Skip to main content
Erschienen in: Monatsschrift Kinderheilkunde 9/2014

01.09.2014 | Leitthema

„Nasal continuous positive airway pressure“ und noninvasive Beatmung bei Frühgeborenen

Funktions- und Wirkungsweisen

verfasst von: PD Dr. M. Wald

Erschienen in: Monatsschrift Kinderheilkunde | Ausgabe 9/2014

Einloggen, um Zugang zu erhalten

Zusammenfassung

Das Verfahren des „continuous positive airway pressure“ (CPAP) bei Neugeborenen wurde erstmals 1971 publiziert. Mittlerweile ist der nasale Continuous positive airway pressure (nCPAP) bei der Erstversorgung auch kleiner Frühgeborener gegenüber der sofortigen invasiven Beatmung bevorzugend in den Guidelines empfohlen. Auf dem Markt sind in den letzten Jahren unzählige nCPAP-Systeme erschienen. Aufgrund ihrer Funktionsweise können diese in 2 Gruppen eingeteilt werden: Dies sind zum einen die Jet-CPAP-Systeme, die auch als „variable flow nCPAP“ bezeichnet werden. Hier wird der Druck über ein oder 2 Jets erzeugt, über die Atemgas mit hoher Geschwindigkeit in Richtung der Atemwege des Patienten geblasen werden. Dadurch entsteht in den Atemwegen oder unmittelbar davor der gewünschte Druck. Diese Geräte erzeugen einen sehr niedrigen Ausatemwiderstand. Sie sind wegen des Jets jedoch für den Patienten sehr laut; Lärmpegel bis über 100 dB(A) wurden gemessen. Die 2. Gruppe erzeugt den Druck über ein Ausatemventil wie bei der invasiven Beatmung. Dieses resultiert zwar in einem höheren Ausatemwiderstand, ist in der Anwendung aber viel leiser und ermöglicht auch eine noninvasive Beatmung der Patienten. Letztere ist bei den Jet-Systemen nur sehr eingeschränkt möglich. „High flow nasal cannulas“ werden aktuell immer häufiger bei kleinen Kindern anstelle herkömmlicher nCPAP-Systeme eingesetzt. Sie stellen eine Mischform der oben beschriebenen Systeme dar. Sie besitzen Jets, der Druck in den oberen Atemwegen wird aber durch das Größenverhältnis der Nasenlöcher zu den Außendurchmessern der Nasenstücke maßgeblich mitbestimmt. Nasenbrillen sind in der Anwendung sehr komfortabel für das Kind, der applizierte Druck kann allerdings nicht überwacht werden.
Literatur
1.
Zurück zum Zitat Baraka A (1975) Jet ventilation during bronchography in children. Middle East J Anaesthesiol 4:63–65PubMed Baraka A (1975) Jet ventilation during bronchography in children. Middle East J Anaesthesiol 4:63–65PubMed
2.
Zurück zum Zitat Benveniste D, Berg O, Pedersen JE (1976) A technique for delivery of continuous positive airway pressure to the neonate. J Pediatr 88:1015–1019PubMedCrossRef Benveniste D, Berg O, Pedersen JE (1976) A technique for delivery of continuous positive airway pressure to the neonate. J Pediatr 88:1015–1019PubMedCrossRef
3.
Zurück zum Zitat Benveniste D, Pedersen JE (1968) A valve substitute with no moving parts, for artificial ventilation in newborn and small infants. Br J Anaesth 40:464–470PubMedCrossRef Benveniste D, Pedersen JE (1968) A valve substitute with no moving parts, for artificial ventilation in newborn and small infants. Br J Anaesth 40:464–470PubMedCrossRef
4.
Zurück zum Zitat Bhandari V (2012) Noninvasive respiratory support in the preterm infant. Clin Perinatol 39:497–511PubMedCrossRef Bhandari V (2012) Noninvasive respiratory support in the preterm infant. Clin Perinatol 39:497–511PubMedCrossRef
5.
Zurück zum Zitat Chan KM, Chan HB (2007) The use of bubble CPAP in premature infants: local experience. HK J Paediatr (new series):86–92 Chan KM, Chan HB (2007) The use of bubble CPAP in premature infants: local experience. HK J Paediatr (new series):86–92
