- Additional breaths stimulate respiration
- Airways are stabilized which facilitates breathing as a result
- The patient’s own breathing is detected and the device switches into CPAP mode
- Available in the devices medinCNO®, medinCNO®mini, medin-NC3®
Apnea and breathing irregularities affect nearly every premature infant and newborn. The more premature the infant is, the more markedly apnea occurs. They represent a disruption in the respiratory mechanics as well as respiratory control. The most important feature of the apnea is the intermittent air flow in the patient’s airway.
Apnea is clinically significant for the patient due to the concomitant symptoms such as bradycardia <80 BPM (decreased heart rate) and hypoxia <80% (decreased oxygen saturation). The goal of prophylaxis and treatment of apnea is to avoid or minimize negative effects. (Pantalitschka 2009, AMWF)
Importance of nCPAP for Apnea-therapy
The efficacy of nasal CPAP is proven in this context by studies and is a part of the applicable guidelines for the treatment of apnea and its concomitant symptoms (Pantalitschka 2009, AMWF, De Paoli AG 2008).
The mechanisms of action are:
- Holding the airways open through positive pressure
- Increasing the FRC
- Increasing the respiratory drive through improved oxygenation
- Reducing the breathing effort
The medin ApneaCPAP mode as a closed-loop apnea treatment can be used from the prophylaxis to the treatment of existing apnea.
Based on the nCPAP mode, central and obstructive apnea is detected with the unique MediTRIG technology and responded to with automatic additional breaths from the CPAP device. The level of the peak pressure of the breaths is adjusted with a second electronic flow meter and added to the basic flow. The parameters of the ApneaCPAP function as well as of the MediTRIG can be individually adapted to the patient.
The following parameters are to be set
- Sensitivity trigger: +/- mbar; upper and lower trigger threshold as the pressure difference with regard to the PEEP
- Apnea time: From 2 s to 20 s; duration of breathing pause until device reacts
- Inspiration time: From 0.2 s to 2 s; duration of breath
- Push flow: Additional adjustable breathing gas flow with which peak pressure can be generated
- Backup rate: Number of automatic breaths per minute which are administered to the patient after the end of apnea time
2 Automated breath
Pantalitschka T, Sievers J, Urschitz MS, Herberts T, Reher C, Poets CF. Randomised crossover trial of four nasal respiratory support systems for apnoea of prematurity in very low birthweight infants. Arch Dis Child Fetal Neonatal Ed. 2009; 94(4):F245-8.
AWMF, 024-013 – S2k- Leitlinie: Therapie idiopatischer Apnoen, Bradykardien und Hypoxämien; AWMF; www.awmf.org
De Paoli AG, Davis PG, Faber B, Morley CJ. Devices and pressure sources for administration of nasal continuous positive airway pressure (NCPAP) in preterm neonates. Cochrane Database Syst Rev. 2008(1):CD002977