Bubble Continuous Positive Airway Pressure Research Articles

Vayu bubble continuous positive airway pressure is a promising solution with favorable treatment outcomes for respiratory distress syndrome in newborns: a qualitative study in Bangladesh

BackgroundAccording to Bangladesh Demographic and Health Survey (2022), neonatal mortality, comprising 67% of under-5 deaths in Bangladesh, is significantly attributed to prematurity and low birth weight (LBW), accounting for 32% of neonatal deaths. Respiratory distress syndrome (RDS) is a prevalent concern among preterm and LBW infants, leading to substantial mortality. The World Health Organization (WHO) recommends bubble continuous positive airway pressure (bCPAP) therapy, but the affordability and accessibility of conventional bCPAP devices for a large number of patients become major hurdles in Bangladesh due to high costs and resource intensiveness. The Vayu bCPAP, a simple and portable alternative, offers a constant flow of oxygen-enriched, filtered, humidified, and pressurized air. Our study, conducted in five health facilities, explores the useability, acceptability, and perceived treatment outcome of Vayu bCPAP in the local context of Bangladesh.MethodsA qualitative approach was employed in special care newborn units (SCANUs) of selected facilities from January to March 2023. Purposive sampling identified nine key informants, 40 in-depth interviews with service providers, and 10 focus group discussions. Data collection and analysis utilized a thematic framework approach led by trained anthropologists and medical officers.ResultsService providers acknowledged Vayu bCPAP as a lightweight, easily movable, and cost-effective device requiring minimal training. Despite challenges such as consumable shortages and maintenance issues, providers perceived the device as user-friendly, operable with oxygen cylinders, and beneficial during referral transportation. Treatment outcomes indicated effective RDS management, reduced hospital stays, and decreased referrals. Though challenges existed, healthcare providers and facility managers expressed enthusiasm for Vayu bCPAP due to its potential to simplify advanced neonatal care delivery.ConclusionsThe Vayu bCPAP device demonstrated useability, acceptability, and favorable treatment outcomes in the care of neonates with RDS. However, sustained quality service necessitates continuous monitoring, mentoring and retention of knowledge and skills. Despite challenges, the enthusiasm among healthcare providers underscores the potential of Vayu bCPAP to save lives and simplify neonatal care delivery. Development of Standard Operating procedure on Vayu bCPAP is required for systematic implementation. Further research is needed to determine how the utilization of Vayu bCPAP devices enhances accessibility to efficient bCPAP therapy for neonates experiencing RDS.

Bedside critical care training: A quasi-experimental study in the paediatric emergency department of a referral hospital in Nigeria

Background. There is a need for critical care services outside intensive care units (ICUs), especially in emergency departments (EDs). However, there is a paucity of skilled manpower for ED critical care or emergency critical care (ECC) in resource-limited settings. Objective. To evaluate the impact of bedside training on emergency critical care practices of clinical staff. Methods. This was a quasi-experimental study using a pretest - post-test design in a paediatric ED. The intervention was a six-week structured bedside training on bubble continuous positive airway pressure (CPAP) high-flow nasal cannula (HFNC) and mechanical ventilation. Participants’ actual ECC practices pre and post training were evaluated, including their perceived proficiency on an uncalibrated 100 mm visual analogue scale (VAS). Descriptive and inferential analyses were done; p<0.05 was considered significant. Results. A total of 35 clinical staff participated in the training, comprising 9 (24.3%) paediatric registrars, 12 (32.5%) senior registrars, 10 (27.0%) nurses, 4 (10.8%) house officers and 2 (5.4%) paediatric consultants. The male:female ratio of the participants was 1:1.6, and their mean (SD) age was 33.24 (6.30 years. Participants’ understanding of testing the CPAP circuit, connecting the patient and weaning significantly improved following training (p=0.004). Their capacity to select appropriate HFNC parameters improved (p=0.013). They performed more endotracheal intubations in the post-training period (p=0.001). Their pretest-post-test proficiency in mechanical ventilation increased on VAS (mean scores 45.26+31.99 v. 63.26+22.26; p=0.038). Also, there was a significant increase in their perceived proficiency in paediatric analgesia/sedation (30.83+29.86 v. 49.83+23.90; p=0.029). Conclusion. Short-term bedside critical care training enhanced the self-reported competency of paediatric ED staff. There is a need for on-the-job ECC training and retraining of clinical staff in our setting.

