Atreya Mihir R, Lorenz John M, Narendran Vivek
Department of Pediatrics (Dr Atreya) and Division of Neonatology (Dr Narendran) Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and Division of Neonatology, College of Physicians and Surgeons, Columbia University, New York, New York (Dr Lorenz).
Adv Neonatal Care. 2018 Dec;18(6):500-506. doi: 10.1097/ANC.0000000000000510.
Bubble continuous positive airway pressure (bCPAP) is a simple, safe, and cost-effective strategy to provide respiratory support to newborns with respiratory distress syndrome in resource-limited settings.
To understand whether implementation of bCPAP, relative to other modes of respiratory support in the care of newborns with respiratory distress syndrome, increases positive attitudes about its potential for consistent and widespread use among providers in neonatal intensive care units (NICUs) of lower middle-income countries.
Semistructured qualitative interviews with 14 healthcare providers, including 5 neonatal nurses, 2 respiratory therapists, 5 postgraduate trainees in pediatrics, and 2 attending physicians, were conducted at a level III NICU in south India where bCPAP had been in consistent use for 6 years. Interviews were transcribed and then coded and categorized using NVivo 10 Software (QSR International, Victoria, Australia).
Categories that emerged from our data include (1) perceived indications, (2) learning curve, (3) perceived costs, (4) perceived shortages, and (5) barriers to use. Providers believed that bCPAP was easy to learn and that it helped empower neonatal nurses in decision-making process. Participants provided a nuanced perspective of cost-benefit associated with bCPAP and that it helped make optimal use of limited resources. Participants identified several barriers to the implementation of bCPAP.
Providers of a level III NICU in a lower- to middle-income country viewed the use of bCPAP favorably. Addressing context-specific barriers will be important for the successful widespread implementation of bCPAP.
Further research will need to focus on whether bCPAP can be safely implemented at level II NICUs.Video Abstract Available at https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx.
气泡持续气道正压通气（bCPAP）是一种简单、安全且经济高效的策略，可在资源有限的环境中为患有呼吸窘迫综合征的新生儿提供呼吸支持。
了解相对于其他呼吸支持模式，在患有呼吸窘迫综合征的新生儿护理中实施bCPAP是否会增加低收入和中等收入国家新生儿重症监护病房（NICU）的医护人员对其持续广泛使用潜力的积极态度。
在印度南部的一家三级NICU进行了半结构化定性访谈，访谈对象包括14名医护人员，其中有5名新生儿护士、2名呼吸治疗师、5名儿科研究生学员和2名主治医师。该NICU已持续使用bCPAP 6年。访谈内容被转录，然后使用NVivo 10软件（QSR国际公司，澳大利亚维多利亚州）进行编码和分类。
从我们的数据中出现的类别包括：（1）感知适应症，（2）学习曲线，（3）感知成本，（4）感知短缺，以及（5）使用障碍。医护人员认为bCPAP易于学习，并且有助于新生儿护士在决策过程中增强能力。参与者对与bCPAP相关的成本效益提供了细致入微的观点，并且认为它有助于优化有限资源的利用。参与者确定了bCPAP实施的几个障碍。
低收入和中等收入国家一家三级NICU的医护人员对bCPAP的使用持积极态度。解决特定背景下的障碍对于bCPAP的成功广泛实施至关重要。
进一步的研究需要关注bCPAP是否可以在二级NICU安全实施。视频摘要可在https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx获取。
