Mayo Clinic School of Medicine, 200 1st Street SW, Rochester, MN, USA.
Northwestern University, Lurie Children's Hospital, 225 E, Chicago, IL, 60611, USA.
BMC Health Serv Res. 2019 Jul 31;19(1):533. doi: 10.1186/s12913-019-4364-y.
In some low-resource settings bubble continuous positive airway pressure (bCPAP) is increasingly used to treat children with pneumonia. However, the time required for healthcare workers (HCWs) to administer bCPAP is unknown and may have implementation implications. This study aims to compare HCW time spent administering bCPAP and low-flow nasal oxygen care at a district hospital in Malawi during CPAP IMPACT (Improving Mortality for Pneumonia in African Children Trial).
Eligible participants were 1-59 months old with WHO-defined severe pneumonia and HIV-infection, HIV-exposure, severe malnutrition, or hypoxemia and were randomized to either bCPAP or oxygen. We used time motion techniques to observe hospital care in four hour blocks during treatment initiation or follow up (maintenance). HCW mean time per patient at the bedside over the observation period was calculated by study arm.
Overall, bCPAP required an average of 34.71 min per patient more than low-flow nasal oxygen to initiate (bCPAP, 118.18 min (standard deviation (SD) 42.73 min); oxygen, 83.47 min (SD, 20.18 min), p < 0.01). During initiation, HCWs spent, on average, 12.45 min longer per patient setting up bCPAP equipment (p < 0.01) and 11.13 min longer per patient setting up the bCPAP nasal interface (p < 0.01), compared to oxygen equipment and nasal cannula set-up. During maintenance care, HCWs spent longer on average per patient adjusting bCPAP, compared to oxygen equipment (bCPAP 4.57 min (SD, 4.78 min); oxygen, 1.52 min (SD, 2.50 min), p = 0.03).
Effective bCPAP implementation in low-resource settings will likely create additional HCW burden relative to usual pneumonia care with oxygen.
Clinicaltrials.gov NCT02484183 , June 29, 2015.
在一些资源匮乏的环境中，越来越多地使用持续气道正压通气（CPAP）治疗肺炎患儿。然而，医护人员（HCW）实施 CPAP 的时间尚不清楚，这可能会产生实施方面的影响。本研究旨在比较马拉维地区医院中 CPAPIMPACT（改善非洲儿童肺炎死亡率试验）期间 HCW 实施 CPAP 和低流量鼻氧疗的时间。
符合条件的参与者为 1-59 个月龄、有世界卫生组织（WHO）定义的严重肺炎、HIV 感染、HIV 暴露、严重营养不良或低氧血症的儿童，随机分配至 CPAP 或氧疗组。我们使用时间动作技术，在治疗开始或随访（维持）期间，每 4 小时观察一次医院护理。通过研究臂计算观察期间每位患者的床边 HCW 平均时间。
总体而言，与低流量鼻氧疗相比，CPAP 平均每个患者多需要 34.71 分钟来启动（CPAP，118.18 分钟（标准偏差（SD）42.73 分钟）；氧疗，83.47 分钟（SD，20.18 分钟），p<0.01）。在启动期间，HCW 为每个患者设置 CPAP 设备多花费 12.45 分钟（p<0.01），为每个患者设置 CPAP 鼻接口多花费 11.13 分钟（p<0.01），而与氧疗设备和鼻塞的设置相比。在维持护理期间，HCW 平均每个患者调整 CPAP 的时间比氧疗设备长（CPAP，4.57 分钟（SD，4.78 分钟）；氧疗，1.52 分钟（SD，2.50 分钟），p=0.03）。
与常规的氧疗相比，在资源匮乏的环境中有效地实施 CPAP 可能会给 HCW 带来额外的负担。
Clinicaltrials.gov NCT02484183 ，2015 年 6 月 29 日。
