressure and volume of gas used is strictly controlled, and reduced as soon as possible. It can be used as a short-term measure for the operation or critical illness (setting of an ICU). It may be used at home or in a nursing institution if patients have chronic diseases that require long-term ventilator assistance. Mainly ventilators categorised into two types  Negative pressure ventilation  Positive pressure ventilation In our project of developing continuous positive airway pressure device is fall under the positive pressure ventilation type. 7

3.1.2 NEGATIVE PRESSURE VENTILATION In this machine, air is withdrawn mechanically to produce a vacuum inside the tank, to create negative pressure. This negative pressure leads to expansion of the chest, which causes a decrease in intrapulmonary pressure (pressure within the lungs), and increases flow of atmospheric air into the lungs. As the vacuum is released, the pressure inside the tank equalizes to that of the atmospheric pressure, and the elastic coil of the chest and lungs leads to passive exhalation. However, when the vacuum is created, the abdomen also expands along with the lung, cutting off venous flow back to the heart, leading to pooling of venous blood in the lower extremities.(Patrick Neligan. MD University of Pennsylvania, 2009) 3.1.3 POSITIVE PRESSURE VENTILATION The positive pressure ventilation is that gas flows along a pressure gradient between the upper airway and the alveoli. The operator determines the magnitude, rate and duration of flow. Flow is either volume targeted and pressure variable, or pressure target and volume variable. The pattern of flow may be either sinusoidal (which is normal), decelerating or constant. Flow is controlled by an array of sensors and microprocessors. Conventionally, inspiration is active and expiration is passive.(Patrick Neligan. MD University of Pennsylvania, 2009) In CPAP device pressure target and volume variable while, the pattern of the flow is constant. The pressure oscillates around zero or atmospheric pressure. The intrapleural (inner surface of the chest wall) pressure is always negative compared to the atmosphere. This is necessary in order to exert a pulling action on the lungs. The pressure varies from about -4 mmHg at the end of expiration, to -8 mmHg and the end of inspiration. Therefore CPAP device maintain the 2.2-3.6 mmHg positive pressure level.

3.3 DESEASES THAT ARE USED CPAP TREATMENT Mainly CPAP treatment are used for following diseases Respiratory distress syndrome (RDS) 1. Obstructive sleep apnoea (OSA)

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3.3.1 RESPIRATORY DISTRESS SYNDROM (RDS) About 23,000 babies were born before the 34th week of pregnancy in a year and suffer from these breathing problems with RDS. lack a protein called surfactant that keeps small air sacs in the lungs from collapsing.(March of Dimes Foundation, 2009) Hundreds of thousands of newborns die every year in the world, because they cannot get enough air into their lungs (respiratory distress). Premature infants lack surfactant (surfactant is a substance that helps keeps lungs open when breathing) in their lungs, a soap-like coating that prevents the interior of the alveoli from sticking together. “Even if neonates are mature enough to have the surfactant, infections and TTN (transient tachypnea of the newborn aka "wet lungs"--fluid in the lungs due to delayed clearance/resorption of fetal lung fluid) lead to a condition where newborns need respiratory assistance.” (Schmid et al., 1976)

Figure 3.7 : CPAP Treatment for poor baby 3.3.1.1 ROLE OF SURFACTANT “Many babies born prematurely have not yet started making surfactant. Surfactant is a substance that helps keeps lungs open when breathing.” (Stevens, 2009)

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3.3.1.2 TREATMENT FOR RDS(Stevens, 2009)  RDS is treated with artificial surfactant.  Baby can be given oxygen with a nasal cannula, or a CPAP (continuous positive airway pressure) keeps alveoli from collapsing. This may be used with or without supplemental oxygen.  Ventilation does work of breathing-ventilator used until baby’s lungs are making surfactant and baby is strong enough to breathe.  Long-term effects - Increased sensitivity to lung irritants, increased risk of

respiratory infections, lung damage. Treatment with surfactant helps affected babies breathe more easily. Since treatment with surfactant was introduced in 1990, deaths from RDS have been reduced by about half .A provider may suspect a baby has RDS if she is struggling to breathe. (March of Dimes Foundation, 2009) In following table represent that the use of CPAP treatment for the premature infant make the way to live.