6.
Zurück zum Zitat Clement KC, Thurman TL, Holt SJ et al (2011) Neurally triggered breaths reduce trigger delay and improve ventilator response times in ventilated infants with bronchiolitis. Intensive Care Med 37:1826–1832PubMedCrossRef Clement KC, Thurman TL, Holt SJ et al (2011) Neurally triggered breaths reduce trigger delay and improve ventilator response times in ventilated infants with bronchiolitis. Intensive Care Med 37:1826–1832PubMedCrossRef
7.
Zurück zum Zitat Collins CL, Barfield C, Horne RS et al (2014) A comparison of nasal trauma in preterm infants extubated to either heated humidified high-flow nasal cannulae or nasal continuous positive airway pressure. Eur J Pediatr 173:181–186PubMedCrossRef Collins CL, Barfield C, Horne RS et al (2014) A comparison of nasal trauma in preterm infants extubated to either heated humidified high-flow nasal cannulae or nasal continuous positive airway pressure. Eur J Pediatr 173:181–186PubMedCrossRef
8.
Zurück zum Zitat Collins CL, Holberton JR, Barfield C et al (2013) A randomized controlled trial to compare heated humidified high-flow nasal cannulae with nasal continuous positive airway pressure postextubation in premature infants. J Pediatr 162:949–954.e941PubMedCrossRef Collins CL, Holberton JR, Barfield C et al (2013) A randomized controlled trial to compare heated humidified high-flow nasal cannulae with nasal continuous positive airway pressure postextubation in premature infants. J Pediatr 162:949–954.e941PubMedCrossRef
9.
Zurück zum Zitat Cook SE, Fedor KL, Chatburn RL (2010) Effects of imposed resistance on tidal volume with 5 neonatal nasal continuous positive airway pressure systems. Respir Care 55:544–548PubMed Cook SE, Fedor KL, Chatburn RL (2010) Effects of imposed resistance on tidal volume with 5 neonatal nasal continuous positive airway pressure systems. Respir Care 55:544–548PubMed
10.
Zurück zum Zitat Davis P, Davies M, Faber B (2001) A randomised controlled trial of two methods of delivering nasal continuous positive airway pressure after extubation to infants weighing less than 1000 g: binasal (Hudson) versus single nasal prongs. Arch Dis Child Fetal Neonatal Ed 85:F82–F85PubMedCentralPubMedCrossRef Davis P, Davies M, Faber B (2001) A randomised controlled trial of two methods of delivering nasal continuous positive airway pressure after extubation to infants weighing less than 1000 g: binasal (Hudson) versus single nasal prongs. Arch Dis Child Fetal Neonatal Ed 85:F82–F85PubMedCentralPubMedCrossRef
11.
Zurück zum Zitat De Paoli AG, Davis PG, Faber B et al (2002) Devices and pressure sources for administration of nasal continuous positive airway pressure (NCPAP) in preterm neonates. Cochrane Database Syst Rev:Cd002977 De Paoli AG, Davis PG, Faber B et al (2002) Devices and pressure sources for administration of nasal continuous positive airway pressure (NCPAP) in preterm neonates. Cochrane Database Syst Rev:Cd002977
12.
Zurück zum Zitat De Paoli AG, Lau R, Davis PG et al (2005) Pharyngeal pressure in preterm infants receiving nasal continuous positive airway pressure. Arch Dis Child Fetal Neonatal Ed 90:F79–F81CrossRef De Paoli AG, Lau R, Davis PG et al (2005) Pharyngeal pressure in preterm infants receiving nasal continuous positive airway pressure. Arch Dis Child Fetal Neonatal Ed 90:F79–F81CrossRef
13.
