Understanding Appropriate CPAP Pressures for Premature Infants
Our little girl, born at just 25 weeks, spent 75 days on a ventilator. Initially, she was placed on a jet ventilator before transitioning to a traditional one. Just last week, we attempted to extubate her, but unfortunately, that effort lasted less than four hours before we had to revert back to ventilation. Currently, she is receiving CPAP via nasal cannula, which is connected to the ventilator. The peak inspiratory pressure (PIP) has been set to 15, which seems excessively high as it appears that the air is forcing itself out of her nose with each breath. Is this level of pressure standard? How can a tiny baby manage to breathe under such conditions? One of the nurses mentioned that it resembles trying to breathe while sticking your head out of a moving vehicle on the highway. This analogy really puts into perspective the challenge our daughter faces with her current settings.
Answers (1)
9/2/2025, 1:40:43 AM
OpenHealth AI
I understand that you are concerned about your daughter's current CPAP settings, especially given her history and the challenges she has faced since her premature birth. It's completely normal to feel worried, and you are right to seek clarity.
Main Points:
- CPAP pressures can vary, and finding the right level is crucial for your infant's comfort and breathing effectiveness.
- A PIP of 15 cm H2O may be on the higher side for some infants, and it’s important to monitor her response to this pressure.
Explanation: Continuous Positive Airway Pressure (CPAP) is used to help maintain open airways and support breathing without the need for invasive ventilation. The appropriate pressure setting can vary based on the infant's age, size, and specific respiratory needs. In preterm infants, pressures usually range from 5 to 12 cm H2O; however, some may temporarily require higher settings during respiratory distress.
Your daughter's high PIP of 15 could be a necessary adjustment depending on her current respiratory health and specific parameters set by her healthcare team. The analogy you shared about breathing with your head out of a moving vehicle illustrates why the right balance of pressure is essential – excessive pressure might lead to discomfort and difficulty for her.
Next Steps:
-
Monitor Clearly: Observe how she is responding to the CPAP. Look for signs of distress such as increased heart rate, agitation, or changes in her color.
-
Discuss with the Healthcare Team: Communicate your observations and concerns with your healthcare team. Ask them to explain the rationale behind the current PIP setting and whether adjustments might be beneficial for her comfort and effectiveness of breathing support.
-
Inquire About Adjustments: If the pressure seems excessively high or if she appears uncomfortable, inquire whether a gradual reduction could be attempted. Continuous reassessment is key.
-
Request a Comprehensive Plan: Ask if they can provide clarity on her long-term respiratory plan, including potential timelines for extubation and adjusting CPAP pressures to promote her transition to independent breathing.
You are doing a tremendous job advocating for your daughter. It’s essential to stay involved and seek answers from the medical team to feel more informed and supported during this challenging time.
Related Questions
Seeking Clarity on a Pediatric Surgical Experience
One of my earliest recollections involves surgical gauze wrapped around my genitals and being cautioned to exercise caution regarding my circumcision. This incident dates back to around 1972, when I was roughly three years old. My brother, who was eleven at the time, corroborates this memory and recalls that the bandage remained in place for "a few weeks." His recollection is a bit unclear, but he does remember seeing me running around without pants and with a gauze dressing. He believes the dressing wasn't overly bulky and doesn't recall any stent being used. However, I am aware that his memory may not be completely accurate based on other conversations we've had. He recalls being informed that I underwent surgery for an undescended testicle, yet was never made aware of a circumcision being involved. Later, a physician indirectly confirmed that I had undergone an early orchidopexy. This memory piques my curiosity, particularly since my parents have never brought it up with me. I have knowledge of having glanular/coronal hypospadias, and the details of my situation appear to align with images I’ve encountered depicting partial hypospadias corrections. This leads me to wonder if my circumcision might have actually been related to hypospadias surgery. Unfortunately, any tangible proof of these events was lost when I underwent gender confirmation surgery as a trans woman three decades ago. It's conceivable that the standard circumcision procedure typically performed at birth could have been postponed, given that I was born slightly premature and had significant Rh disease and hypoxia. But could it have been deferred until I reached the age of three? I have made attempts to obtain my medical records, but unfortunately, they have been destroyed over the years. While I understand that definitive answers may be elusive, I would greatly appreciate any insights or thoughts on this matter.
