A Low-Resource Oxygen Blender Prototype for Use in Modified Bubble CPAP Circuits

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Jared Floersch ◽  
Elsa Hauschildt ◽  
Adam Keester ◽  
Samuel Poganski ◽  
Kiet Tran ◽  
...  
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Low Cost ◽  
World Health ◽  
Pure Oxygen ◽  
Hypodermic Needle ◽  
Low Resource Settings ◽  
Low Resource ◽  
Tract Infections

Abstract Continuous positive airway pressure (CPAP) is a method of respiratory support used around the world to treat children with lower respiratory tract infections (LRTI) (WHO, 2016, Oxygen Therapy for Children, World Health Organization, Geneva, Switzerland, Report). Bubble continuous positive airway pressure (bCPAP) is an effective form of CPAP that is currently used in both high- and low-resource countries. Low-cost, modified bCPAP devices have been designed as an ideal form of CPAP in low-resource areas (Bjorklund, A. R., Mpora, B. O., Steiner, M. E., Fischer, G., Davey, C. S., and Slusher, T. M., 2018, “Use of a Modified Bubble Continuous Positive Airway Pressure (bCPAP) Device for Children in Respiratory Distress in Low- and Middle-Income Countries: A Safety Study,” Paediatr. Int. Child Health, 39(3), pp. 1–8). However, patients in low-resource settings undergoing bCPAP treatment are often given pure oxygen, which has been linked to retinopathy of prematurity, cardiovascular complications, and patient mortality (Rodgers, J. L., Iyer, D., Rodgers, L. E., Vanthenapalli, S., and Panguluri, S. K., 2019, “Impact of Hyperoxia on Cardiac Pathophysiology,” J. Cell. Physiol., 234(8), pp. 1–9; Ramgopal, S., Dezfulian, C., Hickey, R. W., Au, A. K., Venkataraman, S., Clark, R. S. B., and Horvat, C. M., 2019, “Association of Severe Hyperoxemia Events and Mortality Among Patients Admitted to a Pediatric Intensive Care Unit,” JAMA Network Open, 2(8), p. e199812). This problem is typically avoided by using commercial oxygen blenders, which can titrate down the concentration of oxygen delivered to the minimum needed; however, these blenders can cost nearly 1000 USD and are almost always unavailable in low-resource settings. The lack of available low-cost oxygen blenders compatible with modified bCPAP circuits creates a barrier for low-resource hospitals to be able to provide blended oxygen to patients. There is a need for a low-cost oxygen blender for use in low-resource settings. We propose a passive oxygen blender that operates via entrainment of atmospheric air. The device can easily be assembled in low-resource areas using a 22 gauge hypodermic needle, two 3 cc syringes, tape or super glue, and the materials required for bCPAP—for approximately 1.40 USD per device. The blender has not been clinically tested yet, but can achieve oxygen concentrations as low as 60% with bCPAP levels of 5 cm H2O (490 Pa) when used in a standard bCPAP circuit without a patient.

scholarly journals Experiences with implementation of continuous positive airway pressure for neonates and infants in low-resource settings: A scoping review

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252718
Author(s):  
Sara Dada ◽  
Henry Ashworth ◽  
Alina Sobitschka ◽  
Vanitha Raguveer ◽  
Rupam Sharma ◽  
...  
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Barriers And Facilitators ◽  
Positive Pressure ◽  
Original Research ◽  
Low Resource Settings ◽  
Low Resource ◽  
High Resource ◽  
Neonates And Infants

Background Continuous positive airway pressure (CPAP) is the gold standard of care in providing non-invasive positive pressure support to neonates in respiratory distress in high-resource settings. While safety has been demonstrated in low-resource settings, there is a lack of knowledge on the barriers and facilitators to proper implementation. Objective To identify and describe the barriers, facilitators, and priorities for future implementation of CPAP for neonates and infants in low-resource settings. Methods A systematic search (database inception to March 6, 2020) was performed on MEDLINE, Embase, Web of Science, CINAHL, Global Health, and the WHO Global Index Medicus using PRISMA-ScR guidelines. Original research articles pertaining to implementation of CPAP devices in low-resource settings, provider or parent perspectives and experiences with CPAP, cost-benefit analyses, and cost-effectiveness studies were included. Inductive content analysis was conducted. Findings 1385 article were screened and 54 studies across 19 countries met inclusion criteria. Six major themes emerged: device attributes, patient experiences, parent experiences, provider experiences, barriers, and facilitators. Nasal trauma was the most commonly reported complication. Barriers included unreliable electricity and lack of bioengineering support. Facilitators included training, mentorship and empowerment of healthcare providers. Device design, supply chain infrastructure, and training models were imperative to the adoption and sustainability of CPAP. Conclusion Sustainable implementation of CPAP in low resource settings requires easy-to-use devices, ready access to consumables, and holistic, user-driven training. Further research is necessary on standardizing metrics, interventions that support optimal provider performance, and conditions needed for successful long-term health system integration.

