Improvised bubble continuous positive airway pressure ventilation use in neonates in resource-limited settings: a systematic review and meta-analysis

Abstract

Objectives In the face of limited fiscal and technical resources, improvised methods have been used to provide effective and sustainable ventilatory support in low-resource settings to reduce neonatal mortality associated with respiratory complications. This study assessed the use of improvised bubble continuous positive airway pressure (ibCPAP) ventilation among neonates with respiratory complications and determined its effect on neonatal outcomes in low- and middle-income countries (LMICs). Content Hospital-based studies conducted between 2010 and 2020 in LMICs were reviewed. Rayyan® software for systematic review was used for screening and article selection. We used Stata® Statacorp Texas USA software to estimate pooled prevalence, proportion estimates, weighted mean differences and 95% Confidence Interval (CI), using the random effects model. Summary A total of 193 articles were generated and 125 were reviewed. Thirteen articles with 806 neonates on ibCPAP ventilation were included. The pooled prevalence of ibCPAP use was 7.0% (95% CI: 3.0%–13.0%). There was a significant difference in mean oxygen saturation before and after ibCPAP use (−1.34% [95% CI: −1.65% to −1.02%, p<0.01). The duration of oxygen requirement among neonates on ibCPAP was 6.5 hours less than controls (0.27 days [95%CI: −0.49 to −0.05, p<0.01). Outlook IbCPAP had no effect on the respiratory rate, duration of admission, mortality and survival. IbCPAP use in LMIC hospitals is low and its use improved oxygen saturation and duration on oxygen among the neonates, but had no impact on length of stay, respiratory rate, mortality or survival.

Feasibility and usability of a very low-cost bubble continuous positive airway pressure device including oxygen blenders in a Ugandan level two newborn unit

“…Strengths of this study include constant observation of care required for study participants by the research team as well as use of multiple instruments to triangulate and confirm the utility of the device to the healthcare team. Generalizability of this unit's experience with the device is augmented by a broad set of inclusion criteria which did not restrict use of bCPAP from extremely preterm infants nor those with birth asphyxia [17,38]. As well, the median patient-to-nurse ratio of 9.7 was consistent with other African units administering CPAP suggesting similar nurse workload [9].…”

“…To address this care gap, the World Health Organization (WHO) provides guidance on creation of locally made, or improvised bCPAP devices assembled at the point of care from components available in the hospital [15]. These improvised devices, however, have not been bench tested for reliability and their performance is variable, particularly in terms of pressure delivered to the lung due to the variation in the length and bore of tubing used, small cannula sizes, and incorrect assembly of parts [16,17].…”

“…All patients experienced episodes of saturations >95%. Median time for device set up: 15 minutes (IQR [12][13][14][15][16][17][18] and changing the blender: 15 seconds (IQR [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. After initial device use, 9 out of 9 nurses report the set-up as well as blender use was "easy" and their overall satisfaction with the device was 8.5/10 (IQR 6.5-9.5).…”