Feasibility and acceptability of bubble continuous positive airway pressure oxygen therapy for the treatment of childhood severe pneumonia and hypoxaemia in Bangladeshi children

Effective management of hypoxaemia is key to reducing pneumonia deaths in children. In an intensive care setting within a tertiary hospital in Bangladesh, bubble continuous positive airway pressure (bCPAP) oxygen therapy was beneficial in reducing deaths in this population. To inform a future trial,...

Full description

Saved in:

Bibliographic Details
Published in:	Journal of global health Vol. 13; p. 04040
Main Authors:	Chisti, Mohammod Jobayer, Duke, Trevor, Rahman, Ahmed Ehnasur, Ahmed, Tahmeed, Arifeen, Shams E, Clemens, John D, Uddin, Md F, Rahman, Abu Smmh, Rahman, Md M, Sarker, Tapash K, Uddin, S M N, Shahunja, K M, Shahid, Abu Smsb, Faruque, Asg, Sarkar, Supriya, Islam, Md Jahurul, Islam, Muhammad Shariful, Kabir, Md Farhad, Cresswell, Kathrin M, Norrie, John, Sheikh, Aziz, Campbell, Harry, Nair, Harish, Cunningham, Steve
Format:	Journal Article
Language:	English
Published:	Scotland Edinburgh University Global Health Society 26-05-2023 International Society of Global Health
Subjects:	Antibiotics Caregivers Child Child, Preschool Continuous Positive Airway Pressure Data collection Developing countries Fatalities Feasibility Studies Global health Guardians Hospitals Humans Hypoxia - therapy Infant Interviews LDCs Medical personnel Mortality Nurses Oxygen Oxygen therapy Pediatrics Physicians Pneumonia Retrospective Studies Working conditions Bangladesh Ghana
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Effective management of hypoxaemia is key to reducing pneumonia deaths in children. In an intensive care setting within a tertiary hospital in Bangladesh, bubble continuous positive airway pressure (bCPAP) oxygen therapy was beneficial in reducing deaths in this population. To inform a future trial, we investigated the feasibility of introducing bCPAP in this population in non-tertiary/district hospitals in Bangladesh. We conducted a qualitative assessment using a descriptive phenomenological approach to understand the structural and functional capacity of the non-tertiary hospitals (Institute of Child and Mother Health and Kushtia General Hospital) for the clinical use of bCPAP. We conducted interviews and focus group discussions (23 nurses, seven physicians, 14 parents). We retrospectively (12 months) and prospectively (three months) measured the prevalence of severe pneumonia and hypoxaemia in children attending the two study sites. For the feasibility phase, we enrolled 20 patients with severe pneumonia (age two to 24 months) to receive bCPAP, putting in place safeguards to identify risk. Retrospectively, while 747 of 3012 (24.8%) children had a diagnosis of severe pneumonia, no pulse oxygen saturation information was available. Of 3008 children prospectively assessed with pulse oximetry when attending the two sites, 81 (3.7%) had severe pneumonia and hypoxaemia. The main structural challenges to implementation were the inadequate number of pulse oximeters, lack of power generator backup, high patient load with an inadequate number of hospital staff, and inadequate and non-functioning oxygen flow meters. Functional challenges were the rapid turnover of trained clinicians in the hospitals, limited post-admission routine care for in-patients by hospital clinicians due to their extreme workload (particularly after official hours). The study implemented a minimum of four hourly clinical reviews and provided oxygen concentrators (with backup oxygen cylinders), and automatic power generator backup. Twenty children with a mean age of 6.7 (standard deviation (SD) = 5.0)) months with severe pneumonia and hypoxaemia (median (md) SpO = 87% in room air, interquartile range (IQR) = 85-88)) with cough (100%) and severe respiratory difficulties (100%) received bCPAP oxygen therapy for a median of 16 hours (IQR = 6-16). There were no treatment failures or deaths. Implementation of low-cost bCPAP oxygen therapy is feasible in non-tertiary/district hospitals when additional training and resources are allocated.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2047-2978 2047-2986
DOI:	10.7189/jogh.13.04040