Zurück zum Zitat Diblasi RM (2011) Neonatal noninvasive ventilation techniques: do we really need to intubate? Respir Care 56:1273–1294 (discussion 1295–1277)PubMedCrossRef Diblasi RM (2011) Neonatal noninvasive ventilation techniques: do we really need to intubate? Respir Care 56:1273–1294 (discussion 1295–1277)PubMedCrossRef
14.
Zurück zum Zitat Dimitriou G, Greenough A, Laubscher B et al (1998) Comparison of airway pressure-triggered and airflow-triggered ventilation in very immature infants. Acta Paediatr 87:1256–1260PubMedCrossRef Dimitriou G, Greenough A, Laubscher B et al (1998) Comparison of airway pressure-triggered and airflow-triggered ventilation in very immature infants. Acta Paediatr 87:1256–1260PubMedCrossRef
15.
Zurück zum Zitat Flemmer AW, Owen L, Schulze A et al (2012) Respiratory signals from the external body surface in spontaneously breathing preterm infants. Arch Dis Child 97:A509 Flemmer AW, Owen L, Schulze A et al (2012) Respiratory signals from the external body surface in spontaneously breathing preterm infants. Arch Dis Child 97:A509
16.
Zurück zum Zitat Gregory GA, Kitterman JA, Phibbs RH et al (1971) Treatment of the idiopathic respiratory-distress syndrome with continuous positive airway pressure. N Engl J Med 284:1333–1340PubMedCrossRef Gregory GA, Kitterman JA, Phibbs RH et al (1971) Treatment of the idiopathic respiratory-distress syndrome with continuous positive airway pressure. N Engl J Med 284:1333–1340PubMedCrossRef
17.
Zurück zum Zitat Ifflaender S, Rudiger M, Konstantelos D et al (2013) Prevalence of head deformities in preterm infants at term equivalent age. Early Hum Dev 89:1041–1047PubMedCrossRef Ifflaender S, Rudiger M, Konstantelos D et al (2013) Prevalence of head deformities in preterm infants at term equivalent age. Early Hum Dev 89:1041–1047PubMedCrossRef
18.
Zurück zum Zitat Jatana KR, Oplatek A, Stein M et al (2010) Effects of nasal continuous positive airway pressure and cannula use in the neonatal intensive care unit setting. Arch Otolaryngol Head Neck Surg 136:287–291PubMedCentralPubMedCrossRef Jatana KR, Oplatek A, Stein M et al (2010) Effects of nasal continuous positive airway pressure and cannula use in the neonatal intensive care unit setting. Arch Otolaryngol Head Neck Surg 136:287–291PubMedCentralPubMedCrossRef
19.
Zurück zum Zitat John J, Bjorklund LJ, Svenningsen NW et al (1994) Airway and body surface sensors for triggering in neonatal ventilation. Acta Paediatr 83:903–909PubMedCrossRef John J, Bjorklund LJ, Svenningsen NW et al (1994) Airway and body surface sensors for triggering in neonatal ventilation. Acta Paediatr 83:903–909PubMedCrossRef
20.
Zurück zum Zitat Karam O, Donatiello C, Van Lancker E et al (2008) Noise levels during nCPAP are flow-dependent but not device-dependent. Arch Dis Child Fetal Neonatal Ed 93:F132–F134PubMedCrossRef Karam O, Donatiello C, Van Lancker E et al (2008) Noise levels during nCPAP are flow-dependent but not device-dependent. Arch Dis Child Fetal Neonatal Ed 93:F132–F134PubMedCrossRef
21.
Zurück zum Zitat Kirchner L, Wald M, Jeitler V et al (2012) In vitro comparison of noise levels produced by different CPAP generators. Neonatology 101:95–100PubMedCrossRef Kirchner L, Wald M, Jeitler V et al (2012) In vitro comparison of noise levels produced by different CPAP generators. Neonatology 101:95–100PubMedCrossRef
22.
Zurück zum Zitat Kirpalani H, Millar D, Lemyre B et al (2013) A trial comparing noninvasive ventilation strategies in preterm infants. N Engl J Med 369:611–620PubMedCrossRef Kirpalani H, Millar D, Lemyre B et al (2013) A trial comparing noninvasive ventilation strategies in preterm infants. N Engl J Med 369:611–620PubMedCrossRef