Table 2 : comparisons over two time periods(Narendran et al., 2003) Number of admission Mean gestational age (weeks) Mean birth weight (g) Female (%) White (%) Mortality (%) Age at full enteral feeds (days) ICH (grades 3&4) (%) PDA (%) NEC (%) Mean weight at 36 weeks (g) Mean length at 36 weeks (cm) Mean head circumference at 36 weeks (cm) Before CPAP 92 26 763 46 54 38 24 9.8 33.7 12 1917 41.5 31 After CPAP 79 26 753 54 58 34 18 6.3 44.3 8.9 2134 42.2 31.6

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Along with surfactant treatment, babies with RDS may need additional oxygen and mechanical breathing assistance to keep their lungs expanded. They may need the support of a ventilator or they may receive treatment called continuous positive airway pressure. CPAP delivers pressurized air to the baby’s lungs through small tubes in the baby’s nose or through a tube that has been inserted into his windpipe(March of Dimes Foundation, 2009). CPAP helps a baby breathe, but it does not breathe for him. The sickest babies may need the help of a ventilator to breathe for them while their lungs mature. Very sick babies might be put on a “high frequency oscillatory ventilator.” This ventilator inflates and deflates baby’s lungs like a set of billows, the oscillator keeps the lungs open with a constant positive end-expiratory pressure (PEEP) and vibrates air at a very high rate (up to 600 times/second). The vibration helps gases to diffuse quickly in and out of baby’s airways without need for “bellows” action, which may damage delicate lung structure. (Stevens, 2009) 3.3.1.3 CAUSES FOR THE PREMATURE BIRTH(Stevens, 2009) The latest research suggests that many cases are caused by the body’s natural response to certain infections, including those involving amniotic fluid and fetal membranes. However, in about half of all cases of premature birth, providers cannot determine why a woman delivered prematurely. Any woman can give birth prematurely, but some women are at greater risk than others are. Researchers have identified some risk factors, but providers still cannot predict which women will deliver prematurely.

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Three groups of women are at greatest risk for premature birth: 1. Women who have had a previous premature birth 2. Women who are pregnant with twins, triplets or more 3. Women with certain uterine or cervical abnormalities Certain lifestyle factors may put a woman at greater risk for preterm labor. These include:  Smoking  Drinking alcohol  Using illegal drugs  Exposure to the medication  Lack of social support  Extremely high levels of stress Certain medical conditions during pregnancy also may increase the likelihood that a woman will have preterm labor. These include: Infections (including urinary tract, vaginal, sexually transmitted and other infections)  High blood pressure  Obesity  Clotting disorders  Non-Hispanic black race  Younger than age 17, or older than age 35 (Canadian Lung Association, 2009)

3.3.2 OBSTRUCTIVE SLEEP APNOEA Air passages of the nose and the throat of some people, becomes blocked or collapse, while they are sleeping. This airway collapse causes a blockage, which can cause breathing to stop briefly. When breathing stops for a short time, it is known as apnoea(Ohio State University Medical, 2008). Apnoea is a serious condition and needs to be treated. CPAP is the most common treatment for obstructive sleep apnoea. This condition is diagnosed by doing a sleep study. CPAP is used to keep the airway open while you sleep. A small air blower in the CPAP machine pushes air through a flexible tube. The tube attaches to a mask that fits over your nose, or nose and mouth while you sleep (Figure 3.3). The constant flow of air through 12

the tubing prevents the air passages in your nose and throat from collapsing so your breathing does not stop.

Figure 3.8 : CPAP treatment for OSA

Premature babies sometimes stop breathing for 20 seconds or more. This interruption in breathing is called apnoea, and it may be accompanied by a slow heart rate. Premature babies are constantly monitored for apnoea. If the baby stops breathing, a nurse stimulates the baby to start breathing by patting him or touching the soles of his feet. Nasal CPAP is currently the best treatment for severe obstructive sleep apnoea. CPAP is safe and effective, even in children. Tissues are prevented from collapsing during sleep, and apnoea is effectively prevented without surgical intervention. Daytime sleepiness improves or resolves. Heart function and hypertension also improve.(MedicineNet, 2009) At first, CPAP patients should be monitored in a sleep lab to determine the appropriate amount of air pressure for them. The first few nights on CPAP tend to be difficult, with patients experiencing less sleep. Many patients at first find the mask cumbersome, claustrophobic or embarrassing. CPAP is not a cure and must be used every night for life. Non-compliant patients experience a full return of obstructive sleep apnoea and related attribute.(MedicineNet, 2009) Therefore, this CPAP treatment is used for both diseases called Respiratory Distress Syndrome, which caused the premature born, and Obstructive Sleep Apnoea.

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4.0 WHAT IS CPAP WHY CPAP As described above CPAP is a device that helps to breathe and does not breathe machine for the patient. CPAP provides backpressure to prevent premature infant lungs from collapsing treatment is typically necessary for a day or two, after which newborns can breathe on their own infants with severe respiratory distress, are put on a ventilator without a CPAP machine, an estimated 30% of the babies with respiratory distress will choke. (Schmid et al., 1976)

Figure 4.9 : Babylog CPAP

Figure 4.10 : Nasal CPAP 14

Most pregnancies last around 40 weeks. Babies born between 37 and 42 completed weeks of pregnancy are called full term. Babies born before 37 completed weeks of pregnancy are called premature. Premature birth is a serious health problem. Premature babies are at increased risk for newborn health complications, such as breathing problems, and even death. Most premature babies require care in a newborn intensive care unit (NICU), which has specialized medical staff and equipment that can deal with the multiple problems faced by premature infants. (Stevens, 2009) .