scholarly journals Comparison of Saans neonatal continuous positive airway pressure against standard of care for intra-hospital transport of neonates with respiratory distress syndrome

2021 ◽  
Vol 9 (1) ◽  
pp. 220
Author(s):  
Jagadeesh . ◽  
Megha Singh ◽  
Bhavana M. S. ◽  
Kavitha . ◽  
Ravi Chander
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Respiratory Distress ◽  
Airway Pressure ◽  
Oxygen Therapy ◽  
Positive Airway Pressure ◽  
Low Cost ◽  
Cpap Therapy ◽  
Pressure Therapy ◽  
Low Resource ◽  
Oxygen Group

Background: CPAP (continuous positive airway pressure) therapy, effective in managing neonates with respiratory distress. While CPAP therapy is indicated right from birth, existing CPAP systems are designed for/installed in, NICUs. As a result, most neonates with RD (respiratory distress) are managed with only oxygen therapy during transportation in low resource settings. This study compares a novel, low-cost, portable neonatal CPAP system for use in transport from the labor room to the NICU, against conventional oxygen therapy in low resource settings.Methods: This was an open-label, 2 arm study with a treatment arm (low-cost indigenous CPAP device for therapy) and a control group (oxygen therapy). A total of 132 neonates were assigned with 66 in (matched-control study), in each group.Results: Both arms (CPAP and oxygen) had similar gestational age. gender distributions and initial SAS scores. The CPAP group had higher use of antenatal steriods (38 versus 26) compared to oxygen group and a lower need for surfactant (28 versus 40). Also, a larger number of neonates required ventilation in oxygen group (42) versus CPAP group (15), with the p=0.000561 the result is significant at p<0.05.Conclusions: CPAP therapy induced in labor room measurably improves neonates health and reduces respiratory distress. The indigenous low-cost CPAP device (Saans) used in this study effectively provides CPAP therapy to neonates during transport from the labor room to the NICU, reducing respiratory distress and the need for mechanical ventilation, making useful addition to labor rooms.

scholarly journals Bubble Nasal Continuous Positive Airway Pressure (bNCPAP): An Effective Low-Cost Intervention for Resource-Constrained Settings

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Walufu Ivan Egesa ◽  
William Mugowa Waibi
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Neonatal Intensive Care ◽  
Positive Airway Pressure ◽  
Low Cost ◽  
Failure Criteria ◽  
Resource Constrained ◽  
Care Package ◽  
Tertiary Hospitals ◽  
Physiological Benefits

Preterm birth complications are responsible for almost one-third of the global neonatal mortality burden, and respiratory distress syndrome remains the single most common cause of these preventable deaths. Since its inception, almost half a century ago, nasal continuous positive airway pressure (NCPAP) has evolved to become the primary modality for neonatal respiratory care in both the developed and developing world. Although evidence has demonstrated the effectiveness of low-cost bubble NCPAP in reducing newborn mortality, its widespread use is yet to be seen in resource-constrained settings. Moreover, many tertiary hospitals in developing countries still utilise an inexpensive locally assembled bNCPAP system of unknown efficacy and safety. This review provides a brief overview of the history, physiological benefits, indications, contraindications, and complications of bNCPAP. Evidence regarding the effectiveness of low-cost bNCPAP in the neonatal intensive care unit is also summarised. The article further details a locally assembled bNCPAP system used in resource-constrained settings and highlights the care package for neonates receiving bNCPAP, failure criteria, and strategies for weaning.

