Assessment of a storage system to deliver uninterrupted therapeutic oxygen during power outages in resource-limited settings

Calderon, Ryan; Morgan, Melissa C.; Kuiper, Mark; Nambuya, Harriet; Wangwe, Nicholas; Somoskövi, Ákos; Lieberman, Daniel

doi:10.1371/journal.pone.0211027

Cited by 13 publications

(15 citation statements)

References 33 publications

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“…This study compiled survey‐based data using a standardized instrument developed by the WHO. Power data were limited to reports of electricity being “always available,” “sometimes available,” or “not available.” Our study provides objective, comprehensive, and quantitative electrical monitoring data congruent with these past findings 24,25 …”

Section: Discussionsupporting

confidence: 85%

Oxygen insecurity and mortality in resource‐constrained healthcare facilities in rural Kenya

Otiangala

Agai

Olayo

et al. 2020

Pediatric Pulmonology

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Introduction Pneumonia is the leading cause of death globally in children. Supplemental oxygen reduces mortality but is not available in many low‐resource settings. Inadequate power supply to drive oxygen concentrators is a major contributor to this failure. The objectives of our study were to (a) assess the availability of therapeutic oxygen; (b) evaluate the reliability of the electrical supply; and (c) investigate the effects of suboptimal oxygen delivery on patient outcomes in selected healthcare facilities in rural Kenya. Materials and Methods A cross‐sectional descriptive study on oxygen availability and descriptive case series of Kenyan children and youth hospitalized with hypoxemia. Results Two of 11 facilities had no oxygen equipment and nine facilities had at least one concentrator or cylinder. Facilities had a median of seven power interruptions per week (range: 2‐147). The median duration of the power outage was 17 minutes and the longest was more than 6 days. The median proportion of time without power was out 7% (range: 1%‐58%). Fifty‐seven patients hospitalized with hypoxemia (median oxygen saturation 85% [interquartile range {IQR}: 82‐87]) were included in our case series. Patients received supplemental oxygen for a median duration of 4.6 hours (IQR: 3.0‐7.8). Eighteen patients (32%) faced an oxygen interruption of the median duration of 11 minutes (IQR: 9‐20). A back‐up cylinder was used in 5/18 (28%) cases. The case fatality rate was 11/57 (19%). Conclusion Mortality due to hypoxemia remains unacceptably high in low‐resource healthcare facilities and may be associated with oxygen insecurity, related to lack of equipment and/or reliable power.

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Section: Discussionsupporting

confidence: 85%

Oxygen insecurity and mortality in resource‐constrained healthcare facilities in rural Kenya

Otiangala

Agai

Olayo

et al. 2020

Pediatric Pulmonology

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“…Previous studies have assessed the use of high-pressure and low-pressure oxygen storage reservoirs in pre-clinical studies [ 12 , 13 , 26 ]. In hospitals where there is a reliable supply chain from an oxygen plant, high-pressure oxygen cylinders are the standard.…”

Section: Discussionmentioning

confidence: 99%

“…One solution may be to store oxygen in a reservoir while power is available, for use during power outages. Currently, there are a limited number of devices capable of bridging power outages to deliver continuous oxygen [ 6 , 7 , 12 ]. High-pressure oxygen storage systems are associated with safety hazards and may be vulnerable to leakage from fittings.…”

Section: Introductionmentioning

confidence: 99%

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A feasibility study evaluating a reservoir storage system for continuous oxygen delivery for children with hypoxemia in Kenya

et al. 2021

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Background Supplemental oxygen is an essential treatment for childhood pneumonia but is often unavailable in low-resource settings or unreliable due to frequent and long-lasting power outages. We present a novel medium pressure reservoir (MPR) which delivers continuous oxygen to pediatric patients through power outages. Methods An observational case series pilot study assessing the capacity, efficacy and user appraisal of a novel MPR device for use in low-resource pediatric wards. We designed and tested a MPR in a controlled preclinical setting, established feasibility of the device in two rural Kenyan hospitals, and sought user feedback and satisfaction using a standardized questionnaire. Results Preclinical data showed that the MPR was capable of bridging power outages and delivering a continuous flow of oxygen to a simulated patient. The MPR was then deployed for clinical testing in nine pediatric patients at Ahero and Suba Hospitals. Power was unavailable for 2% of the total time observed due to 11 power outages (median 4.6 min, IQR 3.6–13.0 min) that occurred during treatment with the MPR. Oxygen flowrates remained constant across all 11 power outages. Feedback on the MPR was uniformly positive; all respondents indicated that the MPR was easy to use and provided clinically significant help to their patients. Conclusion We present a MPR oxygen delivery device that has the potential to mitigate power insecurity and improve the standard of care for hypoxemic pediatric patients in resource-limited settings.

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“…Concentrators have been used with reservoir tanks to maintain oxygen supply during short power outages and high demands. 13 …”

Section: Ventilators Are Not the Answer In Africamentioning

confidence: 99%

Ventilators are not the answer in Africa

Madzimbamuto

2020

African Journal of Primary Health Care & Family Medicine

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The treatment of severely ill coronavirus disease 2019 (COVID-19) patients has brought the worldwide shortage of oxygen and ventilator-related resources to public attention. Ventilators are considered as the vital equipment needed to manage these patients, who account for 3% – 5% of patients with Covid-19. Most patients need oxygen and supportive therapy. In Africa, the shortage of oxygen is even more severe and needs equipment that is simpler to use than a ventilator. Different models of generating oxygen locally at hospitals, including at provincial and district levels, are required. In some countries, hospitals have established small oxygen production plants to supply themselves and neighbouring hospitals. Oxygen concentrators have also been explored but require dependable power supply and are influenced by local factors such as ambient temperature and humidity. By attaching a reservoir tank, the effect of short power outages or high demands can be smoothed over. The local and regional energy unleashed in the citizens to respond to the COVID-19 pandemic should now be directed towards developing appropriate infrastructure for oxygen and critical care. This infrastructure is education and technology intensive, requiring investment in these areas.

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Assessment of a storage system to deliver uninterrupted therapeutic oxygen during power outages in resource-limited settings

Cited by 13 publications

References 33 publications

Oxygen insecurity and mortality in resource‐constrained healthcare facilities in rural Kenya

Oxygen insecurity and mortality in resource‐constrained healthcare facilities in rural Kenya

A feasibility study evaluating a reservoir storage system for continuous oxygen delivery for children with hypoxemia in Kenya

Ventilators are not the answer in Africa

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