Question 1

Which form of CPAP has been associated with a "thoracic wiggle"?

Accepted Answer

Subjective accounts of a visible "thoracic wiggle" from bubbles are often reported by clinicians caring for infants receiving B-CPAP.The use of higher flows can result in more vigorous bubbling and higher pressure fluctuations in the delivery system.However,higher flows do not appear to improve gas exchange.

Question 2

What is considered the most effective interface option for delivering CPAP to infants?

Accepted Answer

Today,CPAP is most often administered through short binasal prongs,and this method is considered the most effective interface option for delivering CPAP to infants.

Question 3

After increasing the level of CPAP delivered to an infant,the therapist notices that the neonate's PaCO₂ rises and the PaO₂ falls.What may have caused this situation?

Accepted Answer

A rise in PaCO₂ or fall in PaO₂ soon after the CPAP pressure has been increased may indicate that the optimal CPAP level has been exceeded.An increase in mean airway pressure can result in increased alveolar dead space because of mechanical compression of the pulmonary microvasculature.If gas exchange worsens in a patient who appeared to be improving,the CPAP pressure can first be reduced.If the patient's situation does not improve,endotracheal intubation and mechanical ventilation may be indicated.

Question 4

When nasal cannulas are used in infants at high flows,which factors determine the amount of pressure to the airways?
I.Flow rate
II.Size of the leak around the cannula
III.Degree of the mouth opening
IV.FiO₂

Accepted Answer

When the pressures delivered with this technique measured are highly variable,depend on the flow rate,the size of leak around the cannula,and the degree of mouth opening.

Question 5

Which of the following features are often components of CPAP systems incorporated within infant ventilators?
I.Highly responsive demand flow systems
II.Apnea backup breaths
III.FiO₂ compensation mechanisms
IV.Leak compensation capabilities

Accepted Answer

Today,a number of commercially available microprocessor-controlled infant ventilators allow non-invasive application of V-CPAP.In these systems CPAP is maintained with a variable demand-flow system.Flow rate and airway pressure are regulated by servo-controlling the aperture size of the exhalation valve.These ventilators also include the following: (1)highly responsive demand flow systems, (2)leak compensation, (3)airway graphics monitoring,and (4)apnea backup breaths.

Question 6

Where in the CPAP delivery system should the pressure-relief/pop-off valve be placed to detect circuit occlusion?

Accepted Answer

A high-pressure pop-off can be placed as close to the patient as possible should the expiratory limb become occluded.

Question 7

A preterm infant in respiratory distress is a candidate for CPAP.To minimize the work of breathing,which device should be used?

Accepted Answer

IF-CPAP has been shown to significantly reduce inspiratory WOB in preterm infants.

Question 8

Which of the following therapeutic interventions would be appropriate for a neonate with a respiratory rate of 65 breaths/minute while displaying paradoxical chest wall movement with suprasternal and substernal retractions,grunting,nasal flaring,and cyanosis,along with the following blood gas data: pH 7.30;arterial partial pressure of carbon dioxide (PaCO₂),50 mm Hg;arterial partial pressure of oxygen (PaO₂),60 mm Hg?

Accepted Answer

According to American Association for Respiratory Care (AARC)clinical practice guidelines,neonates presenting with a respiratory rate greater than 30% of normal and paradoxical chest wall movement with suprasternal and substernal retractions,grunting,nasal flaring,and cyanosis should be considered for placement on CPAP as long as they are able to demonstrate adequate ventilation as defined by PaCO₂ less than 60 mm Hg and pH greater than 7.25.

Question 9

In order to rinse the system of exhaled CO₂ and meet the inspiratory flow rate requirements of infants placed on B-CPAP,the flow rate of humidified gas should be set at:

Accepted Answer

The flow rate of humidified gas (6 to10 L/min)is set to meet the inspiratory flow rate requirements of the patient,maintain the CPAP level,and rinse the system of exhaled carbon dioxide.

Question 10

Which of the following outcomes are advantages of CPAP over mechanical ventilation in infants?
I.Lower risk of sepsis
II.Lower incidence of lung injury
III.Fewer cases of chronic lung disease
IV.Lower incidence of renal failure

Accepted Answer

Mechanical ventilation in preterm infants is associated with increased risk of sepsis,lung injury,arrested lung development,and chronic lung disease.

Question 11

Which of the following complications of CPAP can develop when an infant experiences inadvertent positive end-expiratory pressure (PEEP)from gas trapping resulting from tachypnea?

Accepted Answer

CPAP is associated with some of the same hazards and complications that are frequently associated with mechanical ventilation.Pneumothorax is a complication occasionally reported in infants receiving CPAP.This is a result of inadvertent positive end-expiratory pressure related to gas trapping when infants are tachypneic and do not have a sufficient expiratory time.This may also occur after surfactant replacement therapy,when pulmonary compliance improves and the infant has not been weaned appropriately and,thus,is exposed to excessive airway and hence alveolar pressure.

Question 12

After initiating IF-CPAP in an infant at 8 cm H₂O,the therapist notices a low-pressure alarm.What should be done to correct this situation?