23.
Zurück zum Zitat Klingenberg C, Pettersen M, Hansen EA et al (2014) Patient comfort during treatment with heated humidified high flow nasal cannulae versus nasal continuous positive airway pressure: a randomised cross-over trial. Arch Dis Child Fetal Neonatal Ed 99:F134–F137PubMedCrossRef Klingenberg C, Pettersen M, Hansen EA et al (2014) Patient comfort during treatment with heated humidified high flow nasal cannulae versus nasal continuous positive airway pressure: a randomised cross-over trial. Arch Dis Child Fetal Neonatal Ed 99:F134–F137PubMedCrossRef
24.
Zurück zum Zitat Kubicka ZJ, Limauro J, Darnall RA (2008) Heated, humidified high-flow nasal cannula therapy: yet another way to deliver continuous positive airway pressure? Pediatrics 121:82–88PubMedCrossRef Kubicka ZJ, Limauro J, Darnall RA (2008) Heated, humidified high-flow nasal cannula therapy: yet another way to deliver continuous positive airway pressure? Pediatrics 121:82–88PubMedCrossRef
25.
Zurück zum Zitat Kugelman A, c et al (2014) A randomized pilot study comparing heated humidified high-flow nasal cannulae with NIPPV for RDS. Pediatr Pulmonol. DOI: 10.1002/ppul.23022 Kugelman A, c et al (2014) A randomized pilot study comparing heated humidified high-flow nasal cannulae with NIPPV for RDS. Pediatr Pulmonol. DOI: 10.1002/ppul.23022
26.
Zurück zum Zitat Laubscher B, Greenough A, Kavadia V (1997) Comparison of body surface and airway triggered ventilation in extremely premature infants. Acta Paediatr 86:102–104PubMedCrossRef Laubscher B, Greenough A, Kavadia V (1997) Comparison of body surface and airway triggered ventilation in extremely premature infants. Acta Paediatr 86:102–104PubMedCrossRef
27.
Zurück zum Zitat Lista G, Castoldi F, Fontana P et al (2010) Nasal continuous positive airway pressure (CPAP) versus bi-level nasal CPAP in preterm babies with respiratory distress syndrome: a randomised control trial. Arch Dis Child Fetal Neonatal Ed 95:F85–F89PubMedCrossRef Lista G, Castoldi F, Fontana P et al (2010) Nasal continuous positive airway pressure (CPAP) versus bi-level nasal CPAP in preterm babies with respiratory distress syndrome: a randomised control trial. Arch Dis Child Fetal Neonatal Ed 95:F85–F89PubMedCrossRef
28.
Zurück zum Zitat Loftus BC, Ahn J, Haddad J Jr (1994) Neonatal nasal deformities secondary to nasal continuous positive airway pressure. Laryngoscope 104:1019–1022PubMedCrossRef Loftus BC, Ahn J, Haddad J Jr (1994) Neonatal nasal deformities secondary to nasal continuous positive airway pressure. Laryngoscope 104:1019–1022PubMedCrossRef
29.
Zurück zum Zitat Manley BJ, Owen LS, Doyle LW et al (2013) High-flow nasal cannulae in very preterm infants after extubation. N Engl J Med 369:1425–1433PubMedCrossRef Manley BJ, Owen LS, Doyle LW et al (2013) High-flow nasal cannulae in very preterm infants after extubation. N Engl J Med 369:1425–1433PubMedCrossRef
30.
Zurück zum Zitat Moa G, Nilsson K (1993) Nasal continuous positive airway pressure: experiences with a new technical approach. Acta Paediatr 82:210–211PubMedCrossRef Moa G, Nilsson K (1993) Nasal continuous positive airway pressure: experiences with a new technical approach. Acta Paediatr 82:210–211PubMedCrossRef
31.
Zurück zum Zitat Morley CJ, Lau R, De Paoli A et al (2005) Nasal continuous positive airway pressure: does bubbling improve gas exchange? Arch Dis Child Fetal Neonatal Ed 90:F343–F344PubMedCentralPubMedCrossRef Morley CJ, Lau R, De Paoli A et al (2005) Nasal continuous positive airway pressure: does bubbling improve gas exchange? Arch Dis Child Fetal Neonatal Ed 90:F343–F344PubMedCentralPubMedCrossRef
