OBJECTIVE: To investigate the effects of nasal continuous positive airway pressure (CPAP) and cannula use in the neonatal intensive care unit. DESIGN: Cross-sectional study. SETTING: Tertiary care children's hospital. PATIENTS: One hundred patients (200 nasal cavities), younger than 1 year, who received at least 7 days of nasal CPAP (n = 91) or cannula supplementation (n = 9) in the neonatal intensive care unit. INTERVENTIONS: External nasal examination and anterior nasal endoscopy with photographic documentation. MAIN OUTCOME MEASURES: The incidence and characteristics of internal and external nasal findings of patients with nasal CPAP or cannula use. RESULTS: Nasal complications were seen in 12 of the 91 patients (13.2%) with at least 7 days of nasal CPAP exposure, while no complications were seen in the 9 patients with nasal cannula use alone. The external nasal finding of columellar necrosis, seen in 5 patients (5.5%), occurred as early as 10 days after nasal CPAP use. Incidence of intranasal findings attributed to CPAP use, in the 182 nostrils examined, included ulceration in 6 nasal cavities (3.3%), granulation in 3 nasal cavities (1.6%), and vestibular stenosis in 4 nasal cavities (2.2%). Intranasal complications were seen as early as 8 to 9 days after nasal CPAP administration. Nasal complications from CPAP were associated with lower Apgar scores at 1 (P = .02) and 5 (P = .06) minutes. CONCLUSIONS: External or internal complications of nasal CPAP can be relatively frequent (13.2%) and can occur early, and patients with lower Apgar scores may be at higher risk. Close surveillance for potential complications should be considered during nasal CPAP use.
OBJECTIVE: To investigate the effects of nasal continuous positive airway pressure (CPAP) and cannula use in the neonatal intensive care unit. DESIGN: Cross-sectional study. SETTING: Tertiary care children's hospital. PATIENTS: One hundred patients (200 nasal cavities), younger than 1 year, who received at least 7 days of nasal CPAP (n = 91) or cannula supplementation (n = 9) in the neonatal intensive care unit. INTERVENTIONS: External nasal examination and anterior nasal endoscopy with photographic documentation. MAIN OUTCOME MEASURES: The incidence and characteristics of internal and external nasal findings of patients with nasal CPAP or cannula use. RESULTS: Nasal complications were seen in 12 of the 91 patients (13.2%) with at least 7 days of nasal CPAP exposure, while no complications were seen in the 9 patients with nasal cannula use alone. The external nasal finding of columellar necrosis, seen in 5 patients (5.5%), occurred as early as 10 days after nasal CPAP use. Incidence of intranasal findings attributed to CPAP use, in the 182 nostrils examined, included ulceration in 6 nasal cavities (3.3%), granulation in 3 nasal cavities (1.6%), and vestibular stenosis in 4 nasal cavities (2.2%). Intranasal complications were seen as early as 8 to 9 days after nasal CPAP administration. Nasal complications from CPAP were associated with lower Apgar scores at 1 (P = .02) and 5 (P = .06) minutes. CONCLUSIONS: External or internal complications of nasal CPAP can be relatively frequent (13.2%) and can occur early, and patients with lower Apgar scores may be at higher risk. Close surveillance for potential complications should be considered during nasal CPAP use.
Authors: Paulo André Freire Magalhães; Ana Carolina Gusmão D'Amorim; Elis Fernanda Araújo Lima de Oliveira; Maria Evelyne Albuquerque Ramos; Ana Patrícia Duarte de Aquino Mendes; Juliana Fernandes de Souza Barbosa; Cyda Maria Albuquerque Reinaux Journal: Rev Bras Ter Intensiva Date: 2022 Apr-Jun