RT obtains trade insights on bubble CPAP administration and the way expertise and finest practices are serving to to make sure extra infants keep efficiently on noninvasive assist.
Bubble CPAP is designed to offer a protected, protecting, and efficient methodology of respiratory assist to spontaneously respiratory neonates. New developments in bubble CPAP expertise allow respiratory therapists to constantly ship important care to new child kids and infants.
On this trade Q&A, RT speaks with producers on the state of bubble CPAP expertise and the way RTs can safely and efficiently implement expertise. Collaborating on this month’s dialogue are:
Erika Ingbretson, Cert. AT, Sr. Advertising Supervisor, Respiratory Consumables, Dräger Inc.
Robert Landis, BS, RRT, Co-founder, Director of R&D, DRW Medical Inc.
RT: What’s new with bubble CPAP? Have improvements in bCPAP techniques improved medical outcomes in neonatal populations?
Erika Ingbretson (Dräger): Innovation in bCPAP is occurring on two fronts: expertise and apply. On the expertise aspect, the Dräger Bubble (Seattle PAP Plus) makes use of a patented 135o angled submersed tube designed to assist scale back the work of respiratory, thereby doubtlessly serving to to stop remedy failure from respiratory muscle fatigue.1 Security and usefulness enhancements reminiscent of a self-sealing expiratory water lure, locking CPAP probe, and longer circuits for kangaroo care could additional assist strengthen remedy supply.2
On the similar time, medical apply has developed. Beginning bCPAP earlier within the supply room, combining it with less-invasive surfactant (LISA/MIST), making use of automated oxygen management, and utilizing gentler interfaces have been related to diminished intubations, enhance security, and make CPAP extra sustainable for fragile neonates.3-5 Collectively, expertise and apply improvements are serving to to make sure extra infants keep efficiently on noninvasive assist.
Robert Landis (DRW Medical): What’s new with bCPAP is that many RTs are utilizing stress screens with excessive/low airway stress alarms. This has the benefit of alerting us of interface dislodgment earlier than a de-sat or bradycardia alarm. This apply is saving numerous quantities of hypoxic occasions permitting the affected person to develop and thrive. It additionally alerts us when rain-out within the exhalation tubing provides stress to the CPAP.
RT: What proof helps the position of bCPAP in lowering the necessity for air flow, and the way are newer applied sciences reinforcing that pattern?
Ingbretson: There are a number of research that present using bCPAP could assist decrease oxygen necessities and scale back respiratory decompensation which reduces the necessity for mechanical ventilation6. This may, in flip, assist scale back the incidence of persistent lung illness and reduce the size of NICU stays.6
Respiratory muscle exhaustion is commonly recognized as a significant explanation for failure in typical CPAP remedy.7 It happens in half of infants receiving this remedy and infrequently necessitates endotracheal intubation and mechanical air flow, each of which carry the danger of tissue injury and irritation.6
Dräger partnered with main specialists within the subject to assist enhance the science and expertise of bubble CPAP remedy. The aim was to create a bubble CPAP answer that might reduce the load on respiratory muscular tissues, assist scale back the probabilities of CPAP remedy failure attributable to respiratory muscle exhaustion and assist infants with respiratory misery syndrome breathe extra simply. To minimize the load on respiratory muscular tissues, Dräger designed Dräger Bubble – Seattle PAP Plus to reinforce bubble CPAP remedy and supply an improved possibility for respiratory assist.
RT: What are the most typical issues related to bCPAP, and the way can they be mitigated by design or protocol enhancements?
Ingbretson: One frequent complication related to bCPAP is unintended modifications in CPAP stress. Such modifications will be dangerous to the affected person and doubtlessly enhance the prospect of remedy failure. These unintended modifications are generally attributable to:
Unintended motion or adjustment of the CPAP probe. That is frequent with the standard design of the CPAP probe on the bubble field because it lacks any built-in safeguards to stop unintentional adjustment/motion.
An excessive amount of condensate trapped within the expiratory limb of the respiratory circuit.
To assist mitigate these dangers, Dräger’s bubble CPAP provides an answer with a locking CPAP probe designed to assist stop any unintentional modifications to CPAP stress. As well as, Dräger’s bubble CPAP incorporates a self-sealing expiratory water lure built-in inside the respiratory system to assist reduce the danger of stress spikes ensuing from condensate.
Landis: The commonest complication is the breakdown of nasal tissue. This may be mitigated considerably by ensuring the interface is fitted with out limiting tissue perfusion. It’s higher to error on the unfastened aspect slightly than becoming too tight.
RT: In comparison with different sorts of respiratory assist, bCPAP is mostly thought of cheap. Are product developments inflating prices or can the trade make enhancements whereas sustaining affordability?
Ingbretson: There isn’t essentially a correlative relationship between product development and value inflation. Dräger’s Bubble CPAP is an modern product with enhanced security options and is obtainable at a value level thought of to be cost-effective.
Landis: Product developments could seem to inflate prices, however it’s extra possible because of the rising prices of medical gadget laws and having access to hospital procurement techniques. The small market measurement for the bCPAP makes it difficult for innovation. Anticipate bCPAP product developments to return from sensible clinicians who’re courageous and enthusiastic about enhancing affected person care.
RT: Inform us about your bubble CPAP system. What are among the options and benefits it provides?
Ingbretson: As a worldwide chief in neonatal and pediatric air flow, Dräger partnered with main specialists within the subject to enhance the science and expertise of bubble CPAP remedy. The aim was to create a bubble CPAP answer that might reduce the load on respiratory muscular tissues, reduce the probabilities of CPAP remedy failure attributable to respiratory muscle exhaustion, and assist infants with respiratory misery syndrome breathe simpler.
