Table 1 Components of CPAP practice before and after the implementation of the new guidelines.
Element | Baseline CPAP practice | New b-CPAP guidelines |
|---|---|---|
Delivery room management | Preterm infants are intubated, and surfactant is administered shortly after | CPAP is the primary mode of support. Preterm infants are intubated if they have apnea or if unable to achieve goal saturation while supported with CPAP |
CPAP device | Machine generated via ventilators, infant flow apparatus, or biphasic CPAP device | Only bubble CPAP |
Facial interface | Facial mask, binasal prongs, or RAM cannula | Only short curved binasal prongs |
CPAP pressure | No limits; ranging from 4 to 12 cmH2O | 5 cmH2O with the option to increase to 6 cmH2O if no improvement |
CPAP failure criteria | Unspecified | FiO2 > 50% in the first day or >60% thereafter, clinically significant apnea, and PCO2 > 65 mmHg accompanied with metabolic acidosis (BD > 10 mmol/L) |
CPAP weaning criteria | Unspecified- frequent transition HFNC | Weaning of FiO2 until reaches 21%. No use of HFNC. No pressure wean. CPAP is tried off once a day until successful. |
CPAP exchange with nasal cannula or HFNC | Yes | Not permitted |
Respiratory support after extubation | NIPPV, CPAP, HFNC | Bubble CPAP |
CPAP implementation tool | ||
Bedside CPAP training | No | Yes |
Bedside checklist | No | Yes |
CPAP guidelines | No | Yes |
Reliability measure | No | Yes |
