title: A randomized clinical trial evaluating nasal continuous positive airway pressure for acute respiratory distress in a developing country.
abstract: OBJECTIVE
  Invasive mechanical ventilation is often not an option for children with acute respiratory infections in developing countries. An alternative is continuous positive airway pressure (CPAP). The authors evaluated the effectiveness of CPAP in children presenting with acute respiratory distress in a developing country.
  
  
  METHODS
  A randomized, controlled trial was conducted in 4 rural hospitals in Ghana. Children, 3 months to 5 years of age, presenting with tachypnea and intercostal or subcostal retractions or nasal flaring were randomly assigned to receive CPAP immediately or 1 hour after presentation. CPAP was applied by locally trained nurses. The primary outcome measure was change in respiratory rate at 1 hour.
  
  
  RESULTS
  The study was stopped after the enrollment of 70 subjects because of a predetermined stop value of P < .001. Mean respiratory rate of children who received immediate CPAP fell by 16 breaths/min (95% CI 10-21) in the first hour compared with no change in children who had CPAP delayed by 1 hour (95% CI -2 to +5). Thirty-five of the patients had a positive malaria blood smear. There were 3 deaths as a result of severe malaria. No major complications of CPAP use were noted.
  
  
  CONCLUSIONS
  CPAP decreases respiratory rate in children with respiratory distress compared with children not receiving CPAP. The technology was successfully used by local nurses. No complications were associated with its use. CPAP is a relatively low-cost, low-technology that is a safe method to decrease respiratory rate in children with nonspecific respiratory distress.
authors.affiliation: Division of Pediatric Critical Care Medicine, Columbia University Medical Center, New York, NY, USA. ptw2107@columbia.edu
authors.forename: Patrick T
authors.initials: PT
authors.lastname: Wilson
authors.forename: Marilyn C
authors.initials: MC
authors.lastname: Morris
authors.forename: Katherine V
authors.initials: KV
authors.lastname: Biagas
authors.forename: Easmon
authors.initials: E
authors.lastname: Otupiri
authors.forename: Rachel T
authors.initials: RT
authors.lastname: Moresky
mesh_terms: D002675:Child, Preschool; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D003906:Developing Countries; D005260:Female; D005869:Ghana; D006801:Humans; D007223:Infant; D008297:Male; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D056152:Respiratory Rate; D016896:Treatment Outcome