Publications relating the use of CPAP in developing countries

To describe the implementation of bubble-CPAP in a referral hospital in a developing country and to investigate: the feasibility of nurses implementing bubble-CPAP and the impact of bubble-CPAP on need for mechanical ventilation and mortality. Retrospective evaluation of prospectively collected data from two time periods: 18 months before and 18 months after the introduction of bubble-CPAP. The introduction of bubbleCPAP was associated with a 50 per cent reduction in the need for mechanical ventilation; from 113 of 1106 (10.2 per cent) prior to bubble-CPAP to 70 of 1382 (5.1%) after introduction of CPAP (χ2, p<0.001). In the 18 months prior to bubble-CPAP there were 79 deaths (case fatality of 7.1 per cent). In the 18 months after bubble-CPAP there were 74 deaths (CF 5.4 per cent), relative risk: 0.75 (0.55–1.02, χ2, p=0.065). Nurses could safely apply bubble-CPAP after 1–2 months of on-the-job training. Equipment for Bubble-CPAP cost 15 per cent of the cost of the cheapest mechanical ventilator. The introduction of bubble-CPAP substantially reduced the need for mechanical ventilation, with no difference in mortality. In models of neonatal care for resourcelimited countries, bubble-CPAP may be the first type of ventilatory support that is recommended. Its low cost and safety when administered by nurses makes it ideal for this purpose. Bubble-CPAP has the potential for being available at even lower cost than the current commercially available bubble systems used in this study. 2. Central nervous system infection is an important cause of death in underfives hospitalised with World Health Organization (WHO) defined severe and very severe pneumonia Vaccine. 2007 Mar 22;25(13):2437-44. Epub 2006 Sep 20. http://www.sciencedirect.com/science/article/pii/S0264410X0601019X Authors: Socorro P. Lupisana, Petri Ruutub, P. Erma Abucejo-Ladesmac, Beatriz P. Quiambaoa, Lorena Gozuma, Lydia T. Sombreroa, Vicente Romanod, Ian Rileye & Eric A.F. Simoes Abstract Over 6 years, 1667 children aged 2–59 months admitted for pneumonia [1287 severe and 380 very severe] were studied. The case fatality rate (CFR) in children with severe pneumonia was 2.1% and 14.3% with CNS infection, with very severe pneumonia the CFR was 18.9%, 10.4% in those with hypoxemia and 43.6% with CNS infection. High CFRs were associated with CNS infection and inability to drink/cyanosis. The appropriate management of children with very severe pneumonia should include cerebrospinal fluid examination, oxygen monitoring and possibly ventilated support, suggesting that these are minimal standards of care at the districtOver 6 years, 1667 children aged 2–59 months admitted for pneumonia [1287 severe and 380 very severe] were studied. The case fatality rate (CFR) in children with severe pneumonia was 2.1% and 14.3% with CNS infection, with very severe pneumonia the CFR was 18.9%, 10.4% in those with hypoxemia and 43.6% with CNS infection. High CFRs were associated with CNS infection and inability to drink/cyanosis. The appropriate management of children with very severe pneumonia should include cerebrospinal fluid examination, oxygen monitoring and possibly ventilated support, suggesting that these are minimal standards of care at the district