Preventing Continuous Positive Airway Pressure Failure: Evidence-Based and Physiologically Sound Practices from Delivery Room to the Neonatal Intensive Care Unit

Clin Perinatol. 2018 Jun;45(2):257-271. doi: 10.1016/j.clp.2018.01.011. Epub 2018 Feb 28.


Routine use of continuous positive airway pressure (CPAP) to support preterm infants with respiratory distress is an evidenced-based strategy to decrease incidence of bronchopulmonary dysplasia. However, rates of CPAP failure remain unacceptably high in very premature neonates, who are at high risk for developing bronchopulmonary dysplasia. Using the GRADE framework to assess the quality of available evidence, this article reviews strategies aimed at decreasing CPAP failure, starting with delivery room interventions and followed through to system-based efforts in the neonatal intensive care unit. Despite best efforts, some very premature neonates fail CPAP. Also reviewed are predictors of CPAP failure in this vulnerable population.

Keywords: Bronchopulmonary dysplasia; Continuous positive airway pressure; INSURE; Infant flow driver; Mechanical ventilation; Randomized controlled trial; Sustained lung inflation; Ventilatory-induced lung injury.

Publication types

  • Review

MeSH terms

  • Adult
  • Bronchopulmonary Dysplasia / etiology
  • Bronchopulmonary Dysplasia / prevention & control*
  • Continuous Positive Airway Pressure / adverse effects*
  • Continuous Positive Airway Pressure / methods
  • Delivery Rooms
  • Evidence-Based Medicine
  • Female
  • Gestational Age
  • Humans
  • Infant, Premature*
  • Intensive Care Units, Neonatal
  • Male
  • Predictive Value of Tests
  • Pregnancy
  • Primary Prevention / methods
  • Randomized Controlled Trials as Topic
  • Respiratory Distress Syndrome, Newborn / diagnosis
  • Respiratory Distress Syndrome, Newborn / therapy*
  • Risk Assessment
  • Time-to-Treatment
  • Treatment Failure*