Abstract
Background/aimLow-cost commercial bCPAP devices have been deployed in resource-limited settings to treat neonatal respiratory failure. The use of these devices has increased access to pediatric respiratory support for infants. However, constrained resources may result in substitution of recommended consumables and/or use in older age groups. We hypothesized that commercially available bCPAP devices, the standard WHO-style device and various improvised adaptations would all generate effective, safe positive pressure at the patient interface.MethodsPerformance of 2 commercially available bCPAP devices was tested against the standard WHO-style bCPAP device, as well as several improvised modifications of these devices, by measuring positive pressure delivered at the patient interface. Variables tested included different flow rates, patient interfaces and respiratory circuit tubing.ResultsBoth commercial devices utilized according to manufacturer recommendations generated the expected positive pressure at the patient interface. When testing the recommended WHO-style bCPAP device with recommended materials as well as other improvised modifications, we found variable and potentially unpredictable generation of positive pressure at the patient interface.ConclusionsModified or improvised bCPAP devices should be used with extreme caution as the support provided may be more or less than expected depending on respiratory tubing and flow rates employed. Our data support the effectiveness of bCPAP in newborns and young infants. But, to our knowledge, there are no bCPAP patient interfaces for older children effective with low liter flow devices. Therefore, based on these results, we recommend against using WHO-style bCPAP devices for non-infant patients with respiratory failure and instead recommend using standard oxygen therapy with nasal cannulae or face-masks, as well as early consideration of transfer to a higher level of care.
Highlights
Respiratory diseases are the most common cause of morbidity and mortality in children under 5 worldwide [1]
Modified or improvised Bubble Continuous Positive Airway Pressure (bCPAP) devices should be used with extreme caution as the support provided may be more or less than expected depending on respiratory tubing and flow rates employed
To test our hypothesis, we compared positive pressure (PP) delivered at the patient interface by the two commercially available bCPAP devices (Table 1, Figs. 2, 3 and 4) to PP delivered at the patient interface from the WHO-style, “low-tech” device and several improvised variations (Table 1, Figs. 5, 6, 7, 8 and 9)
Summary
Respiratory diseases are the most common cause of morbidity and mortality in children under 5 worldwide [1]. 16 & 17 [10]) and promulgated in pediatric global health training websites [11] These devices may be subject to large variability in construction based on the availability of specific equipment. This may variably affect the amount of actual positive pressure delivered. The efficacy of positive pressure generation at the patient interface by variations of WHO-style devices has been incompletely studied [12]. The aim of our study was to measure the amount of positive pressure generated by commercially available bCPAP devices, the standard WHO-style device and various improvised adaptations. We hypothesized that all would generate effective positive pressure (PP) matching the submersion depth at the patient interface
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