about 12 percent of infants within the United States are born prematurely 10% of them is diagnosed with the respiratory distress syndrome (RDS) according to the National Heart, Lung, and Blood Institute (NHLBI). And the earlier a child arrives, the greater chance of developing RDS. For instance, a child born after 29 weeks gestation will have an opportunity of 60% of developing RDS when compared to an infant who is full-term has almost zero chance.
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Mechanical ventilation using constant positive airway pressure (CPAP) assists in preventing the collapse of the alveoli in the lungs, and can improve the chances of survival, some infants continue to develop the condition known as bronchopulmonary dysplasia (BPD). A BMJ study revealed nasal CPAP is a non-invasive method which is superior to intubation in the reduction of BPD. 1
The year 1973 was when Jen-Tien Wung, MD, FCCM, professor of pediatric anesthesiology within Columbia University College of Physicians and Surgeons. Columbia University College of Physicians and Surgeons, developed a revolutionary method that was an efficient, safe and cost-effective treatment of respiratory problems in newborns.
Bubble CPAP Setup (bCPAP) delivery device consists of a humidified air source as well as an interface that connects to the CPAP circuit with the infant’s airway via nasal prongs that are short, and an inflatable tube that is immersed in a water bottle. When the gas leaves through the tube it releases bubbles which cause Airway pressure fluctuations. As these oscillations travel to the lungs of the newborn and the result is enhanced the function of the lung and gas exchange.
bCPAP has been utilized in Columbia Medical Center since 1973. The neonatal intensive-care unit has among the lowest levels of bronchopulmonary dysplasia anywhere in the world. It ranges between 4 and 8 percent against the average national rate of 24%-30 percent. Wung stated, “More than 20,000 infants have been successfully treated with bubble CPAP at Columbia.”
Since its debut in the 1970s, the bubble CPAP has shown its effectiveness within the operating room as a treatment as well as an extubation tool and as a way to manage prematurity-related apnea. 2
Despite the great success of bCPAP however, physicians discovered that older devices could trigger certain nasal-related issues. “Nasal trauma is prevented by maintaining an air cushion of 1 to 2 millimeters between nasal septums and nasal prongs. Additionally, using the right-sized prongs, or one-size larger ones can eliminate the possibility of. Of course, continuous vigilance by nurses is essential,” said Amer Ammari, MD, a specialist in neonatology and perinatology at Chicago.
Ammari also advised healthcare professionals to exercise caution when setting the tubing’s pressure. “Using any of the old tubing that is connected to an orifice within the circuit will trigger an alarm for the ventilator whenever the pressure has been lost. Chinstraps can be attached to the hat’s sides. This will stop the cap from sliding backwards, and also keeps the mouth closed.”
Building a Better System
In the 1980s, a lot of attention was paid to ventilation as per David Hendrickson, neonatal product and sales manager of Fisher and Paykel Health’s North America division. However, this approach was extensively used and major technological advances have changed the marketplace according to him. “Ventilation is invasive and does more harm than good, although there is still a place for ventilators,” he added. “But bubble CPAP is a gentle way to vent a baby.”
Before the invention of reliable and FDA-approved equipment respiratory therapists and other healthcare professionals tried to design the “homemade” device using a tubing, syringe and water bottles. These devices were not only dangerous, but they often weren’t effective, Hendrickson noted.
In the beginning, when Fisher & Paykel began its research and development of bCPAP systems The company considered a number of factors into account. The company’s R&D has paid off and now is one of the FDA’s only complete bCPAP device that is available, Hendrickson reported. “All the components and pieces you’ll need are all available in this Fisher & Paykel device. It’s about security as well as risk control.”
Other systems that come as a set do not have the same level security as the CPAP, he said. Fisher and Paykel’s Bubble CPAP is available in an All-in-1 package that includes a generator, humidification chamber, heated breathing circuits, chamber as well as a pressure manifold. Fisher &Paykel’s system comes with an auto-leveling mechanism to ensure constant pressure delivery. “You need a mechanism to deliver the same pressure, whether a clinician is watching or not,” Hendrickson said. Hendrickson. “This is a big selling point.”
The accuracy of recording medical information is essential during emergencies. “Pressures that are delivered by bubble CPAP are dependent on the length tubing, the resistance to flow, as well as condensation that can lead to an increase in the water levels. It is important to note that the F&P CPAP system is specifically designed to provide the lowest resistance to flow that is possible and the exclusive automatic leveling mechanism in the generator guarantees a consistent water level , and consequently the same pressures. This is a major element that differentiates the two systems,” Hendrickson pointed out.
Beware of the high percentage of turnover among employees and per diem employees, Fisher & Paykel also looked to design an employee system that had an easy learning curve. “Respiratory therapists often work in several hospital environments so any device has to be easy to use,” said the company’s CEO. stated.
While the majority of bubble CPAP systems make use of water, some might utilize an acetic acid solution for their bubblers. Hendrickson stated, “This might be overkill. There’s a distinct smell to it, however this is a medical decision.”
A new product on this market are the B&B Bubbler, a device for bCPAP which received 510(k) acceptance from FDA in March According to Stu Novitz, B&B Medical’s vice director for sales and marketing. The device was developed with the help of a group of nurses, doctors and neonatologists as well as other medical professionals, the device is the first time that bCPAP has a distinct structure.
Derick Corrente Director of B&B Medical’s operations, said the device has safety and convenience, as well as cost-effective and flexible features. It’s made to provide between 10 and 0 cm of 2.O CPAP to infants who weigh less than 10 kilograms. “The device addresses clinical needs and has a financial impact,” Corrente said.
Corrente said that the B&B Bubbler features two chambers to monitor the level of fluid. “The device does not have to be disconnected in order to see the water level,” Corrente explained. The overflow chamber that drains does not allow water to increase above a predetermined threshold. If there is evaporation there is a port that makes it simple to add water without disrupting the flow. Furthermore it is possible to attach the Bubbler Bubbler can be fixed to an equipment pole using one or a custom pole clamps due to its ISO-compliant equipment mount. “This is the first unit to have these features in one device,” Corrente said, adding that the B&B Bubbler is within a centimeter of accuracy.
In addition, Corrente noted that bCPAP can treat 10 to 20 newborns with the same expense as treating one using a different nasal system. The risk of developing ventilator-associated pneumonia is also significantly reduced, since no mechanical ventilation or endotracheal intubation is involved. Novitz declared, “This product is simple, reliable, and provides positive clinical outcomes. It’s also less costly and more cost-effective.”
The Bubble CPAP does not only have shown significant savings in costs when compared to ventilator CPAP however, it has also been proven to have an extremely high frequency and stochastic effect as per Wung. “I have not found any simpler and more cost-effective alternative yet.”