AW Flemmer Krakau 2013 Non Non- invasive invasive Ventilation Ventilation Krakau 2013 Krakau 2013 A.W. Flemmer Div. Div. Neonatology Neonatology, , Children Children‘s Hospital and Perinatal Center, s Hospital and Perinatal Center, LM LM-University Munich, Germany University Munich, Germany AW Flemmer Krakau 2013 • Increased and stabilized lung volume • Stabilized „soft“ thorax of the neonate → reduced work of breathing • …. • Decreased airway resistance • Surfactant „restitution“ • Reduced left-right shunting across patent ductus botalli Physiological effects of CPAP - potential benefits AW Flemmer Krakau 2013 Rees et al. J Rees et al. J Neuropath Neuropath and and Exp Exp Neurol Neurol, June 2009 , June 2009 Extubation to nCPAP after 24 hrs Extubation to nCPAP after 5 days nCPAP & Surfactant: „beyond the lung“ AW Flemmer Krakau 2013 • CPAP-induced overdistention of the lung, inverted diaphragm → impaired exspiration • Airleak / pneumothorax • ET tube and airway- obstruktion • Overdistention → reduced venous return → reduced cardiac output • .... Physiological effects of CPAP - potential harms AW Flemmer Krakau 2013 CPAP CPAP systems nasal ET tube nasal prongs nasal cannula ..... Flow-generator: •Ventilator • cont. flow • demand flow •Bubble-CPAP •Medijet •Infant-flow •... Pressure-generator: expir.-valve surge chamber ... Interface: Hudson prongs Argyle prongs Buenavista Fluid flip device ... AW Flemmer Krakau 2013 nCPAP - Failure
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AW Flemmer Krakau 2013
NonNon --invasiveinvasive VentilationVentilation
Krakau 2013Krakau 2013
A.W. Flemmer
Div. Div. NeonatologyNeonatology , , ChildrenChildren ‘‘s Hospital and Perinatal Center,s Hospital and Perinatal Center,LMLM--University Munich, GermanyUniversity Munich, Germany
AW Flemmer Krakau 2013
• Increased and stabilized lung volume
• Stabilized „soft“ thorax of the neonate→→→→ reduced work of breathing
• ….
• Decreased airway resistance
• Surfactant „restitution“
• Reduced left-right shunting across patent ductus botalli
Physiological effects of CPAP - potential benefits
AW Flemmer Krakau 2013
Rees et al. J Rees et al. J NeuropathNeuropath and and ExpExp NeurolNeurol , June 2009, June 2009
Extubation to nCPAPafter 24 hrs
Extubation to nCPAPafter 5 days
nCPAP & Surfactant:„beyond the lung“
AW Flemmer Krakau 2013
• CPAP-induced overdistention of the lung, inverted diaphragm →→→→ impaired exspiration