Nasal CPAP is standard care of management for spontaneously breathing neonates with respiratory distress. Which of following is not a physiological benefit of CPAP:
Reduction in supraglottic airway resistance
Increase in functional residual capacity
Decrease in Hering-Breuer inflation reflex following airway occlusion
Short binasal prongs as compared to nasopharyngeal prongs have been shown to be associated with:
Decreased need of reintubation after extubation from endotracheal ventilation
Reduced injury to external nares
All of above
Short binasal prongs have been found to be more effective than single prong nasopharyngeal devices. Which of following is not a possible mechanism of increased efficacy:
More effective at transmitting the prescribed pressure to the airway than single prong devices
Increase in airway resistance caused by reduced the diameter of the airway after passage of the nasopharyngeal prong
The SUPPORT trial results indicate that among ELBW neonates needing respiratory support at birth early treatment with continuous positive airway pressure (CPAP) and surfactant is superior to protocol-driven limited ventilation strategy in all of following aspects except:
Decrease in death or BPD
Decrease in need of postnatal steroids
Decrease in total days of ET ventilation
Increase probability of being alive and free from need of ET ventilation at day 7
Which of following has not been observed to be risk factors of failure of CPAP?
No antenatal steroids
Gestation <28 weeks
How surfactant and CPAP interact clinically in neonates with RDS?
CPAP reduced the need of surfactant
Early surfactant reduces the probability of CPAP failure but increases risk of pneumothorax
None of the above
Both of the above
In a neonate ready to be weaned off from CPAP which of following is most suitable based on current best available evidence?
Taken ‘OFF’ CPAP with the view to stay ‘OFF’
Cycled on and off CPAP with incremental time ‘OFF’
The systematic review on use of CPAP in neonates with respiratory distress demonstrated increased risk of pneumothorax with CPAP as compared to oxygen therapy (Number need to harm 7). Which of following statement is most correct?
This increased risk can most likely be attributed to lack of exposure to antenatal steroids non-availability of surfactant. Therefore, in present era this risk is non-existent
Neonates with normal to increased FRC continue to be at risk of pneumothorax if given CPAP and therefore CPAP should not be used in neonates with TTNB or MAS
Pressure delivered with bubble CPAP varies with input air flow and can increase dangerously to cause pneumothorax if not monitored proximally
Pneumothorax in neonates on CPAP is due to underlying disease and cannot be avoided
CPAP machines should be available in special care neonatal units at district hospitals. Which of the following is true statement supporting this recommendation?
Use of CPAP in neonates with respiratory distress decrease the need to up-transfer to higher center
Use of CPAP does not need extensive monitoring and therefore neonates on CPAP can be easily managed by nurses alone
All of the above
In which type of CPAP expiratory limb is open to environment?
Infant flow driver
Amount of gas flow is as an important determinant of CPAP delivery. Which of the following statement is most correct about gas flow?
Infant flow driver needs low gas flow to maintain the distending pressure
High flow in bubble CPAP can increase the work of breathing
Adequacy of gas flow is difficult to determine with bubble CPAP
Leak through open mouth does not alter the needed gas flow
Which of following is not a possible side effect of use of inappropriately high pressure?
Increased pulmonary blood flow leading to pulmonary hemorrhage
None of the above
Which of following is not true about gastrointestinal effect of CPAP?
Tone of upper and lower esophageal sphincter is lower than CPAP and therefore air can easily enter stomach and cause CPAP belly
Due to risk of CPAP belly, feeds should be introduced and increased very cautiously is neonates on CPAP
CPAP can cause reflux of gastrointestinal contents and therefore neonates on CPAP should be nursed in head up position
CPAP or intubation study (COIN) study compared nasal CPAP with intubation and ventilation among neonates born at less than 28 weeks of gestation. Incidence of pneumothorax was three times higher in CPAP group. In your view which factor was least likely to contribute to high incidence of pneumothorax in CPAP group?
Use of high distending pressure of 8 cm water