Unexplained Left Chest Pain, Electric-Like Jabs in Lower Back, and Unusual Headaches
Hi there, I’m a 15-year-old experiencing some peculiar health issues lately. A visit to my doctor led to a diagnosis of anxiety and poor posture after I complained about headaches and strange, electric sensations rising through my head. However, after that appointment, I became aware of pain in my heart and strange discomfort in my left chest accompanied by difficulty breathing. Initially, I thought these symptoms aligned with anxiety, but they persisted long enough to cause concern. To rule out any serious conditions, I underwent a blood test, which fortunately came back normal. Despite the positive results, I continued to feel unusual pains in my heart region and a peculiar ache in my lower abdomen. The doctor had previously mentioned my poor posture and identified an issue with my occipital nerve, which I’ve somewhat addressed. Now, though, I find myself having intermittent back pain and brief discomfort just beneath my left lung. These pains are indeed strange; they don’t always last long, sometimes just fading after five seconds or they might stick around for several minutes. I tend to spend a lot of time in bed and don’t often leave the house, yet when I do, these pains still occur. Thankfully, they aren’t debilitating, but I can't help but feel anxious thinking something might be significantly wrong with my health. It’s unsettling and I’d prefer not to dwell on such thoughts. To summarize: I experience chest pain in my lower left quadrant, specifically near my lung, alongside a mild but uncomfortable sensation that waxes and wanes. Additionally, I suffer from headaches located on the upper left side of my head. I apologize for any grammatical errors as I used voice-to-text for this message. Another detail that might be relevant is that I have recently quit vaping, now almost 22 days ago, and I wonder if this could be part of the recovery process.
Expectorated Large Tissue with Blood
At 28 years old, I experienced a fever the previous night, after which I had no other cold symptoms. To my surprise, today I coughed just once and expelled a significant piece of tissue mixed with blood. Following this alarming incident, I sought medical attention at an urgent care facility because I developed a headache immediately afterward and felt a peculiar "butterfly" sensation in my chest. The healthcare professionals did not conduct any laboratory tests or imaging studies, instead opting to prescribe antibiotics for what they suspected might be an infection. Is this an appropriate response to my situation? This is quite concerning.
Understanding Kidney Pain: Should You Be Concerned?
As a 15-year-old assigned female at birth (AFAB), I've been dealing with acid reflux, although I've been neglecting to take any supplements. I also have scoliosis, which I doubt is linked to my current issue. Recently, I have been experiencing pain in my kidney area, specifically in my back, where my kidneys are situated. My mother suggested that this discomfort might indeed stem from my kidneys. For several months now, I haven't pinpointed the cause. I typically consume about 1 to 1.5 liters of water daily, and occasionally I drink cola, though I've reduced that due to my reflux. I sometimes have peach juice or plain tea, but those drinks have become quite infrequent. Despite my fluid intake, it seems my pain level remains consistent regardless of what I drink. The pain primarily affects my right kidney, but during more intense episodes, I also feel discomfort in my left kidney. I've tried lying down and applying gentle pressure to the area, which provides a bit of relief. Aside from occasional bladder discomfort today, I haven't experienced any additional pain that relates to my kidneys, aside from the persistent back pain from scoliosis and the usual stomach and chest pains from my reflux. Is it necessary for me to consult a doctor about this concern? 🥺 I am hesitant to go unless it's truly serious because I was hospitalized last summer due to undiagnosed tics and twitches—likely anxiety-related—and I spent the entire winter seeing doctors for this issue and my scoliosis. I’m also worried about missing school due to more medical appointments, especially since my doctor has a packed schedule, and I'm uncertain if she would prioritize my concern if it doesn't seem urgent. When I was hospitalized last summer, tests including urine and blood analysis showed no significant issues, so I'm unsure whether this warrants another visit now.
Persistent Shin Discomfort
For the past year, I have been grappling with ongoing discomfort in my shins. Despite consulting multiple physiotherapists and doctors, I have yet to find a solution to my problem. My routine has included extensive strength training targeting my hips, glutes, calves, and lower leg muscles. I've also taken steps to improve my running form and have experimented with various recovery techniques, such as foam rolling and using massage devices. No matter what I try, the pain persists, specifically on the inner side of my lower legs. Initially, I suspected that I was suffering from shin splints. However, given my varied attempts at treatment and the lack of improvement, I am starting to believe that the issue might be something different. Even mundane activities, like walking around at home, have become increasingly uncomfortable, not to mention my inability to ride a stationary bike without experiencing pain. If anyone has any insights or recommendations that could assist me in alleviating this issue, I would be extremely grateful. Thank you for your help! I'm a 20-year-old male, standing at 5 feet 8 inches and weighing 70 kilograms.