Evaluation of a Low-Cost Bubble CPAP System Designed for Resource-Limited Settings

Bennett, Desmond J; Carroll, Ryan W.; Kacmarek, Robert M.

doi:10.4187/respcare.05762

Cited by 14 publications

(12 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although known for decades, the issue of dead space and risk of rebreathing is sometimes neglected when modifying the original bCPAP design 31–33. Without leakage, the use of long connecting tubing to an interface can lead to rebreathing and respiratory failure due to large dead space.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Basic principles of neonatal bubble CPAP: effects on CPAP delivery and imposed work of breathing when altering the original design

Baldursdottir

Falk

Donaldsson

et al. 2020

Arch Dis Child Fetal Neonatal Ed

View full text Add to dashboard Cite

BackgroundThe original bubble continuous positive airway pressure (bCPAP) design has wide-bore tubing and a low-resistance interface. This creates a stable airway pressure that is reflected by the submersion depth of the expiratory tubing. Several systems with alterations to the original bCPAP design are now available. Most of these are aimed for use in low-income and middle-income countries and have not been compared with the original design.ObjectiveWe identified three major alterations to the original bCPAP design: (1) resistance of nasal interface, (2) volume of dead space and (3) diameter of expiratory tubing. Our aim was to study the effect of these alterations on CPAP delivery and work of breathing in a mechanical lung model. Dead space should always be avoided and was not further tested.MethodsThe effect of nasal interface resistance and expiratory tubing diameter was evaluated with simulated breathing in a mechanical lung model without interface leakage. The main outcome was delivered CPAP and imposed work of breathing.ResultsHigh-resistance interfaces and narrow expiratory tubing increased the work of breathing. Additionally, narrow expiratory tubing resulted in higher CPAP levels than indicated by the submersion depth.ConclusionOur study shows the significant effect on CPAP delivery and imposed work of breathing when using high-resistance interfaces and narrow expiratory tubing in bCPAP systems. New systems should include low-resistance interfaces and wide-bore tubing and be compared with the original bCPAP. Referring to all systems that bubble as bCPAP is misleading and potentially hazardous.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Without leakage, the use of long connecting tubing to an interface can lead to rebreathing and respiratory failure due to large dead space. At least two systems were identified that had neglected the issue of large dead space in their design 31–33…”

Section: Discussionmentioning

confidence: 99%

Basic principles of neonatal bubble CPAP: effects on CPAP delivery and imposed work of breathing when altering the original design

Baldursdottir

Falk

Donaldsson

et al. 2020

Arch Dis Child Fetal Neonatal Ed

View full text Add to dashboard Cite

show abstract

“…Figure 1B shows real-time recordings of the pressures achieved at the nasal prongs for CPAP settings of 6 and 10 cm H 2 O when the simulated newborn was breathing at 55 breaths/min with a VT of 20 ml. Nasal pressures were stable when compared with other reported bubble CPAP devices (10,11), in terms of both noise induced by bubbling and fluctuations caused by breathing oscillations. Consistent results emerged when breathing of a 10-kg body weight infant (35 breaths/min, 100 ml VT) was simulated through nasal prongs of the corresponding size.…”

Section: Philanthropic Donation Of Conventional Devices This Optionmentioning

confidence: 69%

“…Consistent results emerged when breathing of a 10-kg body weight infant (35 breaths/min, 100 ml VT) was simulated through nasal prongs of the corresponding size. It is important to note that our setting included heated humidification, which was not included in other reports (10,11), because it could be relevant particularly among premature and full-term infants. However, depending on the specific application, this component can be eliminated.…”

Section: Philanthropic Donation Of Conventional Devices This Optionmentioning

confidence: 99%

Novel Approach for Providing Pediatric Continuous Positive Airway Pressure Devices in Low-Income, Underresourced Regions

