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LETTER TO EDITOR
Year : 2016  |  Volume : 60  |  Issue : 8  |  Page : 609-610  

Oropharyngeal continuous positive airway pressure: An alternative to intubation for newborns not applied nasal continuous positive airway pressure


1 Department of Pediatrics, Division of Neonatology, Inonu University School of Medicine, Malatya, Turkey
2 Department of Anaesthesiology, Turgut Ozal Medical Center, Inonu University School of Medicine, Malatya, Turkey

Date of Web Publication4-Aug-2016

Correspondence Address:
Ahmet Karadag
Department of Pediatrics, Division of Neonatology, Turgut Ozal Medical Center, Inonu University School of Medicine, Malatya 44280
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5049.187818

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How to cite this article:
Demirtas MS, Turgut H, Ozdemir E, Karadag A. Oropharyngeal continuous positive airway pressure: An alternative to intubation for newborns not applied nasal continuous positive airway pressure. Indian J Anaesth 2016;60:609-10

How to cite this URL:
Demirtas MS, Turgut H, Ozdemir E, Karadag A. Oropharyngeal continuous positive airway pressure: An alternative to intubation for newborns not applied nasal continuous positive airway pressure. Indian J Anaesth [serial online] 2016 [cited 2020 Mar 31];60:609-10. Available from: http://www.ijaweb.org/text.asp?2016/60/8/609/187818

Sir,

Nasal continuous positive airway pressure (CPAP) has been used as a non-invasive form of respiratory assistance to support spontaneously breathing infants with respiratory distress. Nasal CPAP is also effectively used to prevent the failure of extubation in newborn infants following a period of endotracheal intubation and mechanical ventilation. [1] Its use may not be feasible in some newborns with anomalies including nasal aplasia or atresia. In that case, oropharyngeal CPAP, recently defined and used with an increasing trend among neonatologists, can be an alternative technique. [2]

A male infant, weighing 2550 g, delivered at the 36 th gestational week, was diagnosed as a case of charge (coloboma of the eye, heart defects, atresia of the nasal choanae, retardation of growth and/or development, genital and/or urinary abnormalities, ear abnormalities and deafness). The patient was transferred to the neonatal Intensive Care Unit for resuscitation and endotracheal intubation.The patient was later operated on the 2 nd post-natal day for bilateral choanal atresia. Both choanae were opened with a probe, and a Nelaton catheter was placed in the nostrils [Figure 1].

He was extubated after 2 days, and oxygen was given by hood-box after extubation using the probes in the nostrils. However, 20 min after extubation, the patient could not tolerate the hood-box process, oxygen saturation fell and he was consequently re-intubated. Optimum settings were activated on mechanic ventilator (peak inspiratory pressure: 12 cmH 2 O, positive end expiratory pressure [PEEP]: 4 cmH 2 O, inspired oxygen concentration [FiO 2 ]: 21% and respiratory rate: 20/min), but respiratory alkalosis developed on the 4 th h of intubation, and the patient was extubated again. Since the patient had no lower respiratory tract problems, the main problem was the airway obstruction leading to oxygen intolerance due to the hood.
Figure 1: Bilateral choanal atresia

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Therefore, oropharyngeal CPAP was attempted. An endotracheal tube (size 3.5 mm) was placed into the oropharynx by means of a laryngoscope. The tip of the endotracheal tube was fixed advancing to the tip of the back of the tongue with support of fixation straps externally around the patient's lips. Oropharyngeal CPAP was adjusted with the settings of PEEP: 6 cmH 2 O and FiO 2 : 30%. Oxygen saturation improved immediately from 74% to 96%. An orogastric tube was used for the decompression of the distended stomach. On the 5 th day of the treatment, oropharyngeal CPAP was discontinued, and we shifted to head-box oxygen which was successfully tolerated.

CPAP is a non-invasive respiratory assistance technique increasingly being used among neonatologists. Oropharyngeal CPAP technique may be a solution for infants with nasal anomalies such as choanal atresia. We want to highlight this aspect to the anaesthesiologists who frequently encounter patients who cannot tolerate the classic nasal CPAP due to nasal anomalies.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Davis PG, Henderson-Smart DJ. Nasal continuous positive airways pressure immediately after extubation for preventing morbidity in preterm infants. Cochrane Database Syst Rev 2003;(2):CD000143.  Back to cited text no. 1
    
2.
Gumus Dogan D, Aslan M, Ozkurt D, Karadag A. Oropharyngeal CPAP: A new CPAP technique for newborns with nasal anomaly. Minerva Anestesiol 2010;76:1097  Back to cited text no. 2
    


    Figures

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