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Bubble CPAP for infants

Novel Approach for Providing Pediatric Continuous Positive Airway Pressure Devices in Low-Income, Underresourced Regions.

Farré R, Trias G, Solana G, Ginovart G, Gozal D, Navajas D.

Am J Respir Crit Care Med. 2019 Jan 1;199(1):118-120. doi: 10.1164/rccm.201808-1452LE

 

ABSTRACT

Background: Globally, pneumonia is the leading cause of under-5 yr old deaths, particularly in sub-Saharan Africa countries. In the case of preterm birth and pediatric respiratory diseases, a particularly effective treatment in low- and middle-income countries (LMICs) is continuous positive airway pressure (CPAP). Given the need for simple and cheap CPAP devices, we developed, tested and disclosed the construction details of such a device. Methods: Room air from a domestic aquarium air pump was fed into a low-cost rotameter. A similar rotameter was connected as an inlet for oxygen supply. Regulating gas flow in both rotameters allowed us to set up an air-oxygen mixture (0–10 L/min range) at the desired concentration of oxygen, which was fed into a closed receptacle containing water, and a submerged stainless-steel heater/controller for a domestic aquarium. The conditioned air was fed into conventional flexible tubing connected to one inlet of newborn nasal prongs. The nasal-prong inlet was connected to similar conventional tubing, which was ended by a rigid tube with a multiorifice piece. CPAP was set by adequately submerging this piece in an open receptacle with water. The performance of the CPAP setting was tested on the bench under well-controlled conditions by connecting the newborn nasal prongs to a patient simulator that was able to reproduce the conventional pediatric VTs and frequencies. Results: Nasal pressures were stable when compared with other reported bubble CPAP devices, in terms of both noise induced by bubbling and fluctuations caused by breathing oscillations. Consistent results emerged when breathing of a 10-kg body weight infant (35 breaths/min, 100 ml VT) was simulated through nasal prongs of the corresponding size. Interestingly, the retail cost of components was <$100. Conclusion: We have effectively implemented a collaborative procedure for health technology transfer to a team in LMICs, enabling autonomous construction and maintenance, thereby facilitating adequate provision of pediatric CPAP settings in markedly underserved regions.

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