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CPAP promising in pediatric respiratory distress

NEW YORK (Reuters Health) – In rural Ghana, nasal bubble continuous positive airway pressure (CPAP) appeared to be an inexpensive means of treating pediatric acute respiratory distress, researchers say – although its ultimate effect on outcome wasn’t clear.

Dr. Patrick T. Wilson, who led the research, told Reuters Health by email, “The results of our randomized controlled trial demonstrate that CPAP can be introduced and successfully used in a low-middle income country. Nurses can safely apply the relatively low cost device with appropriate training. There was a significant decrease in respiratory rate in young children with acute respiratory distress once they received CPAP.”

In a report of the study online November 19th in the Journal of Pediatrics, Dr. Wilson of Columbia University Medical Center, New York and colleagues note that CPAP is much less expensive, has lower complication rates, and requires less technical skill than mechanical ventilation, making it an attractive option in resource-limited countries for patients with appropriate indications.

In the current study, the researchers investigated CPAP in 70 children aged three months to five years presenting with tachypnea and intercostal or subcostal retractions or nasal flaring. They were randomized to receive CPAP immediately or one hour after presentation.

Therapy was administered by locally trained nurses. Both groups received supplemental oxygen via the CPAP circuit or a face mask if arterial oxygen saturation fell below 92%.

In the immediate CPAP group, the mean respiratory rate fell by 16 breaths per minute during the first hour. There was no change in the delayed group.

The approach was well tolerated and there were no complications related to CPAP. However, 35 of the children were positive for malaria and three died of the disease.

Given the beneficial effect on respiratory rates in children with nonspecific respiratory distress the team now intends to investigate whether it actually improves outcome, and in whom.

The authors conclude, “We plan a multicenter controlled trial to determine whether the use of CPAP decreases mortality in our cohort of children and to define the epidemiology of their respiratory distress.”

Dr. Wilson called the present results ” very promising” and said, ‘We are excited to move to the next phase of research.” He added, “If CPAP is found to lower mortality rates in this population many children living in the developing world could benefit from the technology.”

SOURCE: http://bit.ly/VgL22Y

J Pediatr 2012.