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

Dickson Otiangala,David Bell,Christine Bachman,Daniel Lieberman,Michael Hawkes,Ella Forgie,Bernard Olayo,Ryan Calderon,Akos Somoskovi,Steve Adudans,Nicholas O Agai,Chin Hei Ng

doi:10.1186/s12890-021-01433-6

Abstract

BackgroundSupplemental 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.MethodsAn 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.ResultsPreclinical 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.ConclusionWe 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.

Highlights

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
Considerations included in the design were: (1) preference for off-the-shelf commercial products to capitalize on economies of scale costing and manufacturer component durability testing; (2) appropriate boost compressor size so it was not choked by output specifications of the oxygen concentrator and would reliably operate up to our maximum pressure without stalling; (3) safety of operation with respect to ignition risk due to storing high concentration oxygen at elevated pressure
Design and pre‐clinical testing of medium pressure reservoir We designed a novel MPR that integrates with a commercial oxygen concentrator (Airsep Newlife Intensity 10, Chart Industries, Ball Ground, GA) to provide a continuous stream of oxygen during power interruptions (Fig. 1a, Additional file 1: Figure S1, Table S1)

Summary

Introduction

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. Timely diagnosis and Otiangala et al BMC Pulm Med (2021) 21:78 treatment of hypoxemia are essential to optimize patient outcomes [6]. Oxygen cylinders and oxygen concentrators are standard oxygen delivery methods employed in LMICs [6, 7]. Cylinders are costly to transport, require regular replenishment [8], and are only feasible as a method of oxygen delivery where there is a reliable supply chain [9]. Oxygen concentrators [10] are less costly and more convenient than cylinders; they depend on a reliable source of electricity [9]

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