The Context of Bubble CPAP

Continuous positive airway pressure (CPAP) is a type of positive airway pressure ventilation in which a constant pressure greater than atmospheric pressure is continuously applied to a person’s upper respiratory tract.

It was the first time that continuous positive airway pressure (CPAP) was used to assist preterm newborns with breathing.

It has been shown to be an effective technique of preventing extubation failure, is utilised in the treatment of preterm apnoea, and is becoming more widely accepted as a viable alternative to intubation and ventilation in the treatment of respiratory distress syndrome (RDS).

For neonates with infant respiratory distress syndrome(IRDS), bubble CPAP is a non-invasive ventilation method. It is one of the strategies for delivering continuous positive airway pressure (CPAP) to a spontaneously breathing infant in order to prevent alveolar derecruitment and maintain lung volumes during expiration.

The major goal of this study was to see how newborns receiving Bubble Continuous Positive Airway Pressure fared in terms of respiratory distress. 


It minimises the requirement for artificial ventilation and, as a result, the length of stay in the hospital.           


The role of continuous positive airway pressure (CPAP) as a primary support for very preterm newborns with respiratory distress syndrome from birth is unclear. Historically, intubation and ventilation at birth have been used to provide respiratory assistance for very preterm neonates. Nasal CPAP was previously only used to support larger newborns for several hours after birth. However, using CPAP from birth to address babies at risk of RDS is becoming more prevalent.

How it works

Bubble CPAP is appealing to parents due to its ease of use, safety, efficacy, and low cost in treating newborn respiratory problems. Bubble nasal CPAP is superior to mechanical nasal CPAP because the bubbling allows for air exchange in the distal respiratory units. Bubble nasal CPAP is superior to mechanical nasal CPAP because the bubbling allows for air exchange in the distal respiratory units.

 A humidified blended oxygen source, a pressure generator, and an airway interface device make up the Bubble CPAP system. The following three methods can be used to create pressure:

First, the expiratory pressure is adjusted using the ventilator’s expiratory valve;

Second, the pressure is generated by regulating the inspiratory flow or changing the expiratory resistance.

Finally, the bubble CPAP method creates positive pressure by submerging the expiratory tubing’s far end. The pressure is controlled by adjusting the tube’s depth beneath the water’s surface.

The built-in Air/O2 Blender is connected to an oxygen source and uses compressed air to deliver an appropriate concentration of inspired oxygen (FiO2), which can range from 21% to 100%. The mixed oxygen from the humidifier is then pumped through corrugated tubing.

In Bubble CPAP, the positive pressure in the circuit is achieved by simply immersing the distal expiratory tubing in a water column to a desired depth rather than using a variable resistor. Designated pressure is determined by the length of tubing immersed.

As the gas exits the tube, it forms bubbles that cause tiny airway pressure oscillations, which increase gas exchange and lung function in the neonate. An optimal humidity level of more than 33 mg/l increases mucociliary clearance and lowers breathing effort.

It is critical to apply the nasal interface to the newborn without causing air leakage while taking precautions to avoid nasal trauma.

It has to be checked and drained on a regular basis.

Application in Clinical Practice

 It’s also been proven that using CPAP reduces the requirement for up-transfers to higher centres.

 Using CPAP early in the course of the disease, before alveolar collapse occurs, may work better than late CPAP in terms of reducing lung damage and promoting lung function and surfactant pool, especially in very low birth weight and preterm infants, as compared to the pre-CPAP epoch.

Early CPAP, on the other hand, had no influence on overall mortality, BPD, or pneumothorax.

Intubation, surfactant medication, and mechanical ventilation were all used in the past to treat extremely preterm neonates.

Neonates have recently been stabilised using CPAP soon after resuscitation in the delivery room.

 When used early in the delivery room in extreme preterm infants (gestation 28 weeks), either prophylactically or early rescue, CPAP was associated with a nearly 50% reduction in the need for intubation, mechanical ventilation, and surfactant usage when compared to‘mechanical ventilation with or without surfactant’.

As a result, early CPAP stabilisation and provision of rescue surfactant should be the preferred treatment in preterm neonates at 28 weeks of gestation.

Other disorders that cause alveolar collapse or airway narrowing may benefit from CPAP. It helps to alleviate the symptoms of heart failure caused by a patent ductus arteriosus. 

CPAP is frequently used to treat pneumonia, infant transitory tachypnea, postoperative respiratory control, pulmonary edoema, and pulmonary haemorrhage.

Positive pressure therapy (CPAP) has been used to treat laryngo/tracheo/bronchomalacia because it expands the big airways and prevents them from collapsing, especially during expiration. 

When compared to mechanical ventilation, bubble CPAP can treat 10 to 20 neonates for the same cost as treating one with another nasal device, and it is also linked to a lower incidence of bronchopulmonary dysplasia (BPD). 


Side effects

This can irritate the airways and lungs, causing cough or even an infection like bronchitis, pneumonia, or pneumonitis, which is an inflammation of the lungs. These organisms may be blown directly into your lungs by the air pressure.

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