Research Seminar Slides - Charles Christoph Röhr
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Transcript Research Seminar Slides - Charles Christoph Röhr
How continuous positive airway
pressure (CPAP) is currently being
used – an overview
C. C. Roehr, G. Schmalisch,
R. Wauer
Charité Universitätsmedizin Berlin
Germany
NCA/Hudson
Mono-nasales
Tubus CPAP
F&P Bubble CPAP
Beneviste valve
„Kniewasser“
System
Neo-Fit
Infant-Flow driver
Long and short
binasal prongs
NCA/Hudson
Mono-nasal CPAP
F&P Bubble CPAP
„Kniewasser
System
How is CPAP being used
neonatal medicine?
Neo-Fit
Infant-Flow driver
Longe and short
binasal prongs
Use of CPAP in German, Austrian
and Swiss neonatal units
• for which clinical purpose?
• when used as primary therapy?
• what CPAP-system used?
• mono- or bi-nasal?
• flow and CPAP-level
• differences between levels of care?
• CPAP use in the delivery room
Methods
• Questionnaire study
• German national survey and internatinal
survey (FRG, A, Ch)
• all maximum level NICU and paediatr.
Hospitals
• mailed questionnaire
• telephone interview
• Statistical analysis (Statgraph®)
Methods
Nation wide
survey of all NICU (level 1-3)
International (FRG, A, Ch)
survey of all level 3 NICU
Mailed questionnaire
Postal reminder after 4 weeks
Telephone interview
Data-Analysis MS Excell / Statgraphics
Results German survey
Contacted institutions
n = 274
Surveyed institutions
Response 1st questionnaier
n = 147 (53%)
Reponse to questionnair
Response reminder
n = 127 (47%)
Response to tel. contact
Telphone contact
n = 70 (26%)
Roehr C et al. 2007
Results German survey
Contatced institiutions
n = 274
Surveyed institutions
Response 1st questionnaire
n = 147 (53%)
Reponse to questionnair
Response reminder
n = 127 (47%)
Response to tel. contact
Telephone contact
n = 70 (26%)
positive answer n = 218 (79%)
Roehr C et al. 2007
Results German survey
Contatced institutions
n = 274
Surveyed institutions
Response 1st questionnaire
n = 147 (53%)
Reponse to questionnair
Response reminder
n = 127 (47%)
Response to tel. contact
Telephone contact
n = 70 (26%)
positive answer n = 218 (79%)
Roehr C et al. 2007
No aswer n = 57 (21%)
Characteristics of institutions
Admissions
per year*
Primary paed.
care
Secondary
paed. care
Tertiary
paediatric care
Total
<10
ventilator
beds
>10
ventilator
beds
n
(Mean and
(Range)
85
259
(201000)
75 (89%)
7 (11%)
110
312
(501000)
93 (85%)
16 (15%)
23
393
(180-1100)
6 (27%)
16 (73%)
218
*p = 0.014
GGkl1500g/LebendgebJahr*100
Patients < 1500g/year
Box-and-Whisker Plot
10
8
6
4
2
0
Primary
1care hosp.
Secondary
care
2
tertiary
3 care hospital
Institution
Einrichtung
p<0.0001 between
institutions
No sign. difference in CPAP use
across institutions
Guideline
CPAP use
CPAP post extubation
CPAP –
ADS
57 %
95 %
93 %
n
Primary paed.
care
85
CPAP ApnoeaBradycardiaSyndrome
98 %
Secondary
paed. care
Tertiary
paediatric care
p=
95 %
110
97 %
53 %
23
96 %
100 %
100 %
74 %
0,13
100 %
0,57
0,46
0,28
Mono-, bi-nasal, or both CPAP-systems?
Differences between
institutions not statist.
significant
Use of CPAP as commercial system,
composite system or custom made
Commercial
system
Composite
Systems
Custom made
system
Roehr C et al. Eur J Med Res 2007: 12; 139-44
CPAP generators used in
German NICUs
sonstige
Fisher & Paykel Infant Star
Leoni
Bubble CPAPSystem
F 120 B
Christina
9%
26%
F 120 M
F 120 A
13%
Stephanie
36%
Roehr C et al. Eur J Med Res 2007: 12; 139-44 Babylog 8000
Leoni
Infant Flow System (EME)
Babylog 8000
Stephanie
F 120 A
Infant
flowSystem
driver
Infant
Flow
F 120 M
(EME)
(EME)
Christina
F 120 B
Bubble CPAP-System
Infant Star
sonstige
Maximum tolerated CPAP
80
70
60
%
50
40
30
20
10
0
1
5
2
6
3
7
4
8
5
9 -12
CPAP
in cmH
CPAP
in cm
H20
2O
Median 7 cmH2O
Differences between
institutions not statist.
significant
Frequency (%)
Flow under CPAP
1 to 4
4.5 - 5.5
L/min
6-7
Median 6 L/min
8-9
Differences between
institutions not statist.
significant
2nd investigation:
A survey of neonatal units of German
speaking countries
International survey FRG, A, CH
Stepwise approach of tertiary neonatal units
Units approached with
1st questionnaire
2nd questionnaire
n = 249
100%
n = 123
49%
n = 25
10%
Telephone interview
Results: CPAP in DR
O2- Blenders
97
Pulse oxymetry
97
Self-inflating bag
92
T-piece resuscitator
40
sust. inflations <
5sec
34
prol. inflations >
5sec
25
CPAP 4-5 cmH2O
76
Polyethylene foil
62
Hat / head cover
80
Late-clamping
43
0
10
20
30
40
50
60
70
80
90
100
in percent (%)
*no statistical difference between regions, univ. or non-univ. neonatal units
Summary
• Wide spectrum of clinical appliactions
– RDS
– Apnoea-Bradycardia-Syndrome and
– post-extubation
• parallel use of low-flow (bubble) CPAP, high-flow and
respirator generated CPAP
• Heterogeneity of flow and CPAP-levels
• CPAP in DR used with and without prolonged
inflations
Conclusion
• Use of CPAP in German speaking countries
is not standardized
• We believe this may reflect gaps in
knowledge on the potentials of CPAP, as well
as lack of sound evidence for specific areas
of CPAP therapy
further clinical studies are needed.
Educational opportunities to learn about
CPAP should be widely offered.