High-Flow Nasal Cannula Versus Nasal Prong Bubble Continuous Positive Airway Pressure in Children With Moderate to Severe Acute Bronchiolitis: A Randomized Controlled Trial.

To compare high-flow nasal cannula (HFNC) versus nasal prong bubble continuous positive airway pressure (b-CPAP) in children with moderate to severe acute bronchiolitis. A randomized controlled trial was carried out from August 2019 to February 2022. (Clinical Trials Registry of India number CTRI/2019/07/020402). Pediatric emergency ward and ICU within a tertiary care center in India. Children 1-23 months old with moderate to severe acute bronchiolitis. Comparison of HFNC with b-CPAP, using a primary outcome of treatment failure within 24 hours of randomization, as defined by any of: 1) a 1-point increase in modified Wood's clinical asthma score (m-WCAS) above baseline, 2) a rise in respiratory rate (RR) greater than 10 per minute from baseline, and 3) escalation in respiratory support. The secondary outcomes were success rate after crossover, if any, need for mechanical ventilation (invasive/noninvasive), local skin lesions, length of hospital stay, and complications. In 118 children analyzed by intention-to-treat, HFNC (n = 59) versus b-CPAP (n = 59) was associated with a lower failure rate (23.7% vs. 42.4%; relative risk [95% CI], RR 0.56 [95% CI, 0.32-0.97], p = 0.031). The Cox proportion model confirmed a lower hazard of treatment failure in the HFNC group (adjusted hazard ratio 0.48 [95% CI, 0.25-0.94], p = 0.032). No crossover was noted. A lower proportion escalated to noninvasive ventilation in the HFNC group (15.3%) versus the b-CPAP group (15.3% vs. 39% [RR 0.39 (95% CI, 0.20-0.77)], p = 0.004). The HFNC group had a longer median (interquartile range) duration of oxygen therapy (4 [3-6] vs. 3 [3-5] d; p = 0.012) and hospital stay (6 [5-8.5] vs. 5 [4-7] d, p = 0.021). No significant difference was noted in other secondary outcomes. In children aged one to 23 months with moderate to severe acute bronchiolitis, the use of HFNC therapy as opposed to b-CPAP for early respiratory support is associated with a lower failure rate and, secondarily, a lower risk of escalation to mechanical ventilation.

Effectiveness of bubble continuous positive airway pressure for treatment of children aged 1–59 months with severe pneumonia and hypoxaemia in Ethiopia: a pragmatic cluster-randomised controlled trial

The safety and efficacy of bubble continuous positive airway pressure (bCPAP) for treatment of childhood severe pneumonia outside tertiary care hospitals is uncertain. We did a cluster-randomised effectiveness trial of locally made bCPAP compared with WHO-recommended low-flow oxygen therapy in children with severe pneumonia and hypoxaemia in general hospitals in Ethiopia. This open, cluster-randomised trial was done in 12 general (secondary) hospitals in Ethiopia. We randomly assigned six hospitals to bCPAP as first-line respiratory support for children aged 1-59 months who presented with severe pneumonia and hypoxaemia and six hospitals to standard low-flow oxygen therapy. Cluster (hospital) randomisation was stratified by availability of mechanical ventilation. All children received treatment in paediatric wards (in a dedicated corner in front of a nursing station) with a similar level of facilities (equipment for oxygen therapy and medications) and staffing (overall, one nurse per six patients and one general practitioner per 18 patients) in all hospitals. All children received additional care according to WHO guidelines, supervised by paediatricians and general practitioners. The primary outcome was treatment failure (defined as any of the following: peripheral oxygen saturation <85% at any time after at least 1 h of intervention plus signs of respiratory distress; indication for mechanical ventilation; death during hospital stay or within 72 h of leaving hospital against medical advice; or leaving hospital against medical advice during intervention). The analysis included all children enrolled in the trial. We performed both unadjusted and adjusted analyses of the primary outcome, with the latter adjusted for the stratification variable and for the design effect of cluster randomisation, as well as selected potentially confounding variables, including age. We calculated effectiveness as the relative risk (RR) of the outcomes in the bCPAP group versus low-flow oxygen group. This trial is registered with ClinicalTrial.gov, NCT03870243, and is completed. From June 8, 2021, to July 27, 2022, 1240 children were enrolled (620 in hospitals allocated to bCPAP and 620 in hospitals allocated to low-flow oxygen). Cluster sizes ranged from 103 to 104 children. Five (0·8%) of 620 children in the bCPAP group had treatment failure compared with 21 (3·4%) of 620 children in the low-flow oxygen group (unadjusted RR 0·24, 95% CI 0·09-0·63, p=0·0015; adjusted RR 0·24, 0·07-0·87, p=0·030). Six children died during hospital stay, all of whom were in the low-flow oxygen group (p=0·031). No serious adverse events were attributable to bCPAP. In Ethiopian general hospitals, introduction of locally made bCPAP, supervised by general practitioners and paediatricians, was associated with reduced risk of treatment failure and in-hospital mortality in children with severe pneumonia and hypoxaemia compared with use of standard low-flow oxygen therapy. Implementation research is required in higher mortality settings to consolidate our findings. SIDA Sweden and Grand Challenges Ethiopia.

