Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
Department of Paediatrics, Division of Critical Care Medicine, Columbia University Medical Center/New York-Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway, New York, NY 10032, United States of America.
Ghana Med J. 2021 Sep;55(3):221-225. doi: 10.4314/gmj.v55i3.7.
In children, acute respiratory distress (ARD) is a clinical presentation requiring emergency management, including mechanical ventilation. Mechanical ventilators are lacking in sub-Saharan Africa. Continuous Positive Airway Pressure (CPAP) is an alternative form of non-invasive respiratory support that has been used in high-income countries for over four decades. Its use in sub-Saharan Africa is, however, limited and often restricted to neonates. Controlled trials in Ghana have shown that the use of CPAP in children younger aged 1-12 months reduces 2-week all-cause mortality from ARD by 60% (RR 0·40, 0·19-0·82; p=0·01). The absolute reduction in mortality of 4% implies one infant life saved for every 25 children treated with CPAP. This paper reviews the findings of the trials in Ghana and contrasts the findings with those of trials in Bangladesh and Malawi. It makes the case that implementation research (rather than more controlled trials) is now needed to support the routine, safe and effective use of CPAP in managing ARD in older infants in district hospitals in Ghana.
None declared.
在儿童中，急性呼吸窘迫（ARD）是一种需要紧急管理的临床表现，包括机械通气。撒哈拉以南非洲地区缺乏机械呼吸机。持续气道正压通气（CPAP）是一种替代的无创性呼吸支持形式，在高收入国家已经使用了四十多年。然而，CPAP 在撒哈拉以南非洲地区的使用受到限制，通常仅限于新生儿。加纳的对照试验表明，在 1-12 个月大的儿童中使用 CPAP 可将 ARD 的 2 周全因死亡率降低 60%（RR 0·40，0·19-0·82；p=0·01）。死亡率降低 4%意味着每 25 名接受 CPAP 治疗的儿童中就有 1 名婴儿的生命得到挽救。本文回顾了加纳试验的结果，并将其与孟加拉国和马拉维的试验结果进行了对比。本文认为，现在需要实施研究（而不是更多的对照试验）来支持在加纳地区医院中对年龄较大的婴儿管理 ARD 时常规、安全和有效地使用 CPAP。
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