title: Non-invasive ventilation with bubble CPAP is feasible and improves respiratory physiology in hospitalised Malawian children with acute respiratory failure.
abstract: BACKGROUND
  In low-income countries and those with a high prevalence of HIV, respiratory failure is a common cause of death in children. However, the role of non-invasive ventilation with bubble continuous positive airway pressure (bCPAP) in these patients is not well established.
  
  
  METHODS
  A prospective observational study of bCPAP was undertaken between July and September 2012 in 77 Malawian children aged 1 week to 14 years with progressive acute respiratory failure despite oxygen and antimicrobial therapy.
  
  
  RESULTS
  Forty-one (53%) patients survived following bCPAP treatment, and an HIV-uninfected single-organ disease subgroup demonstrated bCPAP success in 14 of 17 (82%). Compared with children aged ≧60 months, infants of 0-2 months had a 93% lower odds of bCPAP failure (odds ratio 0·07, 95% confidence interval 0·004-1·02, P  =  0·05). Following commencement of bCPAP, respiratory physiology improved, the average respiratory rate decreased from 61 to 49 breaths/minute (P  =  0·0006), and mean oxygen saturation increased from 92·1% to 96·1% (P  =  0·02).
  
  
  CONCLUSIONS
  bCPAP was well accepted by caregivers and patients and can be feasibly implemented into a tertiary African hospital with high-risk patients and limited resources.
authors.affiliation: University Medical Centre Utrecht , Utrecht, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Walk
authors.forename: P
authors.initials: P
authors.lastname: Dinga
authors.forename: C
authors.initials: C
authors.lastname: Banda
authors.forename: T
authors.initials: T
authors.lastname: Msiska
authors.forename: E
authors.initials: E
authors.lastname: Chitsamba
authors.forename: N
authors.initials: N
authors.lastname: Chiwayula
authors.forename: N
authors.initials: N
authors.lastname: Lufesi
authors.forename: R
authors.initials: R
authors.lastname: Mlotha-Mitole
authors.forename: A
authors.initials: A
authors.lastname: Costello
authors.forename: A
authors.initials: A
authors.lastname: Phiri
authors.forename: T
authors.initials: T
authors.lastname: Colbourn
authors.forename: E D
authors.initials: ED
authors.lastname: McCollum
authors.forename: H J
authors.initials: HJ
authors.lastname: Lang
keywords: Bubble continuous airway pressure (bCPAP); HIV; Pneumonia; Respiratory disorders; Respiratory failure