Bubble continuous positive airway pressure for children with pneumonia and hypoxaemia in Ethiopia

Bubble continuous positive airway pressure for children with pneumonia and hypoxaemia in Ethiopia

Neonatal high frequency ventilation: Current trends and future directions

High frequency ventilation (HFV) in neonates has been in use for over forty years. Some early HFV ventilators are no longer available, but high frequency oscillatory ventilation (HFOV) and jet ventilators (HFJV) continue to be commonly employed. Advanced HFOV models available outside of the United States are much quieter and easier to use, and are available as options on many conventional ventilators, providing important improvements such as tidal volume measurement and targeting. HFJV excels in treating air leak and non-homogenous lung disease and is often used for other diseases as well. High frequency non-invasive ventilation (hfNIV) is a novel application of HFV that remains under investigation. Similar to bubble CPAP, hfNIV has been applied with a variety of high-frequency ventilators. Efficacy and safety of hfNIV with any device have not yet been established. This article describes the current approaches to these HFV therapies and stresses the importance of understanding how each device works and what disease processes may respond best to the technology employed.

The novel LESS (low-cost entrainment syringe system) O2 blender for use in modified bubble CPAP circuits: a clinical study of safety.

Bubble continuous positive airway pressure (bCPAP) is used in resource-limited settings for children with respiratory distress. Low-cost modifications of bCPAP use 100% oxygen and may cause morbidity from oxygen toxicity. We sought to test a novel constructible low-cost entrainment syringe system (LESS) oxygen blender with low-cost modified bCPAP in a relevant clinical setting. We conducted a clinical trial evaluating safety of the LESS O2 blender among hospitalized children under five years old in rural Cambodia evaluating the rate of clinical failure within one hour of initiation of the LESS O2 blender and monitoring for any other blender-related complications. Thirty-two patients were included. The primary outcome (clinical failure) occurred in one patient (3.1%, 95% CI = 0.1-16.2%). Clinical failure was defined as intubation, death, transfer to another hospital, or two of the following: oxygen saturation <85% after 30 min of treatment; new signs of respiratory distress; or partial pressure of carbon dioxide ≥60 mmHg and pH <7.2 on a capillary blood gas. Secondary outcomes included average generated FiO2's with blender use, which were 59% and 52% when a 5 mm entrainment was used vs. a 10 mm entrainment port with 5-7 cm H2O of CPAP and 1-7 L/min (LPM) of flow; and adverse events including loss of CPAP bubbling (64% of all adverse events), frequency of repair or adjustment (44%), replacement (25%), and median time of respiratory support (44 h). Overall the LESS O2 blender was safe for clinical use. The design could be modified for improved performance including less repair needs and improved nasal interface, which requires modification for the blender to function more consistently.

Implementation of bubble continuous positive airway pressure for children with severe pneumonia and hypoxemia in intensive care unit of Dhaka Hospital, Bangladesh-Effect on pneumonia mortality.

