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dr ayub murad

mechanical cpap alternatives

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hi we work in under sourced circumstances there fore cpap and vents are available in vey few centers and many of our pts suffer .while searching i came across a simple manual oxygen source to under water seal circuit,as we hv no experience with it can any body share on this or any other methods also if any body can inform us about donors for cpap or vent thnks my source was utube bubble cpap/docrajesh75@yahoo.com

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No experience with buble cpap, but check out the benveniste valve for CPAP.

http://www.dameca.dk/produkter/neonataludstyr/ventilen-med-studs.aspx

It has been the primary mode of ventilatory support for neonates in Denmark for three decades. Very easy to use, the valve is comparatively cheap (aprox 300 $ ) and made to be reused ( I don`t know if its still copyright protected, but i think manufacturing should be quite simple and feasible in most corners of the world) . The danish pediatric society has a cooperation with Cuba helping introducing it there, and I think it has been used in India as well.

What part of the world are you practicing in ?

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Hi Dr Ayub I'm glad to share with you our experience with the bubble CPAP. I'm a Neonatologist in Dominican Republic and we have a very good experience with it.

To make the CPAP you will need a neonatal oxygen nasal canula,a 3 way stopcock ,2 pieces of plastic hose, a saline solution plastic bottle, centimeter, Z-O, and a source of oxygen.

First prepare the bottle. Empty the saline a little more than half way,with a blade open a slit and pass through it one hose ( you can use an IV line ).Make a presssure guide with the centimeter and the Z-O, stick it in the bottle from the bottom up.

Conect to the 3 way stopcock, then conect the nasal canula ( you need to cut it to make it fit), and the oxygen hose.

When everything is in place you need to see the bubbles in the saline to know is working properly.

We begin with 3-4 lts of O2, and 3-4 cms of pressure. Move with clinical condition and oxygen sat.

The tip of the saline hose is what you will move up or down to change the pressure.

It really help.. and its not hard to make. Our nurses do it in a blink, it only takes practice. Give it a try. I hope this is clear enough to help you. This is the beauty of 99 NICU. Best wishes for you and your babies.Leonora

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thanks dear padkaer,i practicing n pakistan it province calld Balochistan v v backword area.if you have danish pediatric society emil. thankful

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how u will take care of FIO2 in this system of bubble CPAP?

Use a blender - needs O2 and Air supply - Example : http://www.viamed.co.uk/eng/?uid=&sessionid=&page=catagory&cat=360&subcat=419

Another example: http://www.biomeddevices.com/index.html?neo_blend.html&3

or use a room air plus O2 blender Eg: - http://www.nascor.com.au/public_html/business/pdf/oxygen-air-mixer-brochure.pdf

(I am not sure if the last example is made for use in a cpap circuit but I am sure it can be made to work !!! )

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We also use Bubble CPAP with a good results... We have a small air compressor here, so we can lower the FiO2.. Don't need any oxygen blender (before that, we use to use a venturi adaptor..kind of work though)... With the 2 gas source, you're going to need 2 flowmeters (oxygen and air) blended together with the three way (FiO2 is calculated with concentration formula : V1M1xV2M2=V3M3)... But you need to use a humidifier to... Dry and cold gas is not good for the baby.. I don't see a humidifier in Leonora's CPAP..

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In india also this kind of bubble CPAP have been used with good results....can be used where bubble cpap machines are not available....difficulties regarding FiO2 and warming & humidification exists

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That's great info. Just to add the neonatal team at Columbia presbyeterian NY are the pioneers in bubble cpap and they have shown that their rates of CLD are lower than the national rates due to bubble cpap.

The fact the bubble cpap produces a wavy pattern in flow and possibly pressures in the tube as the bubbles get released is thought to be less barotrauma tic to the lungs.....

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Dear collague Dr.Leonora

realy i am pleasure to know that i can made a CPAP without a machine which usually not present in many NICUs in Egypt and some babies urgently need for them or we need for tansport that babies with many side effect of tansportation...... thank you...., But

if you please ,, could you share a pictures for your hand made CPAP and way for make it by my self

thanx alot

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HI DR Murad,

We have uesd the bubble cpap with the RAM cannula, we use the Fisher&Packle heaters. It works very well, you would need a blender and a flow meter and acetic acid for your water source to prevent any infections. presure manometer to confirm your pressure.

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Hi Dr. Dinag.I'll be very happy to share with you our experience. I will send you the pictures of our CPAP, as soon as I can , I'm now out of town for personal reasons.This is a rudimentary way of giving some pressure, to babies that need respiratory support. But we can talk about a before and after, in our mortality rates from respiratory failure, as soon as we learn how to use them. Thanks for the oppportunity to help your babies from so far away.

Thanks 99 NICU !!!!!. Regards. Leonora.

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Hi Dr. Dinag.I'll be very happy to share with you our experience. I will send you the pictures of our CPAP, as soon as I can , I'm now out of town for personal reasons.This is a rudimentary way of giving some pressure, to babies that need respiratory support. But we can talk about a before and after, in our mortality rates from respiratory failure, as soon as we learn how to use them. Thanks for the oppportunity to help your babies from so far away.

Thanks 99 NICU !!!!!. Regards. Leonora.

dear friend can you please post it with photo so that it become easy to understand, if not possible it here i the forum, u cn mail me at drsandy2005@gmail.com

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thank u >>>>what about acetic acid?is it irritant? we can change the water frequently instead?

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V1M1xV2M2=V3M3 what did mean this formula ?

Dear. Dr. Nashwa,

In our unit, oxygen blender is out of reach, it's too expensive.. We use this formula to lower our oxygen concentration. V1 is volume of the first gas (oxygen), times M1 (which is oxygen concentration of the first gas, central O2=100%).. Added to V2 (volume of the 2nd gas, which is air), times M2 (21%).. Equal to V3 (volume of the 3rd gas), times M3 (the new concentration).

For example : 1 L O2 100% + 6 L Air (21%) = 7 L. M3 (new gas)

So the equation becomes : 1.100 + 6.21 = 7.M3

100 + 126 = 7.M3

So M3 (the new gas concentration) is 226/7 = 32.3%

This is how we lower our oxygen, so the baby would not receive 100%..

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thank u >>>>what about acetic acid?is it irritant? we can change the water frequently instead?

Acetic acid would not going to the baby, it is only in the cpap generator (the bubbling bottle).. It won't irritate anything.. :-)

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And by the way, the formula is not V1M1 x V2M2 but it is V1M1 + V2M2 = V3M3.. Sorry typo.. :-p

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