How continuous positive airway
pressure (CPAP) is currently being
used – an overview
C. C. Roehr, G. Schmalisch,
R. Wauer
Charité Universitätsmedizin Berlin
Germany
NCA/Hudson
Mono-nasales
Tubus CPAP
F&P Bubble CPAP
Beneviste valve
„Kniewasser“
System
Neo-Fit
Infant-Flow driver
Long and short
binasal prongs
NCA/Hudson
Mono-nasal CPAP
F&P Bubble CPAP
„Kniewasser
System
How is CPAP being used
neonatal medicine?
Neo-Fit
Infant-Flow driver
Longe and short
binasal prongs
Use of CPAP in German, Austrian
and Swiss neonatal units
• for which clinical purpose?
• when used as primary therapy?
• what CPAP-system used?
• mono- or bi-nasal?
• flow and CPAP-level
• differences between levels of care?
• CPAP use in the delivery room
Methods
• Questionnaire study
• German national survey and internatinal
survey (FRG, A, Ch)
• all maximum level NICU and paediatr.
Hospitals
• mailed questionnaire
• telephone interview
• Statistical analysis (Statgraph®)
Methods
Nation wide
survey of all NICU (level 1-3)
International (FRG, A, Ch)
survey of all level 3 NICU
Mailed questionnaire
Postal reminder after 4 weeks
Telephone interview
Data-Analysis MS Excell / Statgraphics
Results German survey
Contacted institutions
n = 274
Surveyed institutions
Response 1st questionnaier
n = 147 (53%)
Reponse to questionnair
Response reminder
n = 127 (47%)
Response to tel. contact
Telphone contact
n = 70 (26%)
Roehr C et al. 2007
Results German survey
Contatced institiutions
n = 274
Surveyed institutions
Response 1st questionnaire
n = 147 (53%)
Reponse to questionnair
Response reminder
n = 127 (47%)
Response to tel. contact
Telephone contact
n = 70 (26%)
positive answer n = 218 (79%)
Roehr C et al. 2007
Results German survey
Contatced institutions
n = 274
Surveyed institutions
Response 1st questionnaire
n = 147 (53%)
Reponse to questionnair
Response reminder
n = 127 (47%)
Response to tel. contact
Telephone contact
n = 70 (26%)
positive answer n = 218 (79%)
Roehr C et al. 2007
No aswer n = 57 (21%)
Characteristics of institutions
Admissions
per year*
Primary paed.
care
Secondary
paed. care
Tertiary
paediatric care
Total
<10
ventilator
beds
>10
ventilator
beds
n
(Mean and
(Range)
85
259
(201000)
75 (89%)
7 (11%)
110
312
(501000)
93 (85%)
16 (15%)
23
393
(180-1100)
6 (27%)
16 (73%)
218
*p = 0.014
GGkl1500g/LebendgebJahr*100
Patients < 1500g/year
Box-and-Whisker Plot
10
8
6
4
2
0
Primary
1care hosp.
Secondary
care
2
tertiary
3 care hospital
Institution
Einrichtung
p<0.0001 between
institutions
No sign. difference in CPAP use
across institutions
Guideline
CPAP use
CPAP post extubation
CPAP –
ADS
57 %
95 %
93 %
n
Primary paed.
care
85
CPAP ApnoeaBradycardiaSyndrome
98 %
Secondary
paed. care
Tertiary
paediatric care
p=
95 %
110
97 %
53 %
23
96 %
100 %
100 %
74 %
0,13
100 %
0,57
0,46
0,28
Mono-, bi-nasal, or both CPAP-systems?
Differences between
institutions not statist.
significant
Use of CPAP as commercial system,
composite system or custom made
Commercial
system
Composite
Systems
Custom made
system
Roehr C et al. Eur J Med Res 2007: 12; 139-44
CPAP generators used in
German NICUs
sonstige
Fisher & Paykel Infant Star
Leoni
Bubble CPAPSystem
F 120 B
Christina
9%
26%
F 120 M
F 120 A
13%
Stephanie
36%
Roehr C et al. Eur J Med Res 2007: 12; 139-44 Babylog 8000
Leoni
Infant Flow System (EME)
Babylog 8000
Stephanie
F 120 A
Infant
flowSystem
driver
Infant
Flow
F 120 M
(EME)
(EME)
Christina
F 120 B
Bubble CPAP-System
Infant Star
sonstige
Maximum tolerated CPAP
80
70
60
%
50
40
30
20
10
0
1
5
2
6
3
7
4
8
5
9 -12
CPAP
in cmH
CPAP
in cm
H20
2O
Median 7 cmH2O
Differences between
institutions not statist.
significant
Frequency (%)
Flow under CPAP
1 to 4
4.5 - 5.5
L/min
6-7
Median 6 L/min
8-9
Differences between
institutions not statist.
significant
2nd investigation:
A survey of neonatal units of German
speaking countries
International survey FRG, A, CH
Stepwise approach of tertiary neonatal units
Units approached with
1st questionnaire
2nd questionnaire
n = 249
100%
n = 123
49%
n = 25
10%
Telephone interview
Results: CPAP in DR
O2- Blenders
97
Pulse oxymetry
97
Self-inflating bag
92
T-piece resuscitator
40
sust. inflations <
5sec
34
prol. inflations >
5sec
25
CPAP 4-5 cmH2O
76
Polyethylene foil
62
Hat / head cover
80
Late-clamping
43
0
10
20
30
40
50
60
70
80
90
100
in percent (%)
*no statistical difference between regions, univ. or non-univ. neonatal units
Summary
• Wide spectrum of clinical appliactions
– RDS
– Apnoea-Bradycardia-Syndrome and
– post-extubation
• parallel use of low-flow (bubble) CPAP, high-flow and
respirator generated CPAP
• Heterogeneity of flow and CPAP-levels
• CPAP in DR used with and without prolonged
inflations
Conclusion
• Use of CPAP in German speaking countries
is not standardized
• We believe this may reflect gaps in
knowledge on the potentials of CPAP, as well
as lack of sound evidence for specific areas
of CPAP therapy

further clinical studies are needed.
Educational opportunities to learn about
CPAP should be widely offered.