After the completion of a randomized trial at Dhaka Hospital in 2013, bubble continuous positive airway pressure (BCPAP) oxygen therapy was incorporated as the part of the standard treatment for children with severe pneumonia with hypoxemia in an intensive care unit at Dhaka Hospital in August 2013 instead of World Health Organization (WHO) standard low flow oxygen therapy. To understand the long-term effectiveness of the introduction of bCPAP oxygen therapy by comparing pneumonia mortality in the post-trial period (August 2013 to December 2017) with the pre-trial (February 2009 to July 2011) and trial periods (August 2011 to July 2013). It was a retrospective analysis of prospectively collected hospital data of all admissions. Mortality rates of all children with WHO-defined pneumonia, and the subset of children with severe pneumonia and hypoxemia (oxygen saturation <90%) were evaluated. The analysis covered 10,107 children with pneumonia: 2523 in the pre-trial (414 with severe pneumonia and hypoxemia; none of them received bCPAP), 2959 during the trial (376 with severe pneumonia and hypoxemia; 79 received bCPAP), and 4625 in the post-trial period (1208 with severe pneumonia and hypoxemia; 1125 had bCPAP). The risk of death from pneumonia in the post-trial period was lower than in pre-trial (adjusted risk ratio [RR] = 0.73, 95% confidence interval [CI] = 0.58-0.92; p = 0.007), among children with severe pneumonia and hypoxemia, the risk of death was lower in the post-trial period than in the pre-trial (adjusted RR = 0.46, 95% CI = 0.37-0.58, p < 0.001), and the trial period (adjusted RR = 0.70, 95% CI = 0.51-0.95; p = 0.023). After the introduction of bCPAP oxygen therapy as part of the routine management of severe pneumonia and hypoxemia in the ICU of the Dhaka hospital, we observed significantly lower mortality, even after accounting for measurable confounding.

Bridging Bronchus – An Unsuspected Airway Anomaly Associated with Congenital Heart Disease: A Case Report with Review of Literature

Abstract Background: The association of airway anomalies with congenital heart disease (CHD) is common, but often remains undetected, due to a lack of awareness. We describe the unfortunate demise of an infant with CHD due to delayed diagnosis of a bridging bronchus (BB) with multifocal bronchial stenosis. Clinical Description: An 18-month-old boy, who was a known case of ventricular septal defect (VSD), was hospitalized for the third time with symptoms of pneumonia and congestive heart failure. He also had intermittent stridor and wheeze similar to his earlier illnesses. Management and Outcome: After stabilization with bubble continuous positive airway pressure, antibiotics, and diuretics, he underwent surgery for the VSD and got extubated successfully on day 3. Subsequently, however, he failed to get weaned off further from respiratory support and started having recurrent episodes of stridor along with suprasternal retractions and wheeze. Computerized tomography (CT) showed BB with multifocal stenosis of the airway and sequestration of the left lower lobe of the lung. He developed pneumonia and succumbed to the illness before he could be considered for surgical correction of the airway anomalies. Conclusion: Awareness about associated airway anomalies and their preoperative detection may alter prognostication, parental counseling, surgical approach, and final outcome.

The demographic profile, clinical spectrum, and outcome of term neonates requiring continuous positive airway pressure in a tertiary care teaching hospital

Background: Respiratory distress is the major cause of neonatal intensive care unit (NICU) admission of full-term neonates for which they require different levels of mode of ventilation. Aims and Objectives: The objective of this study was to determine the demographic profile, clinical spectrum, and outcome of term neonates, requiring continuous positive airway pressure (CPAP) in tertiary care teaching hospitals. Materials and Methods: The study was a prospective observational study conducted from December 2020 to November 2022 in the neonatal section of the department of pediatrics. Results: A total of 261 neonates were included in the study. The male-to-female ratio was 1.7:1, the range of birth weight was between 2.1 kg and 3 kg (60.91%), the gestation age was 38 weeks (59.2%), and 73.6% were lower-segment cesarean section born. The age of starting CPAP in most of the newborns was at admission to NICU (in 69.73% of cases). The success rate of CPAP therapy was high (60.9%) and the rest 39.08% of patients did not settle with CPAP and required higher modes of respiratory support such as nasalintermittent positive pressure ventilation (IPPV) (5.89%) and IPPV (94.11%). Conclusion: In the resource-limiting settings, due to the non-availability of higher levels of ventilatory gadgets, the early use of CPAP as a mode of ventilation in full-term babies with transient tachypnea of newborns is well-documented and it can be safely used in other common neonatal conditions which can cause respiratory distress in full-term neonates. The low-middle-income countries are facing challenges to improve comprehensive neonatal care; there is a dire need for simple and cost-effective methods of respiratory support. Bubble CPAP is one such promising ventilatory support intervention, which may reduce the need for costly mechanical ventilators.

