Page 42 - Physiological based CPAP for preterm infants at birth Tessa Martherus

Chapter 1
Although the facemask is the commonly used in the delivery room, it might influence the breathing pattern by stimulating the trigeminal nerve. All studies investigating interfaces were predominantly focused on PPV, it is unclear whether these results are also applicable during CPAP support for spontaneous breathing. Further research investigating the interaction between the interface and infant’s physiology during the transition to spontaneous breathing is warranted to improve the success of non-invasive ventilation in the delivery room.
Conclusion
Non-invasive PPV is often administered to very premature infants who breathe insufficiently at birth, however this is often inadequate and can be injurious to the immature lung and brains. The need for PPV could be avoided by optimising spontaneous breathing with CPAP. Currently, there is heterogeneity in its use in clinical practice and to date available data on physiology underpinning non-invasive respiratory support has been generated in preclinical settings. These experiments highlight that starting with initial high level CPAP promote lung aeration but should be decreased hereafter to support spontaneous breathing and minimise risk of lung and brain injury. New preclinical studies focussing on CPAP strategies enlarge the knowledge of the underlying physiology and provide a fundamental base for clinical CPAP studies in the delivery room. The most effective way to apply CPAP also remains unclear: the clinical relevance of performed bench tests are not known and interfaces have only been compared when delivering PPV. Studies are currently focused on novel devices reducing the WOB, but future studies should also compare the effect of different CPAP delivering devices and interfaces that are already in use in the delivery room.
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