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

Indian J Pediatr. 2011 Oct;78(10):1216-20. doi: 10.1007/s12098-011-0389-x. Epub 2011 Mar 26.


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.

MeSH terms

  • Continuous Positive Airway Pressure / methods*
  • Female
  • Humans
  • Hypoxia / therapy*
  • Hypoxia / virology
  • India / epidemiology
  • Infant
  • Influenza A Virus, H1N1 Subtype*
  • Influenza, Human / epidemiology*
  • Length of Stay
  • Male
  • Pandemics
  • Respiratory Insufficiency / therapy*
  • Respiratory Insufficiency / virology