Effectiveness of a novel bubble CPAP system for neonatal respiratory support at a referral hospital in the Philippines.

To examine the impact of introducing and implementing the Vayu bubble continuous positive airway pressure (bCPAP) system on neonatal survival and neonatal respiratory outcomes in a neonatal intensive care unit (NICU) in the Philippines. We compared clinical outcomes of 1,024 neonates before to 979 neonates after introduction of Vayu bCPAP systems into a NICU. The primary outcome was survival to discharge. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated. Analyses were undertaken separately for the entire NICU population and for neonates who received any form of respiratory support. The introduction of the Vayu bCPAP system was associated with (1) significant reductions in intubation (aOR: 0.75; 95% CI: 0.58-0.96) and in the use of nasal intermittent positive-pressure ventilation (NIPPV) (aOR: 0.69; 95% CI: 0.50-0.96) among the entire NICU population and (2) a significant increase in survival to discharge (aOR: 1.53; 95% CI: 1.09-2.17) and significant reductions in intubation (aOR: 0.52; 95% CI: 0.38-0.71), surfactant administration (aOR: 0.60; 95% CI: 0.40-0.89), NIPPV use (aOR: 0.52; 95% CI: 0.36-0.76), and a composite neonatal adverse outcome (aOR: 0.60; 95% CI: 0.42-0.84) among neonates who received any form of respiratory support. The use of the Vayu bCPAP system in a NICU in the Philippines resulted in significant improvement in neonatal respiratory outcomes.

Evaluation of feasibility phase of adaptive version of locally made bubble continuous positive airway pressure oxygen therapy for the treatment of COVID-19 positive and negative adults with severe pneumonia and hypoxaemia.

Bubble continuous positive airway pressure (bCPAP) oxygen therapy has been shown to be safe and effective in treating children with severe pneumonia and hypoxaemia in Bangladesh. Due to lack of adequate non-invasive ventilatory support during coronavirus disease 2019 (COVID-19) crisis, we aimed to evaluate whether bCPAP was safe and feasible when adapted for use in adults with similar indications. Adults (18-64 years) with severe pneumonia and moderate hypoxaemia (80 to <90% oxygen saturation (SpO2) in room air) were provided bCPAP via nasal cannula at a flow rate of 10 litres per minute (l/min) oxygen at 10 centimetres (cm) H2O pressure, in two tertiary hospitals in Dhaka, Bangladesh. Qualitative interviews and focus group discussions, using a descriptive phenomenological approach, were performed with patients and staff (n = 39) prior to and after the introduction (n = 12 and n = 27 respectively) to understand the operational challenges to the introduction of bCPAP. We enrolled 30 adults (median age 52, interquartile range (IQR) 40-60 years) with severe pneumonia and hypoxaemia and/or acute respiratory distress syndrome (ARDS) irrespective of coronavirus disease 2019 (COVID-19) test results to receive bCPAP. At baseline mean SpO2 on room air was 87% (±2) which increased to 98% (±2), after initiation of bCPAP. The mean duration of bCPAP oxygen therapy was 14.4 ± 24.8 hours. There were no adverse events of note, and no treatment failure or deaths. Operational challenges to the clinical introduction of bCPAP were lack of functioning pulse oximeters, difficult nasal interface fixation among those wearing nose pin, occasional auto bubbling or lack of bubbling in water-filled plastic bottle, lack of holder for water-filled plastic bottle, rapid turnover of trained clinicians at the hospitals, and limited routine care of patients by hospital clinicians particularly after official hours. If the tertiary hospitals in Bangladesh are supplied with well-functioning good quality pulse oximeters and enhanced training of the doctors and nurses on proper use of adapted version of bCPAP, in treating adults with severe pneumonia and hypoxaemia with or without ARDS, the bCPAP was found to be safe, well tolerated and not associated with treatment failure across all study participants. These observations increase the confidence level of the investigators to consider a future efficacy trial of adaptive bCPAP oxygen therapy compared to WHO standard low flow oxygen therapy in such patients. s Although bCPAP oxygen therapy was found to be safe and feasible in this pilot study, several challenges were identified that need to be taken into account when planning a definitive clinical trial.

