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

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 (SpO <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 SpO 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 SpO 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.