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Abstract
Introduction and Objectives Acute respiratory failure (ARF) is a major cause of mortality in the developing world, exacerbated by resource limitation. Non-invasive positive pressure ventilation (NIPPV) is a potential simple way to reduce mortality, and whilst established in adults, evidence in children is lacking.
Methods The study was conducted in Tumu District Hospital in Northern Ghana, which serves a catchment of 56,000 and has an under-5 Mortality of 142 per 1000 live births. Two Nippy Junior paediatric pressure controlled portable ventilators, chosen for ease of use and robustness, were used along with finger monitors to measure oxygen saturation and heart rate. Training of nurses, the nurse anaesthetist and the doctor was achieved with interactive lectures, hands-on workshops and competency assessment over 3 days in November 2011 and April 2012. Laminated guides attached to each machine outlined criteria to commence, escalate and wean NIPPV. Criteria for commencing NIPPV were based on respiratory rate, oxygen saturation, intercostal recession and expiratory grunting.
Results In the initial 4 months of NIPPV use, 657 children under 5 were admitted with 11 deaths, of whom 84 received NIPPV with 3 deaths. In the subsequent 9 months, NIPPV was used in 46 children and 11 adults, with no deaths. Of 140 patients ventilated in 2012, 106 (76%) were under five and 60 (43%) under the age of two. There were 2 deaths from malaria/sepsis with an overall mortality of 1.4% (1.9% <5 years). Primary diagnoses by age as best available are displayed in figure 1. No complications were reported apart from discomfort in some patients. Patients were ventilated for shorter periods than usual in the developed world. Ventilation times were notably shorter in malaria patients. Those with respiratory tract infections and pneumonia tend to be ventilated longer and were often more comfortable with ventilation for longer periods at a time.
Conclusions This feasibility study shows NIPPV for ARF in children in a rural setting can be delivered safely with minimal training and appears to impact significantly on mortality in those under 5.