Accepted Answer

In the IF-CPAP and mechanical ventilator CPAP systems,low-pressure alarms usually indicate a leak caused by nasal prongs that are too small or an excessive oropharyngeal leak.The oropharynx acts as a safety valve,preventing excessive accumulation of pressure in the airway.Oropharyngeal leaks are more common when using CPAP levels exceeding 8 to 10 cm H₂O.A chin strap or pacifier can be helpful at gently sealing the leak and reestablishing the CPAP level.

Question 13

Which of the following anatomic structures should be closely evaluated when using nasal masks in the administration of IF-CPAP?

Accepted Answer

Nasal prongs have been shown to result in nasal and septal wall skin breakdown,whereas nasal masks have been associated with breakdown low on the septum or at the base of the philtrum.

Question 14

After initiating B-CPAP in an infant at 6 cm H₂O,the therapist notices that,although "bubbling" is present,the pressure in the manometer fluctuates between 2 and 5 cm H₂O.What may have caused this situation?

Accepted Answer

Small fluctuations in pressure are common because of the frequency and amplitude of the bubbles;however,if large fluctuations are noted and coincide with the inspiratory phase of the infant,additional flow should be added to the system.

Question 15

How is the positive pressure level established in a bubble CPAP system?

Accepted Answer

A measuring tape is attached to the outside of the water column.The CPAP level is maintained by submerging the distal end of the expiratory circuit straight down into the fluid from the surface of the water line to a measured depth in centimeters,thus creating the amount of CPAP in centimeters of water.If a higher level of CPAP is needed,the tube can be advanced farther down into the fluid column.

Question 16

Which of the following conditions are contraindications for nasal CPAP?
I.Pneumonia
II.Tracheoesophageal fistula
III.Choanal atresia
IV.Atelectasis

Accepted Answer

Infants with persistent apneic episodes who are unable to maintain PaCO₂ less than 60 mm Hg and pH greater than 7.25 should not be given CPAP.If they are already receiving CPAP,mechanical ventilation is indicated.Infants with congenital anomalies such as choanal atresia,cleft palate,tracheoesophageal fistula,or preoperative diaphragmatic hernia should not receive CPAP.CPAP is contraindicated in infants with neural muscular disorders,infants receiving CNS depressants,and infants with central apnea or frequent apneic episodes resulting in desaturation and/or bradycardia.In addition,severe cardiorespiratory instability and poor respiratory drive is also a contraindication to the initiation of CPAP.

Question 17

Which of the following CPAP systems delivers a more consistent pressure,lowers work of breathing (WOB),is less sensitive to leaks,and is more effective at alveolar recruitment compared with other forms of CPAP?

Accepted Answer

The IF-CPAP system has been shown to deliver a more consistent pressure,to lower WOB,to be less sensitive to leaks,and to be more effective at alveolar recruitment compared with other forms of CPAP.

Question 18

How should a therapist determine the size of the nasal prongs to effectively administer CPAP to infants?

Accepted Answer

The prongs should fill the entire nares without blanching the external nares.Selecting prongs that are too small can result in increased resistance and WOB,prong displacement,and excessive leaks.

Question 19

A bubble CPAP has been set up on an infant at 12 L/min and the water column is reading 4 cm H₂O.A chest X-ray reveals mild lung overdistention.What is the most feasible explanation for this finding?

Accepted Answer

The pressure measured at the nasal prong could be slightly higher than the submersion depth of the expiratory tubing below the water surface when higher flow rates are used;therefore,airway pressure should always be monitored at the nasal prong to ensure proper CPAP levels.

Quiz 15: Non-Invasive Mechanical Ventilation and Continuous Positive Pressure of the Neonate

Which form of CPAP has been associated with a "thoracic wiggle"?

What is considered the most effective interface option for delivering CPAP to infants?

After increasing the level of CPAP delivered to an infant,the therapist notices that the neonate's PaCO₂ rises and the PaO₂ falls.What may have caused this situation?

When nasal cannulas are used in infants at high flows,which factors determine the amount of pressure to the airways? I.Flow rate II.Size of the leak around the cannula III.Degree of the mouth opening IV.FiO₂

Which of the following features are often components of CPAP systems incorporated within infant ventilators? I.Highly responsive demand flow systems II.Apnea backup breaths III.FiO₂ compensation mechanisms IV.Leak compensation capabilities

Where in the CPAP delivery system should the pressure-relief/pop-off valve be placed to detect circuit occlusion?

A preterm infant in respiratory distress is a candidate for CPAP.To minimize the work of breathing,which device should be used?

In order to rinse the system of exhaled CO₂ and meet the inspiratory flow rate requirements of infants placed on B-CPAP,the flow rate of humidified gas should be set at:

Which of the following outcomes are advantages of CPAP over mechanical ventilation in infants? I.Lower risk of sepsis II.Lower incidence of lung injury III.Fewer cases of chronic lung disease IV.Lower incidence of renal failure

Which of the following complications of CPAP can develop when an infant experiences inadvertent positive end-expiratory pressure (PEEP) from gas trapping resulting from tachypnea?