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Nasal CPAP Protocols

Continuous Positive Airway Pressure (CPAP) is a machine that provides air to a patient through the use of nasal prongs. This air delivery system is most often used for obstructive sleep apnea, congestive heart failure and in newborns who require additional oxygen. CPAP works by providing continuous air into the nose. According to slideshare, CPAP was first used in the 1940s, originally in hospitals as critically ill patients were weaning off mechanical ventilation. The first use was via full-face mask or endotracheal tube. In the early 1980s, a nasal mask was devised and the first home use for obstructive sleep apnea was prescribed.

  1. Obstructive Sleep Apnea

    • CPAP is the most widely used treatment for obstructive sleep apnea. CPAP's constant airflow into the nose alleviates obstructions and stimulates normal breathing. The treatment is safe for all ages. Typical protocol for obstructive sleep apnea patients is for professional monitoring to take place overnight in a sleep lab, typically housed in a hospital. The sleep lab study measures the severity of sleep apnea and appropriate CPAP dosage. When results and dosage are determined, the patient receives a CPAP machine. Because the machine is somewhat bulky on the face and can cause discomfort or embarrassment, patients usually take a few nights to become accustomed to it. However, the better sleep that CPAP provides due to easier breathing, lack of snoring and less waking up make using the machine extremely beneficial. CPAP does not cure obstructive sleep apnea and must be used every night, as lack of usage causes return of symptoms.

    Congestive Heart Failure

    • Typically congestive heart failure patients who use CPAP also suffer obstructive sleep apnea. CPAP in the treatment of congestive heart failure is a newer use, first introduced in 1989, when researchers discovered that the therapy was responsible for increasing the left ventricular ejection fraction in the heart. A high ejection fraction is a good predictor that sudden cardiac death will not occur. CPAP also provides other benefits to the heart, such as reduced mitral regurgitation and lowered levels of the amino acid known as atrial natriuretic peptide and the catecholamine norepinephrine, both of which are vital for healthy heart function. The CPAP protocol for congestive heart failure is the same as for obstructive sleep apnea, with the patient being monitored overnight in a sleep lab to determine the appropriate dose. As with treatment for obstructive sleep apnea by itself, patients must wear the device every night to see long-term benefits.

    CPAP in Infants

    • CPAP is standard treatment for infants who are born at less than 34 weeks' gestation. These newborns almost all experience recurrent episodes of apnea and are universally treated with CPAP. Two nasal methods can be used for babies: nasal prongs or bubble CPAP, which covers the entire nose with the plastic tubing. Both methods are prepared by a respiratory therapy team. Infants are given CPAP at 70 percent oxygen. At the time of the infant's delivery, the equipment and oxygen blenders are prepared and oxygen flow is adjusted. The humidifier in the CPAP is filled with 5 cm of water and tested for appropriate flow against the palm of the hand. The neonatal team follows resuscitation protocol as per hospital standards, warms the infant, positions the head and suctions the airway. The infant is then dried and stimulated to breathe, then repositioned for CPAP. The CPAP is also used to treat infants who have recently been extubated or who are suffering from respiratory distress. General indications for the use of the device include increased work of breathing, poorly expanded lungs on chest x-ray, atelectasis (collapsed lung), pulmonary edema or hemorrhage, apnea, extubation, tracheomalacia (weakness of the trachea) or other airway deficiency and phrenic nerve palsy (paralysis of the diaphragm).

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