Bubble CPAP in resource-poor settings: friend or foe?

Wilson, Patrick T.

doi:10.1016/s2213-2600(19)30261-9

Cited by 8 publications

(10 citation statements)

References 9 publications

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“…Some studies have described significant barriers to implementation of CPAP devices in LMICs. (18-24) In our study Vayu bCPAP Systems were found to be easy to use across all cadres, appropriate for the MNH setting, and able to be successfully integrated into the Newborn Unit. This ease of use and system integration allowed for task shifting whereby nurses initiated treatment without waiting for an attending pediatrician.…”

Section: Discussionmentioning

confidence: 65%

“…While our study demonstrated that it is feasible to treat neonates with Vayu bCPAP Systems, a few prior studies found that introduction of commercial CPAP devices alone did not improve outcomes in low resource settings. (23,24,26) Further research is necessary to identify approaches to introduction and integration of Vayu bCPAP Systems to optimize quality care and patient outcomes across various settings.…”

Section: Discussionmentioning

confidence: 99%

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Feasibility of a Novel Ultra-Low-Cost Bubble CPAP (bCPAP) System for Neonatal Respiratory Support at Muhimbili National Hospital, Tanzania

Tayler¹,

Ashworth

Saba³

et al. 2022

Preprint

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ObjectiveContinuous Positive Airway Pressure (CPAP) is recommended in the treatment of respiratory distress syndrome of premature newborns, however there are significant barriers to its implementation in low resource settings. The objective of this study was to evaluate the feasibility of use and integration of Vayu bCPAP Systems into the newborn unit at Muhimbili National Hospital in Tanzania.Study DesignA Mixed Methods study was conducted from April 6 to October 6 2021. Demographic and clinical characteristics of patients treated with Vayu bCPAP Systems were collected and analyzed. Healthcare workers were interviewed until thematic saturation. Interviews were transcribed, coded, and analyzed using a framework analysis.Results370 patients were treated with Vayu bCPAP Systems during the study period. Mean birth weight was 1522 g (500-3800), mean duration of bCPAP treatment was 7.2 days (<1-39 d), and survival to wean was 81.4%. Twenty-four healthcare workers were interviewed and perceived Vayu bCPAP Systems as having become essential for treating neonatal respiratory distress at MNH. Key reasons were that Vayu bCPAP Systems improve patient outcomes, are easy to use, and more patients are now able to receive quality care. Barriers to integration included durability of oxygen tubing material and training.ConclusionsIt was feasible to implement and integrate Vayu bCPAP Systems into the care of neonates at Muhimbili National Hospital.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Feasibility of a Novel Ultra-Low-Cost Bubble CPAP (bCPAP) System for Neonatal Respiratory Support at Muhimbili National Hospital, Tanzania

Tayler¹,

Ashworth

Saba³

et al. 2022

Preprint

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“…Analysis of recent research has emphasized the challenges of implementing bubble CPAP treatment in low-resource settings. 45 Further studies are needed to see how effective this novel system is when integrated into health-care facilities in different contexts.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a Bubble CPAP System for Low Resource Settings

Dundek

Ng²,

Brazil³

et al. 2021

Respir Care

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BACKGROUND: Despite its established safety, efficacy, and relative simplicity, CPAP treatment is not widely available for newborns and infants in low-and middle-income settings. A novel bubble CPAP system was designed to address the gaps in quality and accessibility of existing CPAP systems by providing blended, humidified, and pressurized gases without the need for electricity, compressed air, or manual power. This was the first study that tested the performance of the system with a simulated patient model. METHODS: In a spontaneously breathing 3dimensional printed nasal airway model of a preterm neonate, CPAP performance was assessed based on delivered pressure, oxygen level, and humidity at different settings. RESULTS: Preliminary device performance characteristics were within 5% among 3 separate devices. Performance testing showed accurate control of CPAP and oxygen concentration at all settings with the bubble CPAP system. Lung model pressure and oxygen concentration were shown to stay within 60.5 cm H 2 O and 64% of full scale of the device settings, respectively, with relative humidity > 80%. CONCLUSIONS: Performance testing of the bubble CPAP system demonstrated accurate control of CPAP and oxygen concentration with humidity levels suitable for premature newborns on noninvasive support.

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“…The trial showed that in some rural and semi-rural settings, CPAP could be successfully used by physician-supervised nurses to manage acute respiratory distress. 13 The mean respiratory rate of children who received immediate CPAP fell by 16 breaths/min (95% CI [10][11][12][13][14][15][16][17][18][19][20][21] in the first hour compared with no change in children who had CPAP delayed by 1 hour (95% CI -2 to +5). The study was stopped after enrolling 70 out of 96 subjects because the predetermined endpoint had been reached.…”

Section: Using Cpap In Older Childrenmentioning

confidence: 99%

“…Additionally, while the children enrolled in the trials in Ghana and Bangladesh were managed by physician-supervised nurses, those enrolled in the trial in Malawi were managed by clinicians and nurses who worked "without daily physician supervision". 14 It is evident that although the trial was reportedly designed to reflect "real world" district hospital settings in Malawi, it enrolled high-risk children who needed care beyond what CPAP is physiomechanically designed to do. 10 CPAP has been shown to improve the management of children who have moderate-to-severe respiratory-related conditions.…”

Section: Using Cpap In Older Childrenmentioning

confidence: 99%

Continuous positive airway pressure in managing acute respiratory distress in children in district hospitals: evidence for scale-up

Baiden

Wilson

2021

gmj

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In children, acute respiratory distress (ARD) is a clinical presentation requiring emergency management, including mechanical ventilation. Mechanical ventilators are lacking in sub-Saharan Africa. Continuous Positive Airway Pressure (CPAP) is an alternative form of non-invasive respiratory support that has been used in high-income countries for over four decades. Its use in sub-Saharan Africa is, however, limited and often restricted to neonates. Controlled trials in Ghana have shown that the use of CPAP in children younger aged 1-12 months reduces 2-week all-cause mortality from ARD by 60% (RR 0·40, 0·19–0·82; p=0·01). The absolute reduction in mortality of 4% implies one infant life saved for every 25 children treated with CPAP. This paper reviews the findings of the trials in Ghana andcontrasts the findings with those of trials in Bangladesh and Malawi. It makes the case that implementation research (rather than more controlled trials) is now needed to support the routine, safe and effective use of CPAP in managing ARD in older infants in district hospitals in Ghana.

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Bubble CPAP in resource-poor settings: friend or foe?

Cited by 8 publications

References 9 publications

Feasibility of a Novel Ultra-Low-Cost Bubble CPAP (bCPAP) System for Neonatal Respiratory Support at Muhimbili National Hospital, Tanzania

Feasibility of a Novel Ultra-Low-Cost Bubble CPAP (bCPAP) System for Neonatal Respiratory Support at Muhimbili National Hospital, Tanzania

Evaluation of a Bubble CPAP System for Low Resource Settings

Continuous positive airway pressure in managing acute respiratory distress in children in district hospitals: evidence for scale-up

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