The Science Journal of the American Association for Respiratory Care

2001 OPEN FORUM Abstracts

Evaluationof Complications Caused by Conventional and Fluidic Nasal CPAP in the NICU:An Observational Study

Kathleen Deakins RRT,Steven Clark RRT, Timothy Myers BS RRT, RobertChatburn RRT FAARC. Rainbow Babies & Children' s Hospital. Cleveland, Oh.

Introduction: NasalCPAP is used in neonates with Respiratory Distress Syndrome to increase functionalresidual capacity, decrease airway resistance, improve oxygenation and improvepulmonary compliance by the mechanism of alveolar stabilization. (Pediatrics2001; 107:2 304-308) Accompanying the physiologic benefits of delivering nasalCPAP are potential risks of complications. We have observed a number of complicationsin patients receiving conventional and fluidic nasal CPAP in the Neonatal IntensiveCare Unit (NICU) at our institution. The purpose of this study is to comparethe incidence of complications associated with two types of nasal CPAP and toisolate the factors leading to them.

Methods : FromNovember 1, 2000 to May 1, 2001, 111 patients were placed on nasal CPAP in ourNICU. Our NICU primarily utilizes two types of nasal CPAP: Conventional andfluidic nasal CPAP. The conventional nasal CPAP was delivered with CPAP prongs(Medicomp Inc. Princeton MN) on the Infant Star ventilator, and the fluidicnasal CPAP was delivered by the Arabella CPAP system (Hamilton Medical, RenoNV) utilizing their universal generator set and circuit. Conventional nasalCPAP sets were secured with Arabella CPAP caps and twill tape. Fluidic nasalprongs and generator sets were secured with the Arabella CPAP caps. The followingdemographic data were collected: gestational age, weight, type of CPAP, nasalprong and hat size, use of a protective duoderm strip under the nares, circuittemperature, and start/stop dates and start/stop times. Patients were assesseddaily by two observers for complications including: nasal septal breakdown,flaring or stubbing of the nares, bleeding, and orbital edema. Subsequent CPAPepisodes of previously enrolled patients were excluded from this study. TheNICU staff was blinded to this observation. Data were analyzed using a multivariatelogistic regression to determine causative factors for complications.

Results: In thisobservational study, 20 % of all patients placed on nasal CPAP developed complications.20 % of infants placed on continuous flow nasal CPAP developed complications,while 20 % of patients placed on variable flow nasal CPAP developed complications.Complications and their p-values are listed in the table below.


95%Confidence Interval


Odds RatioLowerUpper P-value

CPAP Type: Fluidic

3.73 1.00013.9270.05


1.51 0.8312.7380.18

Hat Size



1.670.6164.504 0.31



Gestational Age


Birth Weight

1.00 0.999 1.001 0.83


Conclusions:Only CPAP type and duration of nasal CPAP had significant effects on complicationrate. Fluidic CPAP was 3.7 times more likely to result in complications thanconventional CPAP. A one-day increase in nasal CPAP duration was associatedwith a 38% increase in the risk of complications.


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