863 An audit of the first use of the LeVe CPAP System in paediatric patients at Mengo Hospital, Kampala, Uganda

• Published in: Archives of disease in childhood 2023-07, Vol.108 (Suppl 2), p.A314-A315
• Main Authors: Hugh, Katie, Toogood, Kate, Winton, Mark, Musasizii, Racheal, Mayega, Rhoda, Nakabugo, Stella, Nampiina, Gorret, Please, Helen, Littlejohns, Anna, Kinwala, Barbara Namugga, Lawton, Tom, Murdoch, Stuart, Parmar, Jiten, Waters, Ian, William Davis Birch, De Boer, Gregory, Culmer, Peter, Kapur, Nikil, Namuddu, Sylvia, Namulema, Edith, Kewaza, Faith
• Format: Article
• Language: English
• Subjects: Asthma; Attrition (Research Studies); Bronchopneumonia; Continuous positive airway pressure; COVID-19; Feasibility studies; Hospitals; Mortality; Patients; Pediatrics; Pneumonia
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2023-rcpch.496

ObjectivesPneumonia remains a leading cause of mortality in children under five years. Continuous positive airway pressure (CPAP) is a key tool for managing paediatric respiratory failure worldwide but there are large barriers to its provision in low resource settings. The LeVe CPAP device has been designed with frugal engineering techniques at the University of Leeds and adapted by the biomedical engineering team at Mengo Hospital, Uganda. Having been successfully used in adult patients with COVID 19 after local approval, here we report its first use in extremis in the paediatric population at Mengo prior to a formal feasibility trial approved in September 2022. Patients offered LeVe CPAP had reached the ceiling of care available but were continuing to deteriorate. Therefore, LeVe CPAP was used in a small number of cases by the local team on a compassionate use basis when no further treatment options were available. It was expected that without further treatment options the child would inevitably die.MethodsThis is a retrospective case note review of patients admitted to the paediatric ward at Mengo Hospital who were treated with LeVe CPAP between May to August 2022. Case books from all paediatric admissions were reviewed to identify those receiving CPAP, and pertinent patient demographics, working diagnosis, oxygen saturations prior to initiation of CPAP, duration on CPAP and clinical outcome were collected.ResultsOverall, 10 patients were identified. This was 4% of the 251 patients admitted with respiratory illness during this time period (pneumonia (n=172), bronchiolitis (n=50), asthma (n=29)). Mean patient age was 15 months (range 4 months to 7 years). The most common indication was respiratory failure secondary to pneumonia (n=8). The mean CPAP duration was 2 days (range 1 – 6 days). The overall mortality was 40%; it was greatest in infants under 1 year old (67%) and those who spend a longer duration on the device.ConclusionsThis audit demonstrates the compassionate use of a novel frugal CPAP system to deliver respiratory support to critically unwell patients, deteriorating despite maximal usual care. The high mortality rate should be viewed in this context. Following this first compassionate use we have reported here, a formal feasibility study has been undertaken, in the same setting. Forty patients were recruited to this and we look forward to publishing the quantitative and qualitative results soon.