Bubble CPAP as first ventilatory choice in extremely premature infants: Relation to outcomes and bronchopulmonary dysplasia

PurposePropose an admission strategy of very PTNB, for quality improvement and prevent adverse events, and risk of developing bronchopulmonary dysplasia-BPD, vascular, and neurological outcomes. Methodsobservational prospective cohort study, from 2020 to 2021. All preterms younger than 32 weeks of gestational age were admitted to bCPAP, recorded failure and main outcomes. Results26 very PTNB (30 weeks+2 days), 6 presented bCPAP failure and intubated. Outcomes: 1 nasal bleeding, 2 septal hyperemia, 1 septal lesion and 1 pneumomediastinum, 5 peri-intraventricular hemorrhages, negative retinopathy of prematurity in those who underwent the examination, 1 death and 2 had a diagnosis of BPD. A positive association was identified with the need for FIO2 greater than 21% and BPD. Conclusionsvery PTNB can be safely admitted to bCPAP with the implementation of the proposed protocol, provided that the multidisciplinary team is prepared with periodic training. Attention should be given to the proper positioning of the interface and the baby in the bed, in addition to constant monitoring of ventilatory parameters and air temperature. Supplemental oxygen is associated with an increased risk of developing BPD.

Evaluation of a Novel Dry Powder Surfactant Aerosol Delivery System for Use in Premature Infants Supported with Bubble CPAP.

Aerosolized lung surfactant therapy during nasal continuous positive airway pressure (CPAP) support avoids intubation but is highly complex, with reported poor nebulizer efficiency and low pulmonary deposition. The study objective was to evaluate particle size, operational compatibility, and drug delivery efficiency with various nasal CPAP interfaces and gas humidity levels of a synthetic dry powder (DP) surfactant aerosol delivered by a low-flow aerosol chamber (LFAC) inhaler combined with bubble nasal CPAP (bCPAP). A particle impactor characterized DP surfactant aerosol particle size. Lung pressures and volumes were measured in a preterm infant nasal airway and lung model using LFAC flow injection into the bCPAP system with different nasal prongs. The LFAC was combined with bCPAP and a non-heated passover humidifier. DP surfactant mass deposition within the nasal airway and lung was quantified for different interfaces. Finally, surfactant aerosol therapy was investigated using select interfaces and bCPAP gas humidification by active heating. Surfactant aerosol particle size was 3.68 µm. Lung pressures and volumes were within an acceptable range for lung protection with LFAC actuation and bCPAP. Aerosol delivery of DP surfactant resulted in variable nasal airway (0-20%) and lung (0-40%) deposition. DP lung surfactant aerosols agglomerated in the prongs and nasal airways with significant reductions in lung delivery during active humidification of bCPAP gas. Our findings show high-efficiency delivery of small, synthetic DP surfactant particles without increasing the potential risk for lung injury during concurrent aerosol delivery and bCPAP with passive humidification. Specialized prongs adapted to minimize extrapulmonary aerosol losses and nasal deposition showed the greatest lung deposition. The use of heated, humidified bCPAP gases compromised drug delivery and safety. Safety and efficacy of DP aerosol delivery in preterm infants supported with bCPAP requires more research.

Comparison of Bubble CPAP Versus Conventional Ventilation in Neonates Having Respiratory Distress

Objective: To compare the outcomes of bubble continuous positive airway pressure (B-CPAP) versus ventilator continuous positive airway pressure (V-CPAP) in neonates experiencing respiratory distress. Methodology: This randomized controlled trial was conducted at the Department of Neonatology, Children's Hospital, Pakistan Institute of Medical Sciences (PIMS), Islamabad, from March 1, 2021, to August 31, 2021. A total of 150 neonates of both genders who presented with respiratory distress and were delivered at &gt;32 weeks of gestation, weighing &gt;1500 grams. The neonates were then randomly allocated to two groups using a lottery method. Treatment failure was defined as a neonate's inability to maintain a SpO2 greater than 90% or an arterial partial pressure (PaO2) greater than 50 mmHg with a maximal CPAP of &gt;7 cm of water and a FiO2 greater than 0.6 or the necessity of mechanical ventilation. Results:  Of these, 82 (54.7%) were male, and 68 (45.3%) were female, resulting in a male-to-female ratio of 1.2:1. The mean gestational age was 36±2.49 weeks in the B-CPAP group and 35.52±1.36 weeks in the V-CPAP group. The mean birth weight was 2381±506.4 grams in the B-CPAP group and 2187.3±427.49 grams in the V-CPAP group. Out of the 75 neonates in the B-CPAP group, 10 (13.3%) were classified as treatment failures, while 19 (25.3%) out of 75 neonates in the V-CPAP group met the criteria for treatment failure, according to our operational definition. Although the failure rate was slightly higher in patients receiving V-CPAP for the management of respiratory distress, these differences were not statistically significant (p-value= 0.052). Conclusion: In the treatment of neonatal respiratory distress, there was no significant difference in the failure rate between bubble CPAP and ventilatory CPAP. Regardless of the neonate's gender, birth weight, gestational age, or Silverman score, bubble CPAP may be considered as the primary mode of respiratory support for neonates with respiratory distress.

