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.