International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Bangladesh University of Engineering and Technology (BUET), Dhaka, Bangladesh.
J Glob Health. 2023 Nov 24;13:06046. doi: 10.7189/jogh.13.06046.
Bubble continuous positive airway pressure (bCPAP) oxygen therapy has been shown to be safe and effective in treating children with severe pneumonia and hypoxaemia in Bangladesh. Due to lack of adequate non-invasive ventilatory support during coronavirus disease 2019 (COVID-19) crisis, we aimed to evaluate whether bCPAP was safe and feasible when adapted for use in adults with similar indications.
Adults (18-64 years) with severe pneumonia and moderate hypoxaemia (80 to <90% oxygen saturation (SpO) in room air) were provided bCPAP via nasal cannula at a flow rate of 10 litres per minute (l/min) oxygen at 10 centimetres (cm) HO pressure, in two tertiary hospitals in Dhaka, Bangladesh. Qualitative interviews and focus group discussions, using a descriptive phenomenological approach, were performed with patients and staff (n = 39) prior to and after the introduction (n = 12 and n = 27 respectively) to understand the operational challenges to the introduction of bCPAP.
We enrolled 30 adults (median age 52, interquartile range (IQR) 40-60 years) with severe pneumonia and hypoxaemia and/or acute respiratory distress syndrome (ARDS) irrespective of coronavirus disease 2019 (COVID-19) test results to receive bCPAP. At baseline mean SpO on room air was 87% (±2) which increased to 98% (±2), after initiation of bCPAP. The mean duration of bCPAP oxygen therapy was 14.4 ± 24.8 hours. There were no adverse events of note, and no treatment failure or deaths. Operational challenges to the clinical introduction of bCPAP were lack of functioning pulse oximeters, difficult nasal interface fixation among those wearing nose pin, occasional auto bubbling or lack of bubbling in water-filled plastic bottle, lack of holder for water-filled plastic bottle, rapid turnover of trained clinicians at the hospitals, and limited routine care of patients by hospital clinicians particularly after official hours.
If the tertiary hospitals in Bangladesh are supplied with well-functioning good quality pulse oximeters and enhanced training of the doctors and nurses on proper use of adapted version of bCPAP, in treating adults with severe pneumonia and hypoxaemia with or without ARDS, the bCPAP was found to be safe, well tolerated and not associated with treatment failure across all study participants. These observations increase the confidence level of the investigators to consider a future efficacy trial of adaptive bCPAP oxygen therapy compared to WHO standard low flow oxygen therapy in such patients.
s Although bCPAP oxygen therapy was found to be safe and feasible in this pilot study, several challenges were identified that need to be taken into account when planning a definitive clinical trial.
在孟加拉国，气泡持续气道正压通气（bCPAP）氧疗已被证明可安全有效地治疗患有严重肺炎和低氧血症的儿童。由于在 2019 年冠状病毒病（COVID-19）危机期间缺乏足够的无创通气支持，我们旨在评估当将 bCPAP 适用于具有类似适应证的成人时，其是否安全和可行。
在孟加拉国达卡的两家三级医院中，我们通过鼻导管为患有严重肺炎和中度低氧血症（80 至<90%血氧饱和度（SpO）在室内空气）的成人提供 bCPAP，流量为 10 升/分钟（l/min）氧气，在 10 厘米（cm）HO 压力下，使用 10 厘米（cm）HO 压力。在引入 bCPAP 之前（n=12）和之后（n=27），对患者和工作人员（n=39）进行了定性访谈和焦点小组讨论，采用描述性现象学方法，以了解引入 bCPAP 的操作挑战。
我们招募了 30 名患有严重肺炎和低氧血症和/或急性呼吸窘迫综合征（ARDS）的成人（中位年龄 52 岁，四分位间距（IQR）为 40-60 岁），无论 2019 年冠状病毒病（COVID-19）检测结果如何，均接受 bCPAP 治疗。在启动 bCPAP 之前，患者在室内空气中的平均 SpO 为 87%（±2），增加至 98%（±2）。bCPAP 氧疗的平均持续时间为 14.4±24.8 小时。没有观察到不良事件，也没有治疗失败或死亡。bCPAP 临床引入的操作挑战是缺乏正常工作的脉搏血氧仪、佩戴鼻环的患者的鼻接口固定困难、水填充塑料瓶中偶尔出现自动冒泡或缺乏冒泡、缺乏水填充塑料瓶的支架、医院医生和护士的快速轮换，以及医院临床医生对患者的常规护理有限，尤其是在下班时间之后。
如果孟加拉国的三家三级医院配备了性能良好的高质量脉搏血氧仪，并对医生和护士进行了适当使用经改编的 bCPAP 的增强培训，那么在治疗患有严重肺炎和低氧血症伴或不伴 ARDS 的成人时，bCPAP 被发现是安全的，耐受良好的，并且在所有研究参与者中均未发生治疗失败。这些观察结果增加了研究人员的信心水平，使其考虑在这些患者中进行适应性 bCPAP 氧疗与世界卫生组织标准低流量氧疗的未来疗效试验。
虽然在这项试点研究中发现 bCPAP 氧疗是安全且可行的，但仍发现了一些需要在计划进行确定性临床试验时考虑的挑战。
