A Randomized Clinical Trial Evaluating Nasal Continuous Positive Airway Pressure for Acute Respiratory Distress in a Developing Country

The Journal of Pediatrics, 12/10/2012

Wilson PT et al. – Continuous positive airway pressure (CPAP) decreases respiratory rate in children with respiratory distress compared with children not receiving CPAP. The technology was successfully used by local nurses. No complications were associated with its use. CPAP is a relatively low–cost, low–technology that is a safe method to decrease respiratory rate in children with nonspecific respiratory distress.

Methods

• A randomized, controlled trial was conducted in 4 rural hospitals in Ghana.
• Children, 3 months to 5 years of age, presenting with tachypnea and intercostal or subcostal retractions or nasal flaring were randomly assigned to receive CPAP immediately or 1 hour after presentation. CPAP was applied by locally trained nurses.
• The primary outcome measure was change in respiratory rate at 1 hour.

Results

• The study was stopped after the enrollment of 70 subjects because of a predetermined stop value of P < .001.
• Mean respiratory rate of children who received immediate CPAP fell by 16 breaths/min (95% CI 10–21) in the first hour compared with no change in children who had CPAP delayed by 1 hour (95% CI –2 to +5).
• Thirty–five of the patients had a positive malaria blood smear. There were 3 deaths as a result of severe malaria.
• No major complications of CPAP use were noted.

Patrick T. Wilson (12/10/2012) comments:

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.

These results are very promising and we are excited to move to the next phase of
research to determine if the use of CPAP in these settings will also decrease the number of deaths in children suffering from acute respiratory distress. If CPAP is found to lower mortality rates in this population many children living in the developing world could benefit from the technology.

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