Continuous positive airway pressure for children in resource-limited settings, effect on mortality and adverse

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Kristen L Sessions1, Andrew G Smith2, Peter J Holmberg3

  • 1Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.

Archives of Disease in Childhood
|December 9, 2021
PubMed

Insights

Continuous positive airway pressure (CPAP) shows uncertain benefits for pediatric respiratory distress in LMICs. Implementing CPAP requires careful safety and monitoring protocols for optimal outcomes.

Area of Science:

  • Pediatric critical care
  • Respiratory medicine
  • Global health

Background:

  • Respiratory distress is a significant cause of mortality in children in low- and middle-income countries (LMICs).
  • Non-invasive ventilation, specifically continuous positive airway pressure (CPAP), is a potential intervention to improve outcomes.
  • The effectiveness and safety of CPAP in LMIC settings require thorough evaluation.

Purpose of the Study:

  • To determine the outcomes of continuous positive airway pressure (CPAP) for pediatric respiratory distress in low- and middle-income countries (LMICs).
  • To systematically review and meta-analyze existing evidence on CPAP use in this population.

Main Methods:

  • A systematic review and meta-analysis of studies assessing CPAP safety, efficacy, or effectiveness in LMIC hospitals.
  • Searched multiple databases (Medline, Embase, LILACS, Web of Science, Scopus) up to April 2020.
  • Included studies of children aged one month to 15 years with respiratory distress, excluding neonatal-only studies. Data extraction and bias assessment were performed by two reviewers.

Main Results:

  • Twenty studies were included in the systematic review, with three randomized controlled trials (RCTs) from Bangladesh, Ghana, and Malawi included in meta-analyses.
  • Meta-analyses found no clear effect of CPAP on mortality (RR 0.75, 95% CI 0.33 to 1.72) or adverse events (RR 1.52, CI 0.71 to 3.26) compared to low-flow oxygen.
  • The certainty of evidence for both mortality and adverse events was downgraded to 'low' due to study design limitations and result discrepancies.

Conclusions:

  • The evidence regarding CPAP's efficacy in reducing mortality and adverse events in pediatric respiratory distress in LMICs is of low certainty and context-dependent.
  • Successful CPAP implementation necessitates robust safety mechanisms, including appropriate location (high dependency or ICU), trained staff, close monitoring, physician supervision, and age-appropriate equipment.
  • Continuous quality improvement and outcome monitoring are crucial for optimizing CPAP use in resource-limited settings.
Abstract

Keywords:
child healthglobal healthinfectious disease medicinepaediatricsrespiratory medicine

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