4.1 HOW DOES CPAP WORK The CPAP machine delivers a constant flow of air through tubing and a mask and into patient airway (Figure 4).The CPAP machine creates enough pressure in your airway to hold the tissue open, so your airway does not collapse. CPAP is a treatment, not a cure.(Canadian Lung Association, 2009)

Figure 4.11 : The soft, steady jet of air from the CPAP machine (Canadian Lung Association, 2009) 4.2 THE CHALLENGE OF CPAP A typical CPAP designed for the domestic market costs is around two million Rupees, and uses hundreds of dollars in disposable parts for each patient. Cost is a key design constraint, not just the purchase price but also the "cost of ownership" (product consumables and maintenance). It is also necessary to consider the local resource constraints, the supply chain

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for replacement parts, the provision of training for users, and the demands of a harsh environment. The project's goal is to develop a prototype of a low-cost neonatal CPAP for poor countries that is more affordable to buy more intuitive to use and locally maintainable. 4.3 IMPORTANT OF THE HUMIDIFICATION DURING CPAP Introduced in 1981, nasal continuous positive airway pressure (nCPAP) therapy has since become the treatment of choice for obstructive sleep apnoea (OSA). However, nCPAP therapy may be associated with a number of side effects, which, in some cases, may result in a considerable decline of treatment compliance. The most common side effect, which occurs in 30–66% of all patients undergoing nCPAP, is upper airway drynests(Wiest et al., 2002). To deal with this situation, the use of a heated humidifier (HH) system integrated in the tube system between the CPAP device and the nasal mask has been recommended. Scientific studies carried out in recent years have shown that dryness of the mouth, nose and throat can be effectively prevented in this way, thus improving compliance .The question now arises as to whether general prophylactic use of HH during CPAP treatment may be of benefit to the patient.(Wiest et al., 2002) One of the predictors of initial treatment refusal is discomfort during the initiation phase of CPAP therapy; hence, the initiation phase should be made as comfortable as possible for the patient. Theoretical benefits of HH use during the initiation phase of CPAP therapy include improved patient comfort; an improved initial acceptance of the therapy should be the result. However, before HH can be recommended for prophylactic use in clinical routine, the hypothesis needs to be tested in clinical trials. Thus, the aim of the present study was to investigate whether, during the initiation phase of CPAP treatment in the sleep laboratory, prophylactic HH would result in improved initial patient comfort and acceptance. (Wiest et al., 2002) 4.4 HOW TO CHOOSE CPAP MASK The key to using CPAP successfully is a good mask fit. Your mask needs to be comfortable. When you are selecting a mask, pick one that feels comfortable as soon as you put it on. There are several kinds of CPAP mask on the market:  Nasal mask 16

 Masks with nasal pillows or cushions  Full face masks  Masks for children

Figure 4.12 : Full-face mask Figure 4.13 : Mask with nasal pillows

Figure 4.14 : Nasal mask

4.5 BENIFIT OF THE CPAP(Canadian Lung Association, 2009)  Keep your airways open while you sleep  Correct snoring so others in your household can sleep  Improve the quality of your sleep  Relieve symptoms of sleep apnea, such as excessive daytime sleepiness  Decrease or prevent high blood pressure 17

4.6 WHAT ARE THE RISK OF CPAP(AMERICAN THORACIC SOCIETY, 2005)  Infections

Feed tube allows germs (bacteria) to get into the lungs more easily. This can cause an infection like pneumonia

 Collapsed lung (pneumothorax)

The lung that is weak can become too full of air and start to leak. The leak lets air get into the empty space between the lung and the chest wall. Air in this space takes up room so the lung starts to collapse.

 Lung damage

The pressure of putting air into the lungs with a ventilator can damage the lungs. Doctors try to keep this risk at a minimum by using the lowest amount of pressure that is needed.

According to the above information, it can be conclude that development of a CPAP is not easy one. It is needed to consider about the patient safety and comfort ability, while developing the CPAP for premature infants.

5.0 CONCLUSION Continuous positive airway pressure (CPAP) devices commonly used to treat breathing disorders of premature infants, including respiratory distress syndrome (RDS) and for patient who has Obstructive Sleep Apnoea. CPAP device continuously provides pressurised air or a mixture of air and oxygen to the entrance of a patient’s airway via an endotracheal tube (flexible plastic tube that is put in the mouth or nose) at a pressure elevated above
gm atmospheric pressure typically in range of 2.2 - 7.35 H m . The positive pressure causes the

gas to flow into the lungs with less effort and prevent the undesirable contracting in alveoli. 18

Finally it can be conclude that CPAP devices has been used primarily to treat surfactant deficiency in preterm infants for much years and still it has been developing. In our project particularly focuses on its potential role to reduce brawbacks , cost value and make comfortable one for patient.

Reference

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