Citation Information :
Anitha GF, Velmurugan L, Sangareddi S, Nedunchelian K, Selvaraj V. Effectiveness of flow inflating device in providing Continuous Positive Airway Pressure for critically ill children in limited-resource settings: A prospective observational study. Indian J Crit Care Med 2016; 20 (8):441-447.
Background and Aims: 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.
Conclusion: 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.
Kinikar A, Kulkarni R, Valvi C, Gupte N. Use of indigenous bubble CPAP during swine flu pandemic in Pune, India. Indian J Pediatr 2011;78:1216-20.
Santhanam I. Flow inflating ventilation device: Non-invasive CPAP in settings without immediate access to mechanical ventilation. In: Pediatric Emergency Medicine Course. 2 nd ed. New Delhi: Jaypee; 2013. p. 53-7.
Sanabria Carretero P, Palomero Rodríguez MA, Laporta Báez Y, Suso Martínez de Bujo B, Suárez Gonzalo L, Muriel Villoria C. Evaluation of a continuous positive airway pressure system without a ventilator to treat acute respiratory failure in children. Rev Esp Anestesiol Reanim 2008;55:621-5.
Yadav A. Short Textbook of Anaesthesia. 3 rd ed. ISBN:8188511609. New Delhi, India: Academa publication; 2007.
Litman RS. Pediatric Anaesthesia - The Requisites in Anaesthesiology. 1 st ed. Amsterdam: Elsevier; 2004. p. 101-3.
Lum LC, Abdel-Latif ME, de Bruyne JA, Nathan AM, Gan CS. Noninvasive ventilation in a tertiary pediatric intensive care unit in a middle-income country. Pediatr Crit Care Med 2011;12:e7-13.
Bernet V, Hug MI, Frey B. Predictive factors for the success of noninvasive mask ventilation in infants and children with acute respiratory failure. Pediatr Crit Care Med 2005;6:660-4.
Abadesso C, Nunes P, Silvestre C, Matias E, Loureiro H, Almeida H. Non-invasive ventilation in acute respiratory failure in children. Pediatr Rep 2012;4:e16.
Antonelli M, Conti G, Moro ML, Esquinas A, Gonzalez-Diaz G, Confalonieri M, et al. Predictors of failure of noninvasive positive pressure ventilation in patients with acute hypoxemic respiratory failure: A multi-center study. Intensive Care Med 2001;27:1718-28.
Essouri S, Chevret L, Durand P, Haas V, Fauroux B, Devictor D. Noninvasive positive pressure ventilation: Five years of experience in a pediatric intensive care unit. Pediatr Crit Care Med 2006;7:329-34.
Mayordomo-Colunga J, Medina A, Rey C, Díaz JJ, Concha A, Los Arcos M, et al. Predictive factors of non invasive ventilation failure in critically ill children: A prospective epidemiological study. Intensive Care Med 2009;35:527-36.
James CS, Hallewell CP, James DP, Wade A, Mok QQ. Predicting the success of non-invasive ventilation in preventing intubation and re-intubation in the paediatric intensive care unit. Intensive Care Med 2011;37:1994-2001.
Ganu SS, Gautam A, Wilkins B, Egan J. Increase in use of non-invasive ventilation for infants with severe bronchiolitis is associated with decline in intubation rates over a decade. Intensive Care Med 2012;38:1177-83.
Campion A, Huvenne H, Leteurtre S, Noizet O, Binoche A, Diependaele JF, et al. Non-invasive ventilation in infants with severe infection presumably due to respiratory syncytial virus: Feasibility and failure criteria. Arch Pediatr 2006;13:1404-9.
Javouhey E, Barats A, Richard N, Stamm D, Floret D. Non-invasive ventilation as primary ventilatory support for infants with severe bronchiolitis. Intensive Care Med 2008;34:1608-14.
Larrar S, Essouri S, Durand P, Chevret L, Haas V, Chabernaud JL, et al. Effects of nasal continuous positive airway pressure ventilation in infants with severe acute bronchiolitis. Arch Pediatr 2006;13:1397-403.
Muñoz-Bonet JI, Flor-Macián EM, Brines J, Roselló-Millet PM, Cruz Llopis M, López-Prats JL, et al. Predictive factors for the outcome of noninvasive ventilation in pediatric acute respiratory failure. Pediatr Crit Care Med 2010;11:675-80.
Mayordomo-Colunga J, Medina A, Rey C, Los Arcos M, Concha A, Menéndez S. Success and failure predictors of non-invasive ventilation in acute bronchiolitis. An Pediatr (Barc) 2009;70:34-9.