Does the RAM Cannula Provide Continuous Positive Airway Pressure as Effectively as the Hudson Prongs in Preterm Neonates?

Abstract

Objective To compare the level of continuous positive airway pressure (CPAP) delivered by the RAM cannula system (Neotech, Valencia, CA) with that delivered by a traditional CPAP nasal delivery interface (Hudson prongs; Hudson-RCI, Temecula, CA) in preterm infants with respiratory distress.

Methods This was a crossover intervention study in a convenience sample of preterm infants with respiratory distress requiring treatment with CPAP. We measured the mean intraoral (pharyngeal) pressure, which approximates the applied CPAP level, using both the RAM cannula and Hudson prongs. The primary outcome was a comparison of the differences between the set CPAP levels and the measured intraoral pressures of both delivery systems.

Results We analyzed data from 12 preterm infants with mean (standard deviation) birth weight of 1,225 (405) g and gestational age of 28.4 (2.1) weeks at a median postnatal age of 10 days. The mean difference (95% confidence interval) between the set CPAP level and measured intraoral pressure was −2.45 cm H₂O (−3.36, −1.55) with the RAM cannula and +0.40 cm H₂O (−0.30, 1.12) with Hudson prongs, p = 0.0002.

Conclusion For given set CPAP pressure level in preterm infants, the RAM cannula system consistently delivers lower pharyngeal pressure (effective CPAP) levels than Hudson prongs.

Keywords

continuous positive airway pressure - nasal interface - preterm

Authors' Contributions

N.S. conceptualized and designed the study, drafted the initial article, and approved the final article as submitted. M.J.M. was involved in study design, conducting the study, data collection, and analysis. R.A.D. developed the system to measure intraoral pressure, and was involved in designing the study and reviewing the article.

Note

ClinicalTrials.gov. ID: NCT03212508.

• References

• 1 De Klerk AM, De Klerk RK. Nasal continuous positive airway pressure and outcomes of preterm infants. J Paediatr Child Health 2001; 37 (02) 161-167
• 2 Polin RA, Sahni R. Newer experience with CPAP. Semin Neonatol 2002; 7 (05) 379-389
• 3 Wright CJ, Polin RA. Noninvasive support: does it really decrease bronchopulmonary dysplasia?. Clin Perinatol 2016; 43 (04) 783-798
• 4 Diblasi RM. Nasal continuous positive airway pressure (CPAP) for the respiratory care of the newborn infant. Respir Care 2009; 54 (09) 1209-1235
• 5 De Paoli AG, Davis PG, Faber B, Morley CJ. Devices and pressure sources for administration of nasal continuous positive airway pressure (NCPAP) in preterm neonates. Cochrane Database Syst Rev 2008; (01) CD002977
• 6 De Paoli AG, Morley CJ, Davis PG, Lau R, Hingeley E. In vitro comparison of nasal continuous positive airway pressure devices for neonates. Arch Dis Child Fetal Neonatal Ed 2002; 87 (01) F42-F45
• 7 Gerdes JS, Sivieri EM, Abbasi S. Factors influencing delivered mean airway pressure during nasal CPAP with the RAM cannula. Pediatr Pulmonol 2016; 51 (01) 60-69
• 8 Chilton HW, Brooks JG. Pharyngeal pressures in nasal CPAP. J Pediatr 1979; 94 (05) 808-810
• 9 Kubicka ZJ, Limauro J, Darnall RA. Heated, humidified high-flow nasal cannula therapy: yet another way to deliver continuous positive airway pressure?. Pediatrics 2008; 121 (01) 82-88
• 10 Miller MJ, DiFiore JM, Strohl KP, Martin RJ. Effects of nasal CPAP on supraglottic and total pulmonary resistance in preterm infants. J Appl Physiol (1985) 1990; 68 (01) 141-146
• 11 Pedersen JE, Nielsen K. Oropharyngeal and esophageal pressure during mono- and binasal CPAP in neonates. Acta Paediatr 1994; 83 (02) 143-149
• 12 De Paoli AG, Lau R, Davis PG, Morley CJ. Pharyngeal pressure in preterm infants receiving nasal continuous positive airway pressure. Arch Dis Child Fetal Neonatal Ed 2005; 90 (01) F79-F81
• 13 Bushell T, McHugh C, Meyer MP. A comparison of two nasal continuous positive airway pressure interfaces--a randomized crossover study. J Neonatal Perinatal Med 2013; 6 (01) 53-59
• 14 Hückstädt T, Foitzik B, Wauer RR, Schmalisch G. Comparison of two different CPAP systems by tidal breathing parameters. Intensive Care Med 2003; 29 (07) 1134-1140
• 15 Kahn DJ, Courtney SE, Steele AM, Habib RH. Unpredictability of delivered bubble nasal continuous positive airway pressure: role of bias flow magnitude and nares-prong air leaks. Pediatr Res 2007; 62 (03) 343-347
• 16 Trevisanuto D, Grazzina N, Doglioni N, Ferrarese P, Marzari F, Zanardo V. A new device for administration of continuous positive airway pressure in preterm infants: comparison with a standard nasal CPAP continuous positive airway pressure system. Intensive Care Med 2005; 31 (06) 859-864
• 17 Bailes SA, Firestone KS, Dunn DK, McNinch NL, Brown MF, Volsko TA. Evaluating the effect of flow and interface type on pressures delivered with bubble CPAP in a simulated model. Respir Care 2016; 61 (03) 333-339
• 18 Hosseini MB, Heidarzadeh M, Balila M. , et al. Randomized controlled trial of two methods of nasal continuous positive airway pressure (N-CPAP) in preterm infants with respiratory distress syndrome: underwater bubbly CPAP vs. Medijet system device. Turk J Pediatr 2012; 54 (06) 632-640