32.
Zurück zum Zitat Mukerji A, Finelli M, Belik J (2013) Nasal high-frequency oscillation for lung carbon dioxide clearance in the newborn. Neonatology 103:161–165PubMedCrossRef Mukerji A, Finelli M, Belik J (2013) Nasal high-frequency oscillation for lung carbon dioxide clearance in the newborn. Neonatology 103:161–165PubMedCrossRef
33.
Zurück zum Zitat O’Brien K, Campbell C, Brown L et al (2012) Infant flow biphasic nasal continuous positive airway pressure (BP-NCPAP) vs. infant flow NCPAP for the facilitation of extubation in infants‘ ≤ 1,250 grams: a randomized controlled trial. BMC Pediatr 12:43CrossRef O’Brien K, Campbell C, Brown L et al (2012) Infant flow biphasic nasal continuous positive airway pressure (BP-NCPAP) vs. infant flow NCPAP for the facilitation of extubation in infants‘ ≤ 1,250 grams: a randomized controlled trial. BMC Pediatr 12:43CrossRef
34.
Zurück zum Zitat Owen LS, Morley CJ, Davis PG (2013) Bench-top accuracy of SiPAP-generated nasal intermittent positive pressure ventilation. Acta Paediatr 102:e385–e388PubMedCrossRef Owen LS, Morley CJ, Davis PG (2013) Bench-top accuracy of SiPAP-generated nasal intermittent positive pressure ventilation. Acta Paediatr 102:e385–e388PubMedCrossRef
35.
Zurück zum Zitat Pandit PB, Courtney SE, Pyon KH et al (2001) Work of breathing during constant- and variable-flow nasal continuous positive airway pressure in preterm neonates. Pediatrics 108:682–685PubMedCrossRef Pandit PB, Courtney SE, Pyon KH et al (2001) Work of breathing during constant- and variable-flow nasal continuous positive airway pressure in preterm neonates. Pediatrics 108:682–685PubMedCrossRef
36.
Zurück zum Zitat Ricotti A, Salvo V, Zimmermann LJ et al (2013) N-SIPPV versus bi-level N-CPAP for early treatment of respiratory distress syndrome in preterm infants. J Matern Fetal Neonatal Med 26:1346–1351PubMedCrossRef Ricotti A, Salvo V, Zimmermann LJ et al (2013) N-SIPPV versus bi-level N-CPAP for early treatment of respiratory distress syndrome in preterm infants. J Matern Fetal Neonatal Med 26:1346–1351PubMedCrossRef
37.
Zurück zum Zitat Schaller P, Kurt E, Gmyrek D (1981) Significance of flow resistance in CPAP system – recommendations for practice. Kinderarztl Prax 49:654–664PubMed Schaller P, Kurt E, Gmyrek D (1981) Significance of flow resistance in CPAP system – recommendations for practice. Kinderarztl Prax 49:654–664PubMed
38.
Zurück zum Zitat Schmolzer GM, Kumar M, Pichler G et al (2013) Non-invasive versus invasive respiratory support in preterm infants at birth: systematic review and meta-analysis. BMJ 347:f5980PubMedCentralPubMedCrossRef Schmolzer GM, Kumar M, Pichler G et al (2013) Non-invasive versus invasive respiratory support in preterm infants at birth: systematic review and meta-analysis. BMJ 347:f5980PubMedCentralPubMedCrossRef
39.
Zurück zum Zitat Stern DJ, Weisner MD, Courtney SE (2013) Synchronized neonatal non-invasive ventilation-a pilot study: The graseby capsule with bi-level NCPAP. Pediatr Pulmonol 49:659–664PubMedCrossRef Stern DJ, Weisner MD, Courtney SE (2013) Synchronized neonatal non-invasive ventilation-a pilot study: The graseby capsule with bi-level NCPAP. Pediatr Pulmonol 49:659–664PubMedCrossRef
40.
