Use of indigenous bubble CPAP during swine flu pandemic in Pune, India

Objective: To assess the effectiveness of an indigenously assembled Nasal Bubble CPAP (NB-CPAP) in children during present swine flu pandemic presenting with acute hypoxemic respiratory failure; in improving gas exchange and vital signs; and assess method safety. Methods: Thirty Six children with acute hypoxemic respiratory failure admitted to swine flu ICU during the present H1NI pandemic were included (18 confirmed H1N1 positive and 18 confirmed H1N1 negative). After a baseline Arterial Blood Gas, all children received Oxygen via indigenous NB-CPAP Circuit which gave expiratory positive airway pressure of 5 cm water and delivered an FiO ₂ of around 70%. Vital signs, pH, PaO ₂, PaCO ₂, PO ₂/FiO ₂ and O ₂ saturation were recorded at start and at 6 h into the study. Results: Median age of the patients was 18 months (58% males, 42% females). Respiratory rate and heart rate improved significantly with indigenous NB-CPAP after 6 h of treatment compared with admission (p∈<∈0.0001 and p∈<∈0.001), respectively. At the end of 6 h on NB-CPAP,PaO ₂ (p∈<∈0.0001), PCO ₂ (p∈<∈0. 0001), PO ₂/FiO ₂ (p∈<∈0.0002) and O ₂ saturation (p∈<∈0.001) improved significantly. Median duration of NB-CPAP use was 2 days and none required endotracheal intubation. The median hospital stay was 7 days. Conclusions: Indigenous NB-CPAP improves hypoxemia and signs and symptoms in hemodynamically stable children with acute respiratory failure due to influenza like illness. It is a cost-effective, safe, well tolerated circuit in highly demanding pandemic situations and may prevent progression to intubation.