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Continuous Positive Airway Pressure

Continuous positive airway pressure (CPAP) is a mode of noninvasive respiratory support that provides a continuous distending pressure throughout the respiratory cycle to spontaneously breathing patients.

CPAP is a well-established treatment that has been in use in clinical practice for more than 40 years.^1-3

CPAP is an accepted alternative to routine intubation and invasive ventilation in preterm infants with respiratory distress syndrome^4,5 and is the preferred initial method of providing noninvasive respiratory support.⁶

How does CPAP therapy work?

CPAP therapy delivers a mixture of heated and humidified air and oxygen and generates a continuous distending pressure throughout the respiratory cycle by means of a sealed interface.^7,8

There are different methods of delivering CPAP therapy, such as bubble CPAP, variable flow CPAP, and ventilator-derived CPAP. Bubble CPAP is a simple and economical mode of delivering CPAP in neonates, including those born preterm and those with a low birth weight.^8,9

There are multiple benefits in providing a continuous distending pressure such as splinting the upper airway, maintaining lung expansion, preventing end-expiratory alveolar collapse and conservation of surfactant.⁷

Key mechanisms and benefits of CPAP therapy are:

Infant residual capacity

Maintains functional residual capacity (FRC)

CPAP can enhance lung volume recruitment and establish and maintain FRC,^11,12 helping to keep the lungs open.

CPAP reduces work of breathing

Reduces the work of breathing

CPAP has been shown to elevate end-expiratory lung volume, which helps to unload the inspiratory muscles and reduce the energy required to expand the lungs for breathing.^11,13,14

Learn more about CPAP Therapy

CPAP Mechanical Ventilation for infants

Decreases the need for mechanical ventilation

The use of CPAP alone, or CPAP in combination with surfactant when used as primary respiratory support has been associated with a reduced need for intubation and invasive ventilation.^15,16

Bubble CPAP Generator

Bubble CPAP system

Fisher & Paykel Healthcare offers a system to deliver bubble CPAP, including circuits, pressure relief manifold, and bubble CPAP generator.

Bubble CPAP Generator

Flexitrunk interface for CPAP therapy

FlexiTrunk™ interface

The Flexitrunk interface is an integrated solution that includes all the components such as nasal masks, nasal prongs, bonnets and headgear for delivering CPAP therapy.

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1. Gregory, G. A., Kitterman, J. A., Phibbs, R. H., Tooley, W. H., & Hamilton, W. K. Treatment of the idiopathic respiratory-distress syndrome with continuous positive airway pressure. N. Engl. J. Med. 284, 1333–1340 (1971).
2. Avery, M. E. et al. Is chronic lung disease in low-birth-weight infants preventable? A survey of eight centers. Pediatrics 79, 26–30 (1987).
3. Wung, J. T., Driscoll, J. M., Epstein, R. A., & Hyman, A. I. A new device for CPAP by nasal route. Crit. Care Med. 3, 76–78 (1975).
4. De Paoli, A. G. Nasal CPAP for neonates: what do we know in 2003? Arch. Dis. Child. - Fetal Neonatal Ed. 88, 168F–172 (2003).
5. Morley, C. & Davis, P. Continuous positive airway pressure: current controversies. Curr. Opin. Pediatr. 16, 141–145 (2004).
6. Sweet, D. G. et al. European consensus guidelines on the management of respiratory distress syndrome – 2019 update. Neonatology 115, 432–450 (2019).
7. Gupta, S. & Donn, S. M. Seminars in Fetal and Neonatal Medicine Continuous positive airway pressure: Physiology and comparison of devices. Semin. Fetal Neonatal Med. 21, 204–211 (2016).
8. Courtney, S. E. & Barrington, K. J. Continuous positive airway pressure and noninvasive ventilation. Clin. Perinatol. 34, 73–92, vi (2007).
9. Alessi, S. Evidence Regarding the Use of Bubble Continuous Positive Airway Pressure in the Extremely Low Birth-Weight Infant: Benefits, Challenges, and Implications for Nursing Practice. Adv. Neonatal Care 18, 199–207 (2018).
10. Martin, S., Duke, T., & Davis, P. Efficacy and safety of bubble CPAP in neonatal care in low- and middle-income countries: a systematic review. Arch. Dis. Child. Fetal Neonatal Ed. 99, F495-504 (2014).
11. Magnenant, E. et al. Dynamic behavior of respiratory system during nasal continuous positive airway pressure in spontaneously breathing premature newborn infants. Pediatr. Pulmonol. 37, 485–491 (2004).
12. Bhutani, V. K. Development of the Respiratory System. In Manual of Neonatal Respiratory Care 3–15 (Springer US, 2012). doi:10.1007/978-1-4614-2155-9_1
13. Diblasi, R. M. Nasal continuous positive airway pressure (CPAP) for the respiratory care of the newborn infant. Respir. Care 54, 1209–1235 (2009).
14. Higgins, R. D., Richter, S. E., & Davis, J. M. Nasal continuous positive airway pressure facilitates extubation of very low-birth-weight neonates. Pediatrics 88, 999–1003 (1991).
15. Finer, N. N. et al. Early CPAP versus surfactant in extremely preterm infants. N. Engl. J. Med. 362, 1970–1979 (2010).
16. Tooley, J. & Dyke, M. Randomized study of nasal continuous positive airway pressure in the preterm infant with respiratory distress syndrome. Acta Paediatr. 92, 1170–1174 (2003).

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