526 - Feasibility of a Novel Ultra-Low-Cost Bubble CPAP (b-CPAP) System for Neonatal Respiratory Support in a Resource-Limited Setting

Poster Number: 526
Publication Number: 526.318

Ashtyn Tayler, MassGeneral Hospital for Children, Medford, MA, United States; Henry Ashworth, Harvard Medical School, Boston, MA, United States; Ghassan Bou Saba, VAYU Global Health Foundation, Boston, MA, United States; Hena K. Wadhwa, Vayu Global Health, Boston, MA, United States; Michelle Dundek, Vayu Global Health Foundation, Malden, MA, United States; Ellie Ng, Vayu Global Health, Boston, MA, United States; Martha F. Mkony, Muhimbili National Hospital, Dar es Salaam, Dar es Salaam, Tanzania; Robert Moshiro, Muhimbili National Hospital, Dar es Salaam, Dar es Salaam, Tanzania; Thomas F. Burke, MassGeneral Hospital for Children, Medford, MA, United States

Background: WHO recommends continuous positive airway pressure (CPAP) as an effective treatment for reducing morbidity and mortality among premature neonates[1]. One million infants succumb to respiratory insufficiency each year, with the majority of these deaths occurring in low-resource settings[2]. The novel Vayu b-CPAP System was developed to treat infants with Respiratory Distress Syndrome (RDS), pneumonia, COVID-19, and other causes of severe respiratory distress. The Vayu b-CPAP System has been utilized successfully for over two years in neonates across 8 countries. It does not require electricity or compressed air, is easy to use, and was granted Emergency Use Authorization by the US FDA.

Objective: The objective of this study was to evaluate the feasibility of the Vayu b-CPAP System in the National Hospital of Tanzania, 20 months after initial introduction via a standardized training package.

Design/Methods: A Mixed Methods study was conducted from April 6 to October 6 2021 to assess the implementation, adaptation, and integration of Vayu b-CPAP Systems at Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania. Demographic and clinical characteristics of all patients treated by Vayu b-CPAP Systems were collected. An interview guide was developed in an iterative fashion and snowballing was used to interview experienced healthcare workers until thematic saturation. Interviews were transcribed, coded, and analyzed using NVivo.

Results: 371 patients were treated with Vayu b-CPAP Systems with an average duration of 6.9 days on the device. RDS was the most common (82%) indication for b-CPAP treatment. Twenty-four healthcare workers (15 nurses, 5 physicians, 4 health attendants, and 1 bioengineer) were interviewed and perceived Vayu b-CPAP Systems as essential for treating neonatal respiratory distress at MNH. Key reasons were: 1) Ease of use in assembly, application, maintenance, monitoring, and troubleshooting. 2) Positive patient outcomes such as reduced mortality rates. 3) Access to the Vayu b-CPAP Systems increased the number of patients that received necessary care. Respondents favored the devices’ ultra-low cost, portability, ability to work without electricity, and simple maintenance. Barriers to integration included durability of humidifier lids and oxygen tubing material. To enhance the success of Vayu b-CPAP Systems at MNH, respondents suggested continuous facility-based hand-on training.Conclusion(s): All healthcare workers viewed the Vayu b-CPAP Systems as essential to their clinical care, recommending them for widespread use in low-resource medical settings.
The Vayu Bubble CPAP SystemFig. 1. A: The bubble CPAP system composed of (1) an external pressurized oxygen source; (2) Venturi blender; (3) 2 bacterial and viral filters, one
on the inspiratory limb and one on the expiratory limb; (4) a humidifier; (5) nasal prongs; (6) a water column with an adjustable wand to control the delivered pressure from 4 to 10 cm H2O; and (7) warmer bracket that stabilizes the system and allows it to be placed inside infant radiant warmers. B: The patient interface, composed of (1) hat; (2) 2 safety pins, (3) 2 rubber bands, (4) hook tape moustache, and (5) loop tape strips. C: The Venturi blender is the distinguishing feature of the bubble CPAP system; it delivers 30 – 100% oxygen by mixing pressurized oxygen and ambient air.