A study by researchers at Columbia University’s Mailman School of Public Health and Columbia University Medical Center found that applying continuous positive airway pressure (CPAP), a form of non-invasive ventilation, decreased mortality in children with respiratory distress. Findings from the clinical trial in Ghana indicate that the procedure especially benefitted children less than one year of age. Results of the study are published online in The Lancet Global Health.
[Photo: Dr. Rachel T. Moresky]
CPAP can improve respiratory rate and survival in children with primary pulmonary diseases. The latest findings confirmed that no serious adverse events were associated with the treatment, that it is safe and effective to use in district-level hospitals, and a step forward in treating children with respiratory distress in resource-limited settings.
The study, which followed 1,025 patients and 1,175 controls, was conducted at two first-level hospitals or district hospitals in Ghana where invasive mechanical ventilation was not routinely available, and nurses initiated and managed care with once or twice daily physician rounds.
Two-week all-cause mortality in children one year of age and younger significantly decreased when CPAP was continuously applied: three percent of patients in the CPAP group versus seven percent of patients in the control group who were not given the therapy. In children of all ages – one month to five years, respiratory rate was significantly lower in the CPAP group at four hour, eight hour, twelve hour, and 24 hour time points.
“In addition to demonstrating the safety of CPAP and the children’s improved survival rates, our study is unique in that CPAP was initiated and managed by emergency ward nurses who work much of the day without direct supervision by a physician,” said Dr. Rachel T. Moresky, Mailman School of Public Health associate professor of Population and Family Health, associate professor of Medicine, Emergency Medicine at Columbia University Medical Center, and senior author.
Dr. Moresky continued, “Other CPAP studies in low-resource settings have been demonstrated at tertiary hospitals or university hospitals and with physician specialists applying the CPAP treatments. Our study demonstrates task-sharing this skill to nurses can bring lifesaving care closer to the community.“
Pneumonia, sepsis, and severe malaria kill more than 2 million children younger than five years every year. These treatable illnesses can progress to respiratory failure. Most of these deaths occur in low-income and middle-income countries, where diagnostic and therapeutic interventions are often severely scarce.
The World Health Organization recommends redistributing healthcare tasks to less highly trained individuals. “With a nurse to doctor ratio of 8:1 in many African nations, successful training of nurses to effectively and safely apply CPAP will be crucial for its proliferation in non-tertiary hospitals,” says Dr. Moresky, who is also director of the International Emergency Medicine Fellowship program at Columbia.
“Our findings coupled with the results from two smaller studies in Bangladesh and Malawi support the use of non-invasive ventilation for children presenting with acute respiratory distress in low-resource settings,” noted Dr. Patrick T. Wilson, Columbia University Medical Center assistant professor of Pediatrics, Mailman School of Public Health assistant professor of Population and Family Health, and lead author.
The results also suggest that the use of CPAP in young children with respiratory insufficiency is appropriate in other parts of the developing world, where diagnostic capabilities are similarly limited. The study showed that for every 25 children under the age of one year treated with CPAP, one life can be saved and most patients will have improved respiratory rates for at least 24 hours.
Dr. Wilson concludes, “The results of the study are remarkable in that it included children with a wide range of disease processes, making it more generalizable to real life settings in low- and middle-income countries around the world.”
Co-authors are: Dr. Sara Lopez-Pintado, Department of Biostatistics, Mailman School of Public Health; Dr. Marilyn C Morris, Department of Pediatrics, Columbia University Medical Center; for additional names see the Lancet paper.
The study was supported by General Electric Foundation, Columbia University sidHARTe Program (#PT-AABK1277).
The research was a LANCET editor’s choice article.Tags: Columbia, Health Promotion and Communication, Maternal and Child Health