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01.10.2006 | Pediatric Original

Does helmet CPAP reduce cerebral blood flow and volume by comparison with Infant Flow driver CPAP in preterm neonates?

verfasst von: Patrizia Zaramella, Federica Freato, Nicoletta Grazzina, Elisabetta Saraceni, Andrea Vianello, Lino Chiandetti

Erschienen in: Intensive Care Medicine | Ausgabe 10/2006

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Abstract

Objective

We compared neonatal helmet continuous positive airway pressure (CPAP) and the conventional nasal Infant Flow driver (IFD) CPAP in the noninvasive assessment of absolute cerebral blood flow (CBF) and relative cerebral blood volume changes (ΔCBV) by near-infrared spectroscopy.

Design and setting

A randomized crossover study in a tertiary referral NICU.

Patients and interventions

Assessment of CBF and ΔCBV in 17 very low birth weight infants with respiratory distress (median age 5 days) treated with two CPAP devices at a continuous distending pressure of 4 mbar.

Measurements and results

Neonates were studied for two consecutive 60-min periods with helmet CPAP and with IFD CPAP. Basal chromophore traces enabled ΔCBV changes to be calculated. CBF was calculated in milliliters per 100 grams per minute from the saturation rise integral and rate of rise O₂Hb-HHb. Median (range) CBF with helmet CPAP was 27.37 (9.47–48.20) vs. IFD CBF 34.74 (13.59–60.10)(p = 0.049) and ΔCBV 0.15 (0.09–0.28) with IFD and 0.13 (0.07–0.27) with helmet CPAP (NS). Using helmet and IFD CPAP, the neonates showed no difference in mean physiological parameters (transcutaneous carbon dioxide and oxygen tension, pulse oximetry saturation, heart rate, breathing rate, mean arterial blood pressure, desaturation rate, axillary temperature).

Conclusion

Assessing CBF and ΔCBV measured by near-infrared spectroscopy with two CPAP devices revealed no differences in relative blood volume, but CBF was lower with helmet CPAP. Greater active vasoconstriction and/or passive capillary and/or venous vessel compression seem the most likely reason, due to a positive pressure around the head, neck, and shoulders by comparison with the airway pressure.

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Titel: Does helmet CPAP reduce cerebral blood flow and volume by comparison with Infant Flow driver CPAP in preterm neonates?
verfasst von: Patrizia Zaramella
Federica Freato
Nicoletta Grazzina
Elisabetta Saraceni
Andrea Vianello
Lino Chiandetti
Publikationsdatum: 01.10.2006
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 10/2006
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-006-0289-0

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Does helmet CPAP reduce cerebral blood flow and volume by comparison with Infant Flow driver CPAP in preterm neonates?