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J Perinatol. 2005 Jul;25(7):453-8.

Work of breathing during nasal continuous positive airway pressure in preterm infants: a comparison of bubble vs variable-flow devices.

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Department of Pediatrics, Schneider Children's Hospital, North Shore Long Island Jewish Health System, New Hyde Park, NY 11040, USA.



To compare work of breathing and breathing asynchrony during bubble nasal continuous positive airway pressure (NCPAP) vs variable-flow (VF)-NCPAP in premature infants.


We studied 18 premature infants of birth weight <1500 g who required NCPAP for mild respiratory distress. Each infant was studied on bubble and VF-NCPAP at 8, 6, 4, and 0 cm H2O. Tidal volumes were obtained by calibrated respiratory inductance plethysmography. Esophageal pressure estimated intrapleural pressure. Inspiratory and resistive work of breathing were calculated from pressure-volume data. Breathing asynchrony was assessed with phase angle. The results at all NCPAP levels were referenced to VF-NCPAP values at 8 cm H2O.


Provision of NCPAP with either device decreased inspiratory work of breathing, tidal volume, and minute ventilation relative to NCPAP of 0 cm H2O. Bubble NCPAP did not decrease resistive work of breathing relative to 0 cm H2O. Resistive work of breathing (p=0.01), respiratory rate (p<0.03), and phase angle (p=0.002) were all greater with bubble compared to VF-NCPAP.


The more labored and asynchronous breathing seen with bubble NCPAP may lead to higher failure rates over the long term than with VF-NCPAP.

[Indexed for MEDLINE]

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