Assessment of a storage system to deliver uninterrupted therapeutic oxygen during power outages in resource-limited settings

by R Calderon, MC Morgan, M Kuiper, H Nambuya, N Wangwe, A Somoskovi, and D Lieberman

Published in PLoS One, 06 February 2019. doi: 10.1371/journal.pone.0211027

 

 

Access to therapeutic oxygen remains a challenge in the effort to reduce pneumonia mortality among children in low- and middle-income countries. The use of oxygen concentrators is common, but their effectiveness in delivering uninterrupted oxygen is gated by reliability of the power grid. Often cylinders are employed to provide continuous coverage, but these can present other logistical challenges. In this study, researchers examined the use of a novel, low-pressure oxygen storage system to capture excess oxygen from a concentrator to be delivered to patients during an outage. A prototype was built and tested in a non-clinical trial in Jinja, Uganda. The trial was carried out at Jinja Regional Referral Hospital over a 75-day period. The flow rate of the unit was adjusted once per week between 0.5 and 5 liters per minute. Over the trial period, 1284 power failure episodes with a mean duration of 3.1 minutes (range 0.08 to 1720 minutes) were recorded. The low-pressure system was able to deliver oxygen over 56% of the 4,295 power outage minutes and cover over 99% of power outage events over the course of the study. These results demonstrate the technical feasibility of a method to extend oxygen availability and provide a basis for clinical trials.

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The Effectiveness of High-Flow Oxygen Therapy and the Fascinating Song of the Sirens

by Fernando Maria de Benedictis, MD, FERS

Published in JAMA Pediatrics, 21 December 2018. doi:10.1001/jamapediatrics.2018.3831

 

 

Bronchiolitis is a common respiratory illness of early childhood and has a high associated health care cost owing to hospitalization. Several therapies have been investigated, but none has shown clear efficacy. The American Academy of Pediatrics guideline recommends only supportive care, including oxygen to correct hypoxemia and appropriate fluid replacement to maintain hydration. Traditionally, low-flow 100% oxygen (up to 2 L/min) through nasal prongs has been used to correct hypoxemia in infants with bronchiolitis.

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Feasibility of high-flow nasal cannula implementation for children with acute lower respiratory tract disease in rural Kenya

by Von Saint André-Von Arnim AO, Okeyo B, Cook N, Steere M, Roberts J, Howard CRA, Stanberry LI, John-Stewart GC, and Shirk A.

Published in Paediatrics and International Child Health, 19 November 2018. doi: 10.1080/20469047.2018.1536874

 

 

High-flow nasal cannula (HFNC) is a well-established respiratory support device in high-income countries, but to our knowledge, its use in sub-Saharan Africa has not been reported. This feasability study describes the implementation process of HFNC in rural Kenya.

 

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Effect of Oxygen vs Room Air on Intrauterine Fetal Resuscitation: A Randomized Non-inferiority Clinical Trial

by Nandini Raghuraman, MD, MS; Leping Wan, MPH; Lorene A. Temming, MD, MSCI; Candice Woolfolk, PhD, MPH; George A. Macones, MD, MSCE; Methodius G. Tuuli, MD, MPH; Alison G. Cahill, MD, MSCI

Published in JAMA Pediatrics, September 2018

 

Two-thirds of women in labor receive supplemental oxygen to reverse perceived fetal hypoxemia and prevent acidemia. Oxygen is routinely administered for category II fetal heart tracings, a class of fetal tracing used to designate intermediate risk for acidemia. This liberal use of oxygen may not be beneficial, particularly because neonatal hyper-oxygenation is harmful. Researchers aimed to test the hypothesis that room air is non-inferior to oxygen in improving fetal metabolic status among patients with category II fetal heart tracings.

 

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Sudden vs Pressure Wean From Nasal Continuous Positive Airway Pressure in Infants Born Before 32 Weeks of Gestation: A Randomized Clinical Trial

Christina Friis Jensen, MD; Anna Sellmer, MD, PhD; Finn Ebbesen, MD; Rasa Cipliene, MD; Anders Johansen, MD; Rikke Monrad Hansen, MD; Jens Peter Nielsen, MD; Olga Hogreffe Nikitina, MD; Jesper Padkær Petersen, MD, PhD; Tine Brink Henriksen, MD, PhD

Published in JAMA Pediatrics, September 2018

 

Nasal continuous positive airway pressure (nCPAP) is a well-established treatment of respiratory distress syndrome in preterm infants. Sub-optimal weaning from nCPAP may be associated with lung injury, pulmonary morbidity, and infant weight gain. To date, the best weaning strategy from nCPAP is unknown. Researchers aimed to compare the effect of sudden wean and pressure wean from nCPAP in very preterm infants.

 

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