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Advanced non-invasive respiratory support in resource-constrained settings: a narrative review.
Theogene Twagirumugabe1,2, Dona Fabiola Gashame3, Doris Lorette Uwamahoro2,3
1University Teaching Hospital of Butare, Butare, Rwanda.
Advanced non-invasive respiratory support, like high flow oxygen, offers a simpler, less resource-intensive alternative for acute respiratory failure in resource-constrained settings. Successful implementation requires careful attention to clinical systems, resources, and training for patient safety and effectiveness.
Area of Science:
- Critical Care Medicine
- Respiratory Medicine
- Global Health
Background:
- Advanced non-invasive respiratory support (high flow oxygen, CPAP, NIV) is less resource-intensive than invasive ventilation.
- These techniques are attractive for acute respiratory failure in resource-constrained settings.
- Despite increased use during COVID-19, access remains limited in low-income countries.
Purpose of the Study:
- To review the potential and challenges of advanced non-invasive respiratory support in resource-constrained settings.
- To highlight key implementation domains for safe and effective use.
- To emphasize the need for context-specific research.
Main Methods:
- Literature review and synthesis of evidence from high-income and low-income countries.
- Analysis of factors critical for successful implementation of non-invasive respiratory support.
- Identification of research gaps.
Main Results:
- Non-invasive respiratory support can be beneficial in resource-constrained settings.
- Successful implementation hinges on careful patient selection and resource investment.
- Key implementation domains include clinical systems, oxygen supply, human resources, cost, and device characteristics.
Conclusions:
- Non-invasive respiratory support offers a viable option for acute respiratory failure in low-resource environments.
- Effective implementation requires addressing specific challenges related to systems, resources, and training.
- Further context-specific research, including RCTs, is crucial for guiding clinical practice.
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