Non-invasive ventilation in children and adults in low- and low-middle income countries: A systematic review and meta-analysis

Mandelzweig, Keren; Leligdowicz, Aleksandra; Murthy, Srinivas; Lalitha, Rejani; Fowler, Robert; Adhikari, Neill K. J.

doi:10.1016/j.jcrc.2018.01.007

Cited by 26 publications

(29 citation statements)

References 80 publications

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“…Although positive pressure ventilation in low-and middle-income countries (LMIC) is most frequently provided invasively, the benefits of NIV are being increasingly recognised. Indeed, for obvious reasons of cost and ease of use, NIV appears to be not only an effective, but also a particularly suitable approach to provide respiratory support in patients living in developing low-income economies [2]. This is especially relevant since in these regions the burden of critical illness is large, and is expected to increase with growing urbanisation, emerging epidemics and expanding access to hospitals [2].…”

Section: Introductionmentioning

confidence: 99%

“…Indeed, for obvious reasons of cost and ease of use, NIV appears to be not only an effective, but also a particularly suitable approach to provide respiratory support in patients living in developing low-income economies [2]. This is especially relevant since in these regions the burden of critical illness is large, and is expected to increase with growing urbanisation, emerging epidemics and expanding access to hospitals [2]. Furthermore, the elevated cost of healthcare staffing, infrastructure needs and onerous access to supplies have hampered the development of fully equipped intensive care units in LMICs [3].…”

Section: Introductionmentioning

confidence: 99%

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Low-cost, easy-to-build noninvasive pressure support ventilator for under-resourced regions: open source hardware description, performance and feasibility testing

et al. 2020

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AimCurrent pricing of commercial mechanical ventilators in low-/middle-income countries (LMICs) markedly restricts their availability, and consequently a considerable number of patients with acute/chronic respiratory failure cannot be adequately treated. Our aim was to design and test an affordable and easy-to-build noninvasive bilevel pressure ventilator to allow a reduction in the serious shortage of ventilators in LMICs.MethodsThe ventilator was built using off-the-shelf materials available via e-commerce and was based on a high-pressure blower, two pressure transducers and an Arduino Nano controller with a digital display (total retail cost <75 USD), with construction details provided open source for free replication. The ventilator was evaluated, and compared with a commercially available device (Lumis 150 ventilator; Resmed, San Diego, CA, USA): 1) in the bench setting using an actively breathing patient simulator mimicking a range of obstructive/restrictive diseases; and b) in 12 healthy volunteers wearing high airway resistance and thoracic/abdominal bands to mimic obstructive/restrictive patients.ResultsThe designed ventilator provided inspiratory/expiratory pressures up to 20/10 cmH2O, respectively, with no faulty triggering or cycling; both in the bench test and in volunteers. The breathing difficulty score rated (1–10 scale) by the loaded breathing subjects was significantly (p<0.005) decreased from 5.45±1.68 without support to 2.83±1.66 when using the prototype ventilator, which showed no difference with the commercial device (2.80±1.48; p=1.000).ConclusionThe low-cost, easy-to-build noninvasive ventilator performs similarly to a high-quality commercial device, with its open-source hardware description, which will allow for free replication and use in LMICs, facilitating application of this life-saving therapy to patients who otherwise could not be treated.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Low-cost, easy-to-build noninvasive pressure support ventilator for under-resourced regions: open source hardware description, performance and feasibility testing

et al. 2020

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“…Congenital or acquired neurological disorders, neuromuscular diseases, complex craniofacial abnormalities, and severe obesity complicated by obstructive sleep apnea are diseases that often require LTV [1,4].…”

Section: Introductionmentioning

confidence: 99%

Characteristics and outcomes in children on long-term mechanical ventilation: the experience of a pediatric tertiary center in Rome

et al. 2020

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Background: Children with chronic respiratory failure and/or sleep disordered breathing due to a broad range of diseases may require long-term ventilation to be managed at home. Advances in the use of long-term non-invasive ventilation has progressively leaded to a reduction of the need for invasive mechanical ventilation through tracheostomy. In this study, we sought to characterize a cohort of children using long-term NIV and IMV and to perform an analysis of those children who showed significant changes in ventilatory support management.

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“…To overcome this problem, staff should optimize the use of NPPV as much as possible . Previous studies have found that NPPV was mainly used in ICU and use of NPPV outside of ICU was uncommon in underdeveloped countries . However, with progress in NPPV technology and changes in the perception and familiarity of medical staff with therapy, ward NPPV has increased significantly .…”

Section: Strategies and Important Issues For Implementation Of Nppv Imentioning

confidence: 99%

“…33 Previous studies have found that NPPV was mainly used in ICU and use of NPPV outside of ICU was uncommon in underdeveloped countries. 16,34 However, with progress in NPPV technology and changes in the perception and familiarity of medical staff with therapy, ward NPPV has increased significantly. 35,36 Overall, NPPV has good cost-effectiveness when used in general wards, which makes it an attractive option for respiratory support in underdeveloped countries.…”

Section: Strategies and Important Issues For Implementation Of Nppv Imentioning

confidence: 99%

Challenges to and opportunities for the implementation of non‐invasive positive pressure ventilation in the Asia‐Pacific region

et al. 2019

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Non‐invasive positive pressure ventilation (NPPV) is undoubtedly one of the most significant advancements in mechanical ventilation technology in the past 30 years. With accumulating evidence from clinical studies and support from clinical guidelines, NPPV is now widely used in hospitals and increasingly prescribed for home therapy in the Asia‐Pacific region. However, in comparison with the developed Western countries, overall use of NPPV in the region is lagging behind. This study reviews this imbalance of NPPV use both in the acute and domiciliary settings in the Asia‐Pacific region. Important issues related to NPPV use are also discussed along with speculation around potential strategies that could promote wider implementation of NPPV in the region. We hope this review will stimulate interest in the clinical application and potential research avenues for NPPV in the Asia‐Pacific region, and promote education and staff training in the technique.

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Non-invasive ventilation in children and adults in low- and low-middle income countries: A systematic review and meta-analysis

Cited by 26 publications

References 80 publications

Low-cost, easy-to-build noninvasive pressure support ventilator for under-resourced regions: open source hardware description, performance and feasibility testing

Low-cost, easy-to-build noninvasive pressure support ventilator for under-resourced regions: open source hardware description, performance and feasibility testing

Characteristics and outcomes in children on long-term mechanical ventilation: the experience of a pediatric tertiary center in Rome

Challenges to and opportunities for the implementation of non‐invasive positive pressure ventilation in the Asia‐Pacific region

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