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HMFW Bubble CPAP System Improves Outcomes for Premature Babies
12/10/2007

FORT WORTH, Texas – Bubbles have entertained kids for generations. Now they are helping improve the care of premature infants. The Harris Methodist Fort Worth Hospital (HMFW) neonatal intensive care unit recently implemented the use of the Bubble CPAP – a breathing assistance system showing promising results in decreasing the incidence of chronic lung disease among premature infants. HMFW was the first to implement the system and is one of only two hospitals in the Metroplex currently using Bubble CPAP.

Babies born prematurely often have underdeveloped lungs. Continuous positive airway pressure, or CPAP, is a breathing system commonly used to deliver airflow and pressure to an infant’s lungs via short prongs in the nose. This air pressure helps to keep the lungs open at the end of exhalation while allowing the baby to initiate his/her own breathing.

But a simple twist in this system – the addition of bubbles – is proving more effective in helping infants breathe on their own and decreasing the need to put some babies on mechanical ventilators.

How it Works
In the CPAP process, a tube connected to the tiny nasal prongs allows airflow blended with precise amounts of oxygen to enter an infant’s lungs. Exhaled air exits through an expiratory tube. Some methods of CPAP utilize a valve at the end of the expiratory tube to partially block exhaled air, causing pressure to maintain lung inflation.

Bubble CPAP creates this pressure by placing the expiratory tube in a column of liquid. The flow of air into the liquid causes the solution to bubble. This bubbling creates vibrations that are transmitted to the baby’s chest, helping the infant maintain better lung inflation and aiding in the proper movement of gases into and out of the lungs.

“It’s a very simple approach,” said Randy Grubbs, M.D., a neonatologist on the medical staff at HMFW, “but I think it will ultimately become the best practice for NICUs nationwide when it comes to improving the lung development of premature babies.”

Why HMFW Chose Bubble CPAP
Several types of CPAP can be used to aid babies in their breathing, but HMFW now exclusively uses the Bubble CPAP to give spontaneously breathing infants the respiratory support they need while still allowing them to breathe on their own.

The decision to implement the Bubble CPAP system came after a year-long review of clinical research demonstrating the system improves outcomes more effectively than others.

“This implementation was completely evidence-based,” Dr. Grubbs said. “We reviewed the medical research literature thoroughly and modeled our process after NewYork-Presbyterian Hospital/Columbia University Medical Center, which reports the lowest rate of chronic lung disease in the world – six percent compared to the national average of 24 to 30 percent.”

Chronic lung disease remains one of the most common and debilitating outcomes for very low birth weight premature infants and is the result of permanent alteration of lung development associated with the use of mechanical ventilators.

“Although infant ventilators have become increasingly sophisticated over the past several years, and are certainly necessary in many instances to save babies’ lives, they remain one of the major factors associated with developing chronic lung disease.”

Chronic lung disease leads to increased susceptibility and severity of respiratory infections and asthma and has been associated with neurologic and developmental setbacks, according to Dr. Grubbs. In addition, the invasive process of placing a breathing tube into the trachea and breathing with the aid of a ventilator carries risks such as vocal cord or airway injury, ventilator-associated pneumonia and infection.

 “I think the Bubble CPAP also has the benefit of being very parent friendly,” said Pam White, NICU clinical nurse educator. “It is very easy to let a parent hold an infant with Bubble CPAP. If the nose prongs fall out while being held, they easily slip back in, unlike when a baby is accidentally extubated if the ventilator tube is dislodged.”

Nurses Key to System’s Success
“Any hospital that implements Bubble CPAP will tell you the acceptance of the system by the bedside nurse is essential to its success, because it is more labor intensive for the nurse than having an infant on a ventilator,” said Amy Hailey, director of Women and Infants’ Services at HMFW. “Our doctors, nurses and respiratory therapists have embraced the use of the Bubble CPAP whole-heartedly because they know it’s the best for their tiny patients.

“Patient-focused care and continuous quality improvement are the hallmarks of a Magnet hospital, which we are. So it’s no surprise to me that our staff embraced this system when they saw the evidence of its quality.”

For more information about neonatal intensive care services at HMFW, log on to www.TexasHealth.org/HMFW or call 817-250-BABY.

About Harris Methodist Fort Worth Hospital
Opened in 1930, Harris Methodist Fort Worth Hospital is a Magnet-designated hospital, and Tarrant County's largest and busiest hospital and regional referral center. A member of Texas Health Resources, HMFW is licensed for 710 beds and provides the following services: cardiovascular; high risk and routine obstetrics and gynecology; neurosciences; orthopedics and sports medicine; rehabilitation; adult critical care and neonatal intensive care; trauma and emergency medicine; cancer care; medical/surgical; kidney transplants; occupational health; and more. The campus is home to almost 1,000 members of the medical staff, more than 4,000 employees, 200 volunteers and the new state-of-the-art 100-bed Harris Methodist Heart Center. For more information, please call 1-888-4-HARRIS, or visit www.TexasHealth.org/HMFW.

About Texas Health Resources
Texas Health Resources is one of the largest faith-based, nonprofit health care delivery systems in the United States and the largest in North Texas in terms of patients served. THR controls 13 affiliated hospitals and a medical research organization, and is a corporate member or partner in seven additional hospitals and surgery centers. THR's family of hospitals includes Harris Methodist Hospitals, Arlington Memorial Hospital and Presbyterian Healthcare System. For more information about Texas Health Resources, visit http://www.texashealth.org/.

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