Continuous positive airway pressure causes lung injury in a model of sepsis

2005 ◽  
Vol 289 (4) ◽  
pp. L554-L564 ◽  
Author(s):  
Shinya Tsuchida ◽  
Doreen Engelberts ◽  
Matthias Roth ◽  
Colin McKerlie ◽  
Martin Post ◽  
...  
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Lung Injury ◽  
Circuit Design ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Low Cost ◽  
Conventional Mechanical Ventilation ◽  
Pulmonary Atelectasis ◽  
Primary Form

Continuous positive airway pressure, aimed at preventing pulmonary atelectasis, has been used for decades to reduce lung injury in critically ill patients. In neonatal practice, it is increasingly used worldwide as a primary form of respiratory support due to its low cost and because it reduces the need for endotracheal intubation and conventional mechanical ventilation. We studied the anesthetized in vivo rat and determined the optimal circuit design for delivery of continuous positive airway pressure. We investigated the effects of continuous positive airway pressure following lipopolysaccharide administration in the anesthetized rat. Whereas neither continuous positive airway pressure nor lipopolysaccharide alone caused lung injury, continuous positive airway pressure applied following intravenous lipopolysaccharide resulted in increased microvascular permeability, elevated cytokine protein and mRNA production, and impaired static compliance. A dose-response relationship was demonstrated whereby higher levels of continuous positive airway pressure (up to 6 cmH2O) caused greater lung injury. Lung injury was attenuated by pretreatment with dexamethasone. These data demonstrate that despite optimal circuit design, continuous positive airway pressure causes significant lung injury (proportional to the airway pressure) in the setting of circulating lipopolysaccharide. Although we would currently avoid direct extrapolation of these findings to clinical practice, we believe that in the context of increasing clinical use, these data are grounds for concern and warrant further investigation.

scholarly journals Non-invasive continuous positive airway pressure in monolateral lung transplant patient with pneumonia and IPF

2016 ◽  
Vol 73 (4) ◽  
Author(s):  
S. Aliberti ◽  
M.C. Andrisani ◽  
P. Tarsia ◽  
R. Trevisan ◽  
R. Cosentini ◽  
...  
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Lung Transplantation ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Left Lung ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Native Lung ◽  
The Right ◽  
Tract Infections

Patients who undergo lung transplantation are prone to develop lower respiratory tract infections, leading to severe acute respiratory failure (ARF). Endotracheal intubation may not be indicated in these patients in light of a higher rate of mortality due to infections. The application of non-invasive ventilation could play a role in bridging these patients through the episode of ARF waiting for medical treatment to have effect. We report the evidence of morphological and physiological effects of the application of non-invasive continuous positive airway pressure during ARF sustained by pneumonia in a patient who underwent left lung transplantation because of idiopathic pulmonary fibrosis (IPF). We studied the effects of the application of positive end-expiratory pressure on both the right native lung affected by IPF and the transplanted lung affected by pneumonia.

scholarly journals An Internet of Medical Things System to Increase Continuous Positive Airway Pressure Usage in Patients with Sleep-Disordered Breathing

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Angelo Croatti ◽  
Sara Montagna ◽  
Carolina Lombardi ◽  
Gianfranco Parati ◽  
Martino F. Pengo ◽  
...  
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Behavioral Interventions ◽  
Sleep Disordered Breathing ◽  
Positive Airway Pressure ◽  
Spectral Power ◽  
Low Cost ◽  
Mobile App ◽  
Obstructive Sleep ◽  
Acceleration Sensors

AbstractObstructive sleep apnea (OSA) is a highly prevalent sleep disorder associated with increased daytime sleepiness and cardiovascular risk. Continuous positive airway pressure (CPAP), requiring a pressure-generating device connected via tubing to a mask during sleep, is an effective treatment. However, patients’ adherence to CPAP is often suboptimal. Behavioral interventions are effective in improving adherence to CPAP. We aimed to provide proof of principle for the operation of a low-cost, self-standing, internet-based system to measure and promote adherence to CPAP. The system is composed of triaxial acceleration sensors attached to the CPAP mask and to the wrist, able to record CPAP usage information, and a mobile app that collects such information and, thorough a chatbot, feeds back to the patient to improve adherence to treatment. The mask subsystem identifies time periods when the mask is put on based on relatively high values of the ratio between acceleration spectral power at frequencies $$< 0.35$$ < 0.35 Hz vs. 0.35–2 Hz over 1-min windows. Accuracy in identification may be increased taking account of the surges in the standard deviation of wrist accelerations over 1-min windows that accompany putting on and taking off the mask. The whole system can represent a unique tool capable of monitoring and improving patients’ adherence to CPAP treatment. Its main strength lies in its simplicity, low cost, and independence from the specific CPAP device and mask employed.

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