Farré

Trias

Solana

et al. 2019

Am J Respir Crit Care Med

View full text Add to dashboard Cite

According to recently released World Health Organization data on mortality, in 2015 there were 5.9 million deaths among children under the age of 5 years, and 2.7 million occurred in the neonatal period (1). Globally, pneumonia was the leading cause of under-5 deaths, particularly in sub-Saharan Africa countries, where the decrease in child mortality from pneumonia from 2010 to 2015 was reduced compared with the already modest 6% observed globally (1). Although improvements in survival are directly linked to socioeconomic progress and concurrent improvements in healthcare systems in low-income settings, premature deaths among children can be prevented with access to simple and affordable interventions. In the case of preterm birth (2) and pediatric respiratory diseases (3), a particularly effective treatment is continuous positive airway pressure (CPAP), in particular bubble CPAP (4), with demonstrated efficacy in low-income countries (LICs) (5, 6). The simplest and cheapest way to provide CPAP is to use the central gas pressure source in a hospital, and as such, hospitals would seem to be the most suitable setting in LICs. Nevertheless, because the number of hospitals in LICs with central gas supply facilities is exceedingly low, CPAP is usually restricted to private medical facilities in urban settings and therefore is unavailable to the majority of the population receiving care in extremely underserviced regional hospitals and rural healthcare sites. Hence, readily extending potential CPAP treatment relies on the provision of stand-alone devices incorporating autonomous gas pressure sources. There are three potential options to provide healthcare centers in LICs with the CPAP devices they cannot afford:

show abstract

“…The effectiveness of various bNCPAP devices in reducing neonatal respiratory failure, need for surfactant, mechanical ventilation, and mortality has been evaluated by heterogeneous studies in both developed and developing countries [ 11 , 32 , 34 – 36 ]. In fact, low-cost bNCPAP devices may be comparable in performance to standard bNCPAP systems used in the developed world [ 13 , 36 – 38 ], although some relatively inexpensive bNCPAP devices designed for resource-limited settings are of high resistance, low pressure stability, and impose increased work of breathing [ 39 ].…”

Section: Effectiveness Of Low-cost Bncpapmentioning

confidence: 99%

Bubble Nasal Continuous Positive Airway Pressure (bNCPAP): An Effective Low-Cost Intervention for Resource-Constrained Settings

Egesa

Waibi

2020

International Journal of Pediatrics

View full text Add to dashboard Cite

Preterm birth complications are responsible for almost one-third of the global neonatal mortality burden, and respiratory distress syndrome remains the single most common cause of these preventable deaths. Since its inception, almost half a century ago, nasal continuous positive airway pressure (NCPAP) has evolved to become the primary modality for neonatal respiratory care in both the developed and developing world. Although evidence has demonstrated the effectiveness of low-cost bubble NCPAP in reducing newborn mortality, its widespread use is yet to be seen in resource-constrained settings. Moreover, many tertiary hospitals in developing countries still utilise an inexpensive locally assembled bNCPAP system of unknown efficacy and safety. This review provides a brief overview of the history, physiological benefits, indications, contraindications, and complications of bNCPAP. Evidence regarding the effectiveness of low-cost bNCPAP in the neonatal intensive care unit is also summarised. The article further details a locally assembled bNCPAP system used in resource-constrained settings and highlights the care package for neonates receiving bNCPAP, failure criteria, and strategies for weaning.

show abstract

Evaluation of a Low-Cost Bubble CPAP System Designed for Resource-Limited Settings

Abstract: The low-cost bubble CPAP device evaluated in this study is comparable to a bubble CPAP system used in developed settings. Extensive clinical trials, however, are necessary to confirm its effectiveness.

Cited by 14 publications

References 27 publications

Basic principles of neonatal bubble CPAP: effects on CPAP delivery and imposed work of breathing when altering the original design

Basic principles of neonatal bubble CPAP: effects on CPAP delivery and imposed work of breathing when altering the original design

Novel Approach for Providing Pediatric Continuous Positive Airway Pressure Devices in Low-Income, Underresourced Regions

Bubble Nasal Continuous Positive Airway Pressure (bNCPAP): An Effective Low-Cost Intervention for Resource-Constrained Settings

Contact Info

Product

Resources

About