Zurück zum Zitat Surenthiran SS, Wilbraham K, May J et al (2003) Noise levels within the ear and post-nasal space in neonates in intensive care. Arch Dis Child Fetal Neonatal Ed 88:F315–F318PubMedCentralPubMedCrossRef Surenthiran SS, Wilbraham K, May J et al (2003) Noise levels within the ear and post-nasal space in neonates in intensive care. Arch Dis Child Fetal Neonatal Ed 88:F315–F318PubMedCentralPubMedCrossRef
41.
Zurück zum Zitat Sweet DG, Carnielli V, Greisen G et al (2013) European consensus guidelines on the management of neonatal respiratory distress syndrome in preterm infants – 2013 update. Neonatology 103:353–368PubMedCrossRef Sweet DG, Carnielli V, Greisen G et al (2013) European consensus guidelines on the management of neonatal respiratory distress syndrome in preterm infants – 2013 update. Neonatology 103:353–368PubMedCrossRef
42.
Zurück zum Zitat Theilade D (1978) Nasal CPAP treatment of the respiratory distress syndrome: a prospective investigation of 10 new born infants. Intensive Care Med 4:149–153PubMedCrossRef Theilade D (1978) Nasal CPAP treatment of the respiratory distress syndrome: a prospective investigation of 10 new born infants. Intensive Care Med 4:149–153PubMedCrossRef
43.
Zurück zum Zitat Wald M, Jeitler V, Pollak A et al (2010) Danger of low pressure alarm failure in preterm infants on continuous positive airway pressure. Eur J Pediatr 169:585–589PubMedCrossRef Wald M, Jeitler V, Pollak A et al (2010) Danger of low pressure alarm failure in preterm infants on continuous positive airway pressure. Eur J Pediatr 169:585–589PubMedCrossRef
44.
Zurück zum Zitat Wald M, Kribs A, Jeitler V et al (2011) Variety of expiratory resistance between different continuous positive airway pressure devices for preterm infants. Artif Organs 35:22–28PubMedCrossRef Wald M, Kribs A, Jeitler V et al (2011) Variety of expiratory resistance between different continuous positive airway pressure devices for preterm infants. Artif Organs 35:22–28PubMedCrossRef
45.
Zurück zum Zitat Wilkinson DJ, Andersen CC, Smith K et al (2008) Pharyngeal pressure with high-flow nasal cannulae in premature infants. J Perinatol 28:42–47PubMedCrossRef Wilkinson DJ, Andersen CC, Smith K et al (2008) Pharyngeal pressure with high-flow nasal cannulae in premature infants. J Perinatol 28:42–47PubMedCrossRef
46.
Zurück zum Zitat Wung JT, Driscoll JM Jr, Epstein RA et al (1975) A new device for CPAP by nasal route. Crit Care Med 3:76–78PubMedCrossRef Wung JT, Driscoll JM Jr, Epstein RA et al (1975) A new device for CPAP by nasal route. Crit Care Med 3:76–78PubMedCrossRef
47.
Zurück zum Zitat Yoder BA, Stoddard RA, Li M et al (2013) Heated, humidified high-flow nasal cannula versus nasal CPAP for respiratory support in neonates. Pediatrics 131:e1482–e1490PubMedCrossRef Yoder BA, Stoddard RA, Li M et al (2013) Heated, humidified high-flow nasal cannula versus nasal CPAP for respiratory support in neonates. Pediatrics 131:e1482–e1490PubMedCrossRef
Metadaten
Titel
„Nasal continuous positive airway pressure“ und noninvasive Beatmung bei Frühgeborenen
Funktions- und Wirkungsweisen
verfasst von
PD Dr. M. Wald
Publikationsdatum
01.09.2014
Verlag
Springer Berlin Heidelberg
Erschienen in
Monatsschrift Kinderheilkunde / Ausgabe 9/2014
Print ISSN: 0026-9298
Elektronische ISSN: 1433-0474
DOI
https://doi.org/10.1007/s00112-014-3109-6

Weitere Artikel der Ausgabe 9/2014

Monatsschrift Kinderheilkunde 9/2014 Zur Ausgabe

Mitteilungen der DGKJ

Mitteilungen der DGKJ

Mitteilungen der ÖGKJ

Mitteilungen der ÖGKJ

Einführung zum Thema

Neonatologie

Update Pädiatrie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.