Testing positive pressure delivered from commercial and WHO-style pediatric bubble CPAP devices

Abstract Background/aim Low-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 re...

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Autores principales:	Nicholas A. Ettinger, Nathan Serazin, Richard Nguyen, Jennifer Werdenberg, Minke Huibers, Susan Torrey
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Pediatrics Bubble CPAP Critical care Global health Resource limited setting; respiratory failure RJ1-570
Acceso en línea:	https://doaj.org/article/21dfb57dd42f4e75b7ad6cd18fb822c6
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spelling	oai:doaj.org-article:21dfb57dd42f4e75b7ad6cd18fb822c62021-11-28T12:30:15ZTesting positive pressure delivered from commercial and WHO-style pediatric bubble CPAP devices10.1186/s12887-021-03006-21471-2431https://doaj.org/article/21dfb57dd42f4e75b7ad6cd18fb822c62021-11-01T00:00:00Zhttps://doi.org/10.1186/s12887-021-03006-2https://doaj.org/toc/1471-2431Abstract Background/aim Low-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. Methods Performance 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. Results Both 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. Conclusions Modified 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.Nicholas A. EttingerNathan SerazinRichard NguyenJennifer WerdenbergMinke HuibersSusan TorreyBMCarticlePediatricsBubble CPAPCritical careGlobal healthResource limited setting; respiratory failurePediatricsRJ1-570ENBMC Pediatrics, Vol 21, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Pediatrics Bubble CPAP Critical care Global health Resource limited setting; respiratory failure Pediatrics RJ1-570
spellingShingle	Pediatrics Bubble CPAP Critical care Global health Resource limited setting; respiratory failure Pediatrics RJ1-570 Nicholas A. Ettinger Nathan Serazin Richard Nguyen Jennifer Werdenberg Minke Huibers Susan Torrey Testing positive pressure delivered from commercial and WHO-style pediatric bubble CPAP devices
description	Abstract Background/aim Low-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. Methods Performance 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. Results Both 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. Conclusions Modified 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.
format	article
author	Nicholas A. Ettinger Nathan Serazin Richard Nguyen Jennifer Werdenberg Minke Huibers Susan Torrey
author_facet	Nicholas A. Ettinger Nathan Serazin Richard Nguyen Jennifer Werdenberg Minke Huibers Susan Torrey
author_sort	Nicholas A. Ettinger
title	Testing positive pressure delivered from commercial and WHO-style pediatric bubble CPAP devices
title_short	Testing positive pressure delivered from commercial and WHO-style pediatric bubble CPAP devices
title_full	Testing positive pressure delivered from commercial and WHO-style pediatric bubble CPAP devices
title_fullStr	Testing positive pressure delivered from commercial and WHO-style pediatric bubble CPAP devices
title_full_unstemmed	Testing positive pressure delivered from commercial and WHO-style pediatric bubble CPAP devices
title_sort	testing positive pressure delivered from commercial and who-style pediatric bubble cpap devices
publisher	BMC
publishDate	2021
url	https://doaj.org/article/21dfb57dd42f4e75b7ad6cd18fb822c6
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Testing positive pressure delivered from commercial and WHO-style pediatric bubble CPAP devices

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