For preterm infants receiving nasal continuous positive airway pressure (CPAP), how does bubble CPAP compare with ventilator or Infant Flow Driver CPAP?

For preterm infants receiving nasal continuous positive airway pressure (CPAP), how does bubble CPAP compare with ventilator or Infant Flow Driver CPAP?

A low-cost oxygen-air mixer device extends accessibility of safer neonatal respiratory support in a resource-poor setting

Background information: High cost of commercial-grade bubble continuous positive airway pressure (CPAP) machine has led to its limited availability for respiratory support of neonates in resource poor facilities. Most Nigeria facilities resorted to an improvised setup which supplies oxygen at 100% concentration exposing neonates to hyperoxia with possible ROP. PoliteO2blend® is a cheaper device that mixes supplied oxygen with atmospheric air, delivering variable fractions of inspired oxygen (FiO2) to neonates via tracheal tube or nasal prongs extended into a disposable PEEP water bottle as used in the improvised setup. The system microfilters and humidifies the blended gas unlike conventional improvised application. This study evaluated the PoliteO2blend as a standalone device as well as an upgraded version of improvised-CPAP. Methods: Four units of the politeO2blend were installed at the University Teaching Hospital Abakaliki for trialling and were operated by four designated staff after prior training on the modes of application of the device. Forty-five neonates, birthweight ≥1500g were treated following parental consents. The systems were operated as improved improvised-CPAP in 16 neonates of which 18.8% (3/16) were delivered preterm. All patients initially experienced respiratory distress with 75% (12/16) having pre-treatment respiratory rate &gt;60c/m and SPO2 as low as 43% in some. The neonatal impact analyses of continuing usage of the devices at the hospital was evaluated based on the fraction of the total number of needy neonates at the centre who necessarily got treated using the device. Results: The target SPO2 of 90-95% was achieved in all neonates using FiO2 that ranged from 0.21 to 0.6. Duration of improvised setup with PoliteO2blend before successful discharge ranged from 5hrs to 7days. Conclusion: Our target SPO2 was rapidly achieved at a safer FiO2 in most neonates that received respiratory support. Improvised-CPAP application via PoliteO2blend may reduce the incidence of oxygen toxicity owing to conventional use of improvised setup. PoliteO2blend is recommended as safer alternative for facilities lacking sufficient funds.

Barriers to optimal use of continuous positive airway pressure machines in preterm babies with respiratory distress syndrome at a Tertiary Referral Hospital in Addis Ababa, Ethiopia

Background: Neonatal mortality is a significant contributor to under-five mortality in low-income countries like Ethiopia, carrying  neonatal mortality of 30 per 1000 live births. Preterm newborns with respiratory distress can be effectively managed with a Continuous  Positive Airway pressure machine. It is recommended as an essential lifesaving intervention by the World Health Organization. The study  aimed to assess barriers to the optimal use of continuous positive airway pressure machines in preterm babies by Pediatrics residents at  a tertiary referral hospital.&#x0D; Methods: A hospital-based cross-sectional study was carried out among pediatric residents at Tikur Anbessa  Specialized Hospital from September to October 2021. The data were collected through a self-administered structured questionnaire and  analyzed using SPSS version 25. A Pvalue &lt;0.05 was considered statistically significant.&#x0D; Results: One hundred twelve pediatrics residents  were included; 41(36.6%) were females and 89 (79.5 %) were aged between 25-30 years and 106 (94.6%) had NICU experience of less than  one year. Forty-one (36.6%) had a moderate level of practicing continuous positive airway pressure safety checklists. There was a  statistically significant difference in the practice of CPAP safety checklist usage with the year of residency (P= 0.001). A majority, 90  (80.4%), of `pediatrics residents used locally-made improvised water bottle systems as bubble continuous positive airway pressure  machines. The perceived barriers to continuous positive airway pressure machine use included lack of commercial bubble machine, 77  (85.5%), unavailability of oxygen, and lack of appropriately sized nasal prongs.&#x0D; Conclusion: Lack of commercial continuous positive airway  pressure machines and essential equipment were the reported barriers. Tackling the perceived barriers would contribute to the  national effort to decrease neonatal mortality and achieve Sustained Development-3  

