Bubble CPAP Project

We worked with a team from AIC Kijabe Hospital to establish bubble CPAP in the NBU of a low-resource hospital in Western Kenya.
• Respiratory distress syndrome (RDS) accounts for 50 percent of preterm and neonatal deaths.
• The lungs do not expand enough for neonates with respiratory distress to generate adequate pressure difference to facilitate gaseous exchange.
• Bubble CPAP is a low-cost setup that helps generate enough positive pressure to facilitate gaseous exchange.
• Studies in AIC Kijabe Hospital revealed a reduction of over 20 percent among preterm patients with respiratory distress with the use of Bubble CPAP. (Survival to discharge percentage from 61% to 85%)
• Bubble CPAP also helps prevent chronic lung disease.
Components
1. 500 cc bottle with a scale of cm
2. Nasogastric tube
3. Nasal prongs (patient interface)
4. Oxygen source

Set-Up
1. Fill water into the NS bottle to level of 10cm
2. Connect an NG tube to the bottle to the level of 5cm. Ensure the lid is not airtight and change the water in the bottle daily.
3. Connect the NG tube to one end of the nasal prongs.
4. The other end of the nasal prongs should be connected to an oxygen source.
5. Increase oxygen pressure until bubbling is visible on the NS bottle. This is the source of positive pressure.
6. If there is no bubbling, investigate for leaks in the system.
7. If there are no leaks, the baby is probably breathing through the mouth, and the lower jaw should be stabilized. Other sources of air loss, such as pneumothorax, should also be ruled out.
8. Monitor the patient’s sp02; too much pressure may result in barotrauma.
9. Stabilize the prongs using gauze loosely or strapping. The baby should also have a hat.

• This setup can easily be done in a low-resource hospital.

Common Indications for Bubble CPAP
1. Respiratory distress syndrome
2. Apnea of prematurity
3. Collapsible airway conditions, e.g., Tracheomalacia
4. Transient tachypnea of the newborn.
Complications
1. Nasal septal injuries
2. Gastric distension due to swallowed air (use orogastric tube to decompress)
3. Pneumothorax
4. Secretions causing obstructions.
Precautions
1. Optimal nursing care is necessary.
2. Change water in the bottle every 24 hours.
3. Ensure the system is airtight, as any escaping air through the system or the baby may negate the positive pressure.
4. If the patient has signs of severe distress, refer to a NICU for mechanical ventilation.