Background: Early management of respiratory distress is critical to reducing mortality in infants and children in resource-limited settings. Bubble continuous positive airway pressure (bCPAP) can offer effective and affordable non-invasive respiratory support. Objective: To determine the best physical components of bubble CPAP circuits for respiratory support of children in low-resource settings. Methods: Using PubMed, CINAHL and LILACS, studies of any design in any language published before June 2017 which examined the physical components of bCPAP circuits were identified and reviewed. Results: After screening, the review included 45 articles: 17 clinical trials, 11 literature reviews, 10 technical assessments of bCPAP components, three reports of real-world implementation in low-resource settings, three cost analyses and one case report. There is no ideal bCPAP circuit for all settings and patients, but some choices are generally better than others in designing a circuit for low-resource settings. Oxygen concentrators are usually the best source of oxygen. As yet, there is no affordable and accurate oxygen blender. Nasal prongs are the simplest patient interface to use with the fewest complications but are not the cheapest option. Expiratory limbs should be at least 1 cm in diameter. Home-made pressure generators are effective, safe and affordable. Conclusion: This narrative review found many studies which evaluated the real clinical outcomes with bCPAP in the target population as well as technical comparison of bCPAP components. However, many studies were not blinded or randomised and there was significant heterogeneity in design and outcome measures. Abbreviations: bCPAP, bubble continuous positive airway pressure; CPAP, continuous positive airway pressure; FiO2, fractional oxygen concentration; HFNC, high-flow nasal cannula; HIC, high-income countries; LMIC, low- and middle-income countries; NP, nasopharyngeal; O2, oxygen; PEEP, positive end-expiratory pressure; PICO, Population, Intervention, Comparison and Outcome.

译文

背景: 在资源有限的环境中,呼吸窘迫的早期管理对于降低婴儿和儿童的死亡率至关重要。气泡持续气道正压通气 (bCPAP) 可以提供有效且负担得起的无创呼吸支持。目的: 确定低资源环境下儿童呼吸支持的气泡CPAP回路的最佳物理成分。方法: 使用PubMed,CINAHL和LILACS,对2017年6月前发表的任何语言的任何设计进行了研究,这些研究检查了bCPAP电路的物理成分。结果: 筛选后,该综述包括45篇文章: 17篇临床试验,11篇文献综述,10篇bCPAP组件的技术评估,3篇在低资源环境中实际实施的报告,3篇成本分析和1篇病例报告。对于所有设置和患者,没有理想的bCPAP电路,但是在为低资源设置设计电路时,某些选择通常比其他选择更好。氧气浓缩器通常是氧气的最佳来源。到目前为止,还没有负担得起的精确氧气搅拌机。鼻插脚是最简单的患者界面,并发症最少,但不是最便宜的选择。呼气肢体的直径应至少1厘米。自制压力发生器是有效、安全和负担得起的。结论: 本叙述性综述发现许多研究评估了bCPAP在目标人群中的真实临床结果以及bCPAP成分的技术比较。然而,许多研究不是盲法或随机化的,在设计和结果测量方面存在显著的异质性。缩写: bCPAP,气泡持续气道正压; CPAP,持续气道正压; FiO2,氧浓度分数; HFNC,高流量鼻插管; HIC,高收入国家; LMIC,中低收入国家; NP,鼻咽; O2,氧气; PEEP,呼气末正压; PICO,人群,干预,比较和结果。

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