Continuous positive airway pressure for children with undifferentiated respiratory distress in Ghana: an open-label, cluster, crossover trial

Wilson, Patrick T.; Baiden, Frank; Brooks, Joshua C; Morris, Marilyn C.; Giessler, Katie; Punguyire, Damien; Apio, Gavin; Agyeman-Ampromfi, Akua; López‐Pintado, Sara; Sylverken, Justice; Nyarko-Jectey, Kwadwo; Tagbor, Harry; Moresky, Rachel T

doi:10.1016/s2214-109x(17)30145-6

Cited by 48 publications

(83 citation statements)

References 21 publications

(8 reference statements)

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“…CPAP improved respiratory rate, heart rate and SpO 2 after six hours, compared to admission . By far the largest study so far was a pragmatic cross‐over trial in Ghana, which showed that CPAP did not decrease all‐cause two‐week mortality in children one month to five years of age with undifferentiated respiratory distress, however, after adjustment for confounding factors the authors reported a lower mortality for infants treated with CPAP than those treated with standard oxygen therapy .…”

Section: Discussionmentioning

confidence: 96%

Continuous positive airway pressure in children with severe pneumonia and hypoxaemia in Papua New Guinea: an evaluation of implementation

2019

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Aim To prospectively evaluate the use of bubble continuous positive airway pressure (CPAP) in children with very severe pneumonia and other acute lower respiratory infections, during its trial introduction in a low resource hospital in Papua New Guinea. Methods Prospective observational study of children treated with CPAP who had severe pneumonia and severe respiratory distress with hypoxaemia (SpO2 <90%). CPAP was driven by oxygen concentrators in which the fraction of inspired oxygen could be adjusted, and using low‐resistance tubing and nasal oxygen prongs. Results A total of 64 children were commenced on CPAP: 29 (45.3%) survived and were discharged well, 35 (54.7%) died. Prior to commencing CPAP, the median SpO2 was 78% (IQR 53.3–86.8%), at one hour SpO2 was 92% (IQR 80–97.75%, n = 64), and at 84 hours (3½ days) 98% (IQR 93–98%, n = 29), in survivors at each of these time points. A higher SpO2 at one hour after commencement of CPAP predicted survival (p = 0.013), and human immunodeficiency virus infection was an independent predictors of death (p = 0.017). Technical and clinical problems encountered are described. Conclusion Bubble CPAP improved oxygenation and reduced the severity of respiratory distress in some children with severe pneumonia; however, mortality was high reflecting high severity of illness and comorbidities. CPAP requires a quality system to be safe and effective.

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Section: Discussionmentioning

confidence: 96%

Continuous positive airway pressure in children with severe pneumonia and hypoxaemia in Papua New Guinea: an evaluation of implementation

2019

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“…Two published randomised, controlled trials in Bangladesh (a tertiary centre) and Ghana (two district level hospitals) showed physiological and mortality benefits with the use of bCPAP in select paediatric populations under 5 years of age. 7,8 The Bangladesh trial (n=146) was stopped early due to the significant reduction in mortality (15% vs 4%) in children receiving bCPAP for severe hypoxaemic pneumonia as compared with low flow oxygen. The clinical trial in Ghana (n=2182) showed significant improvement in respiratory rate in all age groups and decreased mortality (7% vs 3%) in children under 1 year of age with the application of bCPAP in undifferentiated acute respiratory distress.…”

Section: Bubble Cpap In Resource-poor Settings: Friend or Foe?mentioning

confidence: 99%

Bubble CPAP in resource-poor settings: friend or foe?

Wilson

2019

The Lancet Respiratory Medicine

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“…A recent randomised controlled trial (RCT) conducted in Bangladesh showed that children with VSPNA treated with bCPAP had a significantly lower mortality rate (4%) compared with a group treated with low-flow O 2 (15%) 23. A further study conducted in Ghana demonstrated that CPAP can be used efficiently in the management of children with respiratory distress in SSA 24…”

Section: Introductionmentioning

confidence: 99%

Use of bubble continuous positive airway pressure (bCPAP) in the management of critically ill children in a Malawian paediatric unit: an observational study

et al. 2019

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IntroductionIn low-resource countries, respiratory failure is associated with a high mortality risk among critically ill children. We evaluated the role of bubble continuous positive airway pressure (bCPAP) in the routine care of critically ill children in Lilongwe, Malawi.MethodsWe conducted an observational study between 26 February and 15 April 2014, in an urban paediatric unit with approximately 20 000 admissions/year (in-hospital mortality <5% approximately during this time period). Modified oxygen concentrators or oxygen cylinders provided humidified bCPAP air/oxygen flow. Children up to the age of 59 months with signs of severe respiratory dysfunction were recruited. Survival was defined as survival during the bCPAP-treatment and during a period of 48 hours following the end of the bCPAP-weaning process.Results117 children with signs of respiratory failure were included in this study and treated with bCPAP. Median age: 7 months. Malaria rapid diagnostic tests were positive in 25 (21%) cases, 15 (13%) had severe anaemia (Hb < 7.0 g/dL); 55 (47%) children had multiorgan failure (MOF); 22 (19%) children were HIV-infected/exposed. 28 (24%) were severely malnourished. Overall survival was 79/117 (68%); survival was 54/62 (87%) in children with very severe pneumonia (VSPNA) but without MOF. Among the 19 children with VSPNA (single-organ failure (SOF)) and negative HIV tests, all children survived. Survival rates were lower in children with MOF (including shock) (45%) as well as in children with severe malnutrition (36%) and proven HIV infection or exposure (45%).ConclusionDespite the limitations of this study, the good outcome of children with signs of severe respiratory dysfunction (SOF) suggests that it is feasible to use bCPAP in the hospital management of critically ill children in resource-limited settings. The role of bCPAP and other forms of non-invasive ventilatory support as a part of an improved care package for critically ill children with MOF at tertiary and district hospital level in low-resource countries needs further evaluation. Critically ill children with nutritional deficiencies and/or HIV infection/exposure need further study to determine bCPAP efficacy.

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Continuous positive airway pressure for children with undifferentiated respiratory distress in Ghana: an open-label, cluster, crossover trial

Abstract: General Electric Foundation.

Cited by 48 publications

References 21 publications

Continuous positive airway pressure in children with severe pneumonia and hypoxaemia in Papua New Guinea: an evaluation of implementation

Continuous positive airway pressure in children with severe pneumonia and hypoxaemia in Papua New Guinea: an evaluation of implementation

Bubble CPAP in resource-poor settings: friend or foe?

Use of bubble continuous positive airway pressure (bCPAP) in the management of critically ill children in a Malawian paediatric unit: an observational study

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