Failure Factors of Bubble CPAP in Neonates with Respiratory Distress

Background: Respiratory distress is the most frequent presenting complaint of newborn encountered within the first 48–72 hours of life. An infant who is breathing on instinct is given non-invasive respiratory support called Bubble Continuous Positive Airway Pressure (Bubble CPAP) to help them to maintain a long volume during expiration. The study aimed to identify failure factors of Bubble CPAP in neonate with respiratory distress. Material &amp; Methods: From April to September 2017, a cross-sectional study was carried out at the Department of Neonatal Medicine in Bangladesh Shishu Hospital &amp; Institute. One hundred and eight (N=108) newborns with respiratory distress who were given Bubble CPAP were enrolled for the study. After receiving the parent’s or guardian’s written informed consent, all the necessary information were recorded in a predesigned proforma that included the patient’s specifics. Then completed data forms were reviewed, updated, and prepared for computer data input. The “t” test, “r” test and Statistical Package for the Social Sciences (SPSS) Version 23.0 were used to analyze the data. Results: Among study patients (N=108), most of the neonates 49 (45.4%) belonged to age ≤24 hours and the neonates with respiratory distress which needed Bubble CPAP support 18 (16.7%) had RDS, 18 (16.7%) had PNA, 15(13.9%) had pneumonia, 14(13.0%) had PPHN, and 10(9.3%) had sepsis. More than three-fourths of the patients (85) were found successfully weaned and one-fifth of the patients (23) failed. Conclusion: The most frequent causes of respiratory distress were RDS, PNA, PPHN, Sepsis, congenital pneumonia, and pneumonia. Grunting respiration, higher RR, lower SPO2, higher FiO2 and cyanosis were substantially associated with Bubble CPAP failure among the respiratory distress symptoms. PPHN and sepsis have a causal relationship with Bubble CPAP failure. More duration of Bubble CPAP and more hospital stay also have relation with Bubble CPAP failure. The majority of patients were weaned, however, patients who failed Bubble CPAP died more frequently.

Development of Monitoring Parameters of Oxygen Concentration, Oxygen Flow Rate, Temperature and Humidity in IoT-Based CPAP Bubble (Oxygen and Humidity Concentration)

Bubble Continuous Positive Airway Pressure (CPAP) is a device to maintain positive pressure in the neonate's airway as long as it can breathe spontaneously. FiO2 percentage, flowmeter, humidifier mode, PEEP depth are parameters that must be set for oxygen therapy using a cpap bubble device, but this tool has minimal monitoring. It has been developed by several previous researchers but has several shortcomings, namely there is no digital result display, no measurement of oxygen rate, oxygen concentration, temperature and humidity. The purpose of this research is to design a parameter monitoring tool on the cpap bubble so that it can monitor the baby's condition in real time and can be used as an indicator of achieving the desired concentration setting. The contribution in this study is a monitoring system or remote monitoring so that nurses and doctors can monitor the baby's condition even though they are not accompanying him. In order to facilitate the process of monitoring and diagnosing patients, a parameter monitoring tool on the cpap bubble based on the Internet of Things is made with notifications on telegrams so that patients can be treated quickly. The design of this tool uses OCS-3f as a sensor for detecting oxygen concentration and DHT22 as a sensor for detecting humidity. The output of oxygen and humidity concentrations is then processed by the ESP32 microcontroller into the ADC pin. Data that has been processed from analog sensor data into digital data on the ESP32 is then sent to the https://thinger.io site using the internet network via the wifi module contained in the ESP32 module build-in. In measuring positioned in the settings of 21% to 95%. The largest error value obtained is 4.6% and the smallest is 0.04%.