Conceptual model of low-cost improvised bubble continuous positive airway pressure device for adults and its potential use in the COVID-19 pandemic

Himal Kharel, Zeni Kharel, Samikchhya Keshary Bhandari

Abstract
Low-cost improvised continuous positive airway pressure (CPAP) device is safe and efficacious in neonatal respiratory distress. There is a great necessity for similar device in adults, and this has been especially made apparent by the recent Coronavirus Disease 2019 (COVID-19) pandemic, which is unmasking the deficiencies of healthcare system in several low-resource countries. We propose a simplified and inexpensive model of improvised CPAP in adults using locally available resources including aquarium air pumps and a novel pressure release mechanism. Although the safety and efficacy of improvised CPAP in adults are not established, the conceptual model we propose has the potential to serve as a lifesaving technology in many low-resource settings during this ongoing pandemic and thus calls for expedited research.

Introduction
Bubble continuous positive airway pressure (BCPAP) has been proven to be a safe and efficacious mode of noninvasive ventilation for neonatal respiratory distress. Commercially available adult continuous positive airway pressure (CPAP) machines are expensive to purchase and maintain, making them inaccessible to a large population of low-resource countries. The need for such devices has especially been realized during the current Coronavirus Disease 2019 (COVID-19) pandemic, which is ravaging the fragile health system of several low-income countries. Hence, we propose a conceptual model of improvised CPAP that could have widespread applications in low-resource settings.

Conceptual design
A basic form of functional BCPAP for neonates consists of a nasal cannula, normal saline bottle, measuring tape, and an oxygen source. One of the limbs of nasal cannula is cut and occluded, while the other end is dipped into normal saline. The depth of submersion determines the amount of CPAP. A 14-gauge intravenous cannula is inserted into the normal saline bottle to function as air escape orifice.

Discussion
Noninvasive CPAP may be beneficial in COVID-19–associated acute hypoxemic respiratory failure. A retrospective single-center study found that CPAP prevented intubation and mechanical ventilation in 36 out of 53 patients with moderate to severe acute hypoxemic respiratory failure possessing gas exchange and computerized tomography (CT) scan findings that were severe enough to warrant intubation and mechanical ventilation [7]. Similarly, another study found that CPAP is beneficial in avoiding excessive burden on intensive care unit resources by significantly increasing intubation-free survival [8]. Unfortunately, noninvasive CPAP machines are costly, and compressed air supply is not readily available in low-resource settings. Improvised CPAP, however, can be constructed cheaply with minimum resources

Citation: Kharel H, Kharel Z, Bhandari SK (2022) Conceptual model of low-cost improvised bubble continuous positive airway pressure device for adults and its potential use in the COVID-19 pandemic. PLoS Negl Trop Dis 16(3): e0010221. https://doi.org/10.1371/journal.pntd.0010221

Academic Editor: Liesl Joanna Zuhlke, University of Cape Town Faculty of Health Sciences, SOUTH AFRICA

Published: March 3, 2022

Copyright: © 2022 Kharel et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: The author(s) received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

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