Continuous positive airway pressure (CPAP) is used for spontaneously breathing neonates and can be indicated for respiratory distress syndrome, meconium aspiration syndrome, apnea of prematurity, and other indications. The positive airway pressure helps to keep the alveoli open during expiration.
Mechanism of Action
CPAP devices deliver warmed and humidified air or oxygen/air mixtures to patients via nasal prongs or other airway interfaces. The flow of gas maintains expiratory pressures in lungs in one of two ways: continuous or variable flow. Continuous flow CPAP provides a fixed flow of gasses to the neonate regardless of the patient’s phase of respiration. Conventional CPAP machines, ventilators, and bubble CPAP all use this method. Variable flow devices do not require the patient to exhale against the full continuous flow of gas.
Current Use in High-Resource Settings
CPAP is frequently a bundled function of high end ventilators, but it can be implemented in a stand-alone device--an option that is particularly attractive where costs are more constrained. Typically, in resourced health care settings, several disposable consumables are used with each patient, including the airway interface.
Application in Low-Resource Settings
Stand alone CPAP is more common in low-resource settings. A variety of different models are used throughout the world and many hospitals have built their own by a bubble method. CPAP costs can be 15% of the cost of even the most economical mechanical ventilators. There are also a number of relatively affordable devices manufactured through local suppliers or at the point of care for as little as $550. CPAP is used almost exclusively in the hospital setting as it requires specialized training both to set for a patient and to maintain.