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| CPAP | |
|---|---|
| Name | CPAP |
| Caption | Continuous positive airway pressure device |
| Specialty | Pulmonology, Sleep medicine, Otolaryngology |
CPAP CPAP is a noninvasive respiratory therapy that delivers continuous positive airway pressure to maintain upper airway patency and improve gas exchange. It is widely used in sleep-related breathing disorders and acute or chronic respiratory failure across settings such as hospitals, sleep laboratories, and home care. CPAP interfaces with diagnostics, standards, and institutions involved in respiratory care and has influenced public health policy, medical device regulation, and biomedical engineering.
CPAP is primarily indicated for obstructive sleep apnea and is recommended by organizations such as the American Academy of Sleep Medicine, National Institute for Health and Care Excellence, World Health Organization, American Thoracic Society, and European Respiratory Society. It is used in acute cardiogenic pulmonary edema, a scenario often managed alongside guidelines from the European Society of Cardiology and American Heart Association. In neonatology, CPAP supports preterm infants with respiratory distress syndrome, following protocols influenced by World Health Organization neonatal recommendations and neonatal units in centers like Boston Children's Hospital and Great Ormond Street Hospital. CPAP is also employed perioperatively in patients at risk of postoperative hypoxemia, with practice informed by societies such as the American Society of Anesthesiologists and Royal College of Anaesthetists. Use in chronic obstructive pulmonary disease has been explored in trials associated with institutions like Mayo Clinic and Johns Hopkins Hospital.
CPAP systems generate a continuous distending pressure to splint the upper airway and reduce pharyngeal collapse, a principle examined in research from Harvard Medical School, University of Pennsylvania, and University of Oxford. Core components include a flow generator or motor developed by manufacturers influenced by standards from the International Organization for Standardization and Food and Drug Administration, an interface or mask (nasal, oronasal, nasal pillows), tubing, and humidification systems used in hospitals such as Cleveland Clinic and Mount Sinai Hospital. Mechanistic research has been advanced by laboratories at Massachusetts Institute of Technology, Stanford University, and Karolinska Institutet, integrating physiology described by pioneers affiliated with institutions like Guy's Hospital and Mayo Clinic Graduate School of Medicine.
Devices range from fixed-pressure CPAP units to auto-adjusting devices and bilevel machines produced by companies historically linked to innovation in respiratory technology, including firms associated with the Medical Research Council (United Kingdom), collaborations with universities like University of Sydney, and industry leaders that supply hospitals such as UCSF Medical Center. Delivery can be via bedside ventilators in intensive care units at institutions like Johns Hopkins Hospital or portable home devices used by patients connected to services in systems like the National Health Service (United Kingdom). Device classes are regulated by agencies such as the European Medicines Agency and Food and Drug Administration.
Randomized controlled trials and meta-analyses by groups at Cochrane Collaboration, National Institutes of Health, Imperial College London, and Duke University School of Medicine have assessed CPAP for obstructive sleep apnea, demonstrating improvements in apnea–hypopnea index and daytime sleepiness in many cohorts studied at centers like Brigham and Women's Hospital and Vanderbilt University Medical Center. Evidence for reduction in cardiovascular outcomes has been mixed in large trials coordinated with networks including Framingham Heart Study collaborators and consortia linked to European Heart Journal authors. Neonatal trials led by teams at Neonatal Intensive Care Units in universities such as University of Toronto have compared CPAP with mechanical ventilation for respiratory distress. Systematic reviews from entities like BMJ and The Lancet have synthesized clinical outcomes, adherence data, and health economics analyses.
Common adverse effects include nasal congestion, mask-related skin breakdown, and aerophagia reported in cohorts treated at sleep centers like Stanford Sleep Medicine Center and Royal Papworth Hospital. Contraindications are uncommon but include untreated facial trauma or recent craniofacial surgery, scenarios managed in multidisciplinary teams at institutions such as Mayo Clinic and Cleveland Clinic. Rare complications described in case series from tertiary centers, including barotrauma and ventilator-associated events, prompted guidance from organizations like the Centers for Disease Control and Prevention and American Association for Respiratory Care.
Prescribing and titration of CPAP involve polysomnography or home sleep testing protocols developed by the American Academy of Sleep Medicine and implemented in laboratories across hospitals like Massachusetts General Hospital and NewYork-Presbyterian Hospital. Machine settings are chosen by clinicians trained in programs associated with universities such as University of California, San Francisco and University of Melbourne. Routine maintenance—filter changes, mask replacement, and humidifier care—is advised by manufacturers and clinical services in health systems like Kaiser Permanente and regulated through standards from International Organization for Standardization committees.
Concepts of positive airway pressure trace to early 20th-century respiratory physiology research at institutions such as Guy's Hospital and University College London. Modern therapeutic CPAP was popularized following work in sleep medicine units at Hammersmith Hospital and research groups linked to Royal Free Hospital and St Bartholomew's Hospital. Technological advances occurred through collaborations between engineering departments at Massachusetts Institute of Technology, Imperial College London, and companies influenced by regulatory frameworks from the Food and Drug Administration and European Medicines Agency. The diffusion of CPAP into home care paralleled developments in telemedicine and home health services provided by systems like Veterans Health Administration and National Health Service (United Kingdom), and was accelerated by professional societies including the American Thoracic Society.
Category:Respiratory therapy