PC1082: A Novel Method of Measuring Pressures on Bubble Nasal CPAP, Using Vascular Pressure Monitoring Device

Background: Bubble nasal CPAP (bnCPAP) is a prevalent noninvasive form of respiratory support in neonates. However, pressure delivery can be unreliable and lead to complications. Lower pressures can cause atelectasis and higher pressure can cause air leaks. Bubble CPAP lacks self-adjusting ability and can deliver unpredictable pressures. Continuous monitoring and recording of PEEP are vital, but no such method is currently available. We introduce a novel method for continuously measuring and recording PEEP on bnCPAP using a vascular pressure monitoring device (VPMD) at the expiratory limb of the nasal prong. We aim to test the hypothesis that VPMD can be used to continuously monitor and record pressures.

Methods: This is a prospective, single-arm, observational study of neonates requiring bnCPAP. VPMD was connected to the proximal end of the expiratory limb of nasal prongs. Measurements (in mm of Hg =1.36 cm of H20) were displayed as central venous pressure (CVP) on the monitors. Data were continuously recorded per millisecond for 24 hrs using Philips IntelliVue MP70 Neonatal Monitors and ixTrend 2.0 software and saved to a Microsoft Excel file. Spot measurements were recorded 8 hourly using a standard pressure monitoring manometer-AG Cufill (Hospitech). Simultaneous measurements were recorded for set PEEP, VPMD, and Cufill. Data were analyzed using Freidman’s two-way analysis of variance ANOVA.

Results: Twenty patients were enrolled. Data analysis was performed on 18. There were no differences between the medians of the CVP, PEEP, and Cufill values. There were no statistically significant differences between CVP and PEEP (p-value 0.6), CVP and Cuffil (p-value 0.2), or between PEEP and Cufill (p-value 0.08). Patients stayed within 1 point of set PEEP for 68.1% of the time, within 2 points for 80.5 % of the time, and within 3 points for 89.5% of the time.

Conclusion: We conclude VPMD can be used to continuously monitor PEEP. This device is feasible, easily accessible, and can reliably monitor and record pressures. It provides an objective, bedside tool for accurate measurement of PEEP and setting alarm limits. Alarm limits can alert staff about any leakage, disconnect, or any changes in pressures to avoid complications of low and high PEEP.