Bubble CPAP

Bubble CPAP is a non-invasive ventilation strategy for newborns with infant respiratory distress syndrome (IRDS). It is one of the methods by which continuous positive airway pressure (CPAP) is delivered to a spontaneously breathing newborn to maintain lung volumes during expiration. With this method, blended and humidified oxygen is delivered via short binasal prongs or a nasal mask and pressure in the circuit is maintained by immersing the distal end of the expiratory tubing in water. The depth to which the tubing is immersed underwater determines the pressure generated in the airways of the infant. As the gas flows through the system, it “bubbles” out and prevents buildup of excess pressures. Bubble CPAP is a non-invasive ventilation strategy for newborns with infant respiratory distress syndrome (IRDS). It is one of the methods by which continuous positive airway pressure (CPAP) is delivered to a spontaneously breathing newborn to maintain lung volumes during expiration. With this method, blended and humidified oxygen is delivered via short binasal prongs or a nasal mask and pressure in the circuit is maintained by immersing the distal end of the expiratory tubing in water. The depth to which the tubing is immersed underwater determines the pressure generated in the airways of the infant. As the gas flows through the system, it “bubbles” out and prevents buildup of excess pressures. Bubble CPAP is appealing because of its simplicity and low cost. It is also associated with a decreased incidence of bronchopulmonary dysplasia (BPD) compared to mechanical ventilation. Not all infants with IRDS are candidates for initial treatment with CPAP and not all those who are given CPAP can be successfully managed with this modality. In the early 1970s, Gregory et al. demonstrated that providing CPAP using an anesthesia bag improved oxygenation in preterm infants with respiratory distress syndrome. Subsequently, Jen-Tien Wung at Children’s Hospital of New York, Columbia University developed the bubble CPAP system using short nasal prongs. In 1987 Avery et al. reported large differences in the risk-adjusted incidence of BPD in a comparison of 12 academic neonatal intensive care units in the United States. This study first identified the Columbia approach of using bubble CPAP in the delivery room as a possible strategy to reduce the incidence of BPD as compared to mechanical ventilation.