title: Effectiveness of flow inflating device in providing Continuous Positive Airway Pressure for critically ill children in limited-resource settings: A prospective observational study.
abstract: OBJECTIVE
  Noninvasive ventilation (NIV) is an emerging popular concept, which includes bi-level positive airway pressure or continuous positive airway pressure (CPAP). In settings with scarce resources for NIV machines, CPAP can be provided through various indigenous means and one such mode is flow inflating device - Jackson-Rees circuit (JR)/Bain circuit. The study analyses the epidemiology, various clinical indications, predictors of CPAP failure, and stresses the usefulness of flow inflating device as an indigenous way of providing CPAP.
  
  
  METHODS
  A prospective observational study was undertaken in the critical care unit of a Government Tertiary Care Hospital, from November 2013 to September 2014. All children who required CPAP in the age group 1 month to 12 years of both sexes were included in this study. They were started on indigenous CPAP through flow inflating device on clinical grounds based on the pediatric assessment triangle, and the duration and outcome were analyzed.
  
  
  RESULTS
  This study population included 214 children. CPAP through flow inflating device was successful in 89.7% of cases, of which bronchiolitis accounted for 98.3%. A prolonged duration of CPAP support of >96 h was required in pneumonia. CPAP failure was noted in 10.3% of cases, the major risk factors being children <1 year and pneumonia with septic shock.
  
  
  CONCLUSIONS
  We conclude that flow inflating devices - JR/Bain circuit are effective as an indigenous CPAP in limited resource settings. Despite its benefits, CPAP is not a substitute for invasive ventilation, as when the need for intubation arises timely intervention is needed.
authors.affiliation: Department of Pediatrics, Chengalpattu Medical College, Chengalpattu, Tamil Nadu, India.
authors.forename: G Fatima Shirly
authors.initials: GF
authors.lastname: Anitha
authors.affiliation: Department of Pediatrics, Stanley Medical College, Chennai, Tamil Nadu, India.
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Velmurugan
authors.affiliation: Department of Pediatrics, Stanley Medical College, Chennai, Tamil Nadu, India.
authors.forename: Shanthi
authors.initials: S
authors.lastname: Sangareddi
authors.affiliation: Department of Pediatrics, Dr. Mehta's Children's Hospital, Chennai, Tamil Nadu, India.
authors.forename: Krishnamurthy
authors.initials: K
authors.lastname: Nedunchelian
authors.affiliation: Department of Pediatrics, Chengalpattu Medical College, Chengalpattu, Tamil Nadu, India.
authors.forename: Vinoth
authors.initials: V
authors.lastname: Selvaraj
keywords: Bain circuit; Bronchiolitis; Continuous Positive Airway Pressure; Jackson-Rees circuit