To minimize the load on respiratory muscular tissues, Dräger designed the Dräger Bubble – Seattle PAP Plus to reinforce bubble CPAP remedy and supply an improved possibility for respiratory assist. (See Desk 1.)
Desk 1. Options & Advantages of Drager Bubble
| Dräger Bubble Options | Dräger Bubble Advantages |
|---|---|
| CPAP probe locks in place | • Helps stop undesirable stress spikes that may happen in techniques with out built-in safeguards—a profit as a result of unintended modifications in CPAP stress can hurt the affected person and enhance the danger of remedy failure |
| Proprietary 135° angle within the submersed tubing | • Will increase the amplitude of oscillations • Supplies results much like excessive frequency oscillatory air flow • Confirmed to cut back the affected person’s work of respiratory |
| Lengthy and versatile circuits | • Helps scale back the danger of unintentional disconnection from affected person throughout transition / transport and parental kangaroo / skin-to-skin care |
| Self-sealing expiratory water lure | • Mitigates danger of stress spikes ensuing from condensate in tubes – a typical challenge with tubes missing hooked up expiratory valves that, if not continuously monitored, will increase the prospect of remedy failure |
| 24/7 technical / medical assist | • Provides clients 24/7 reside entry to clinicians acquainted with Dräger Bubble who might help troubleshoot conditions |
RT: How does interface choice and match affect the efficacy and security of bCPAP in NICU infants? What developments have interfaces seen in recent times?
Ingbretson: Interface selection and match can instantly have an effect on delivered stress, tolerance, and pores and skin integrity. A noninvasive respiratory assist system will be designed to assist maximize efficiency and affected person consolation.
The Dräger BabyFlow Plus respiratory assist system was designed utilizing state-of-the-art expertise (Computational Move Evaluation) to assist scale back the imposed work of respiratory for the affected person. Each single part, together with individually sized masks and nasal prongs, have been designed with the aim of supporting optimum efficiency and affected person consolation. As well as, the streamlined adapter head is meant to reinforce circulate distribution.
We would like your sufferers to really feel snug. The much less discomfort a affected person experiences, the better the chance the affected person could have for wholesome development and improvement throughout this important time within the affected person’s restoration.
The adjustable angle on the BabyFlow Plus interface allows you to match the prongs and masks correctly on the affected person, thus serving to to cut back leaks and supply extra steady CPAP ranges. Extra steady CPAP ranges can scale back noise ranges, making BabyFlow plus a low noise stage respiratory assist system, due to this fact, supporting Developmental Care practices and providing glorious remedy for tiny sufferers. The flexible, kink resistant hoses assist allow appropriate positioning of the affected person. Swivel connectors might help reduce pointless disconnections of the respiratory circuit, thereby serving to to make sure steady CPAP pressures.
Landis: Interface choice is commonly pushed by affected person consolation and tissue injury avoidance slightly that bCPAP efficacy. For instance, selecting a excessive circulate RAM cannula for consolation and including an underwater bubbler will not be bCPAP. With this setup, the depth of the tube effervescent underneath water will not be the stress within the affected person’s airway, which is unknown. Sufferers exhale round excessive circulate cannula not into them. Bubble CPAP is outlined by having the nasal cannula fitted sealingly into the nares requiring the affected person to inhale from the cannula and exhale again by the cannula in opposition to the depth of water within the bubbler to generate the CPAP. Interfaces will proceed to be refined, since avoiding tissue breakdown is a main aim.
RT: What different developments in expertise, or expanded medical indications, do you foresee within the subsequent 5 years and past? (If any)
Ingbretson: As a part of Dräger’s dedication to reinforce affected person outcomes whereas lowering general care prices, Dräger sees this as a chance to research patient-ventilator synchrony to assist improve noninvasive modalities, advance security measures to reduce human error, in addition to enhance workflow processes to accommodate the various medical calls for of those tiny sufferers.
Landis: The subsequent development is utilizing higher airway pressures to handle excessive circulate remedy. After that we’re taking a look at noninvasive tidal quantity for bCPAP and high-flow remedy.
RT
For extra data, contact [email protected]
References
- Kamlin CO, et al. Bubble CPAP with Seattle-PAP vs typical bubble CPAP: a multicenter randomized managed trial. Journal of Pediatrics. 2023;254:62-69.e2. doi:10.1016/j.jpeds.2022.11.035
- Draeger, Inc. Seattle PAP: Product Overview and Technical Options. Lübeck, Germany: Draeger Medical Techniques; 2022.
- DeMauro SB, et al. Impression of supply room steady constructive airway stress on outcomes in extraordinarily preterm infants. Journal of Pediatrics. 2013;163(1):144-149.e1. doi:10.1016/j.jpeds.2012.12.017
- Aldana-Aguirre JC, et al. Much less invasive surfactant administration versus intubation for surfactant supply in preterm infants with respiratory misery syndrome: a scientific overview and meta-analysis. Arch Dis Baby Fetal Neonatal Ed. 2017;102(1):F17-F23. doi:10.1136/archdischild-2015-309216
- Claure N, et al. Automated adjustment of impressed oxygen in preterm infants with frequent episodes of hypoxemia. J Pediatr. 2011;159(4):512-518.e1. doi:10.1016/j.jpeds.2011.04.011
- Sujakhu E, et al. Bubble CPAP in Infants. [Updated 2025 Jun 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan. Accessible from:
- Welty S, et al. Brief time period analysis of respiratory effort by untimely infants supported with bubble nasal steady airway stress utilizing Seattle-PAP and a typical bubble gadget. Plos One. 2018 Mar 28.
