Low-Cost Bubble-CPAP Treatment of a Severe Case of Pneumonia in a Low- and Middle-Income Country: A Case Report on the Importance of Optimizing Bubble-CPAP Setup

Abstract A homemade low-cost bubble continuous positive airway pressure (bCPAP) setup can be created using resources available at most secondary healthcare facilities in low- and middle-income countries (LMICs). This setup has the potential of saving millions of children’s lives worldwide; however, treatment failure due to bCPAP setup insufficiencies and lack of educated staff remains a significant obstacle. Here, we report a first-hand experience on the use of an established low-cost bCPAP setup to be used in LMICs and how optimization of two parameters was critical to effectively treat a severe case of lower respiratory disease in a 6-month-old infant in Tanzania. We report this case to strengthen that reducing the resistance in the tube system and minimizing air leakage at the nasal interface are crucial for efficient delivery of the CPAP therapy. Lay Summary This case report describes how it is possible to successfully treat a 6-month-old infant with severe pneumonia in a low resource setting at a district hospital in Tanzania with a homemade low-cost oxygen therapy system called bubble continuous positive airway pressure (bCPAP). The construction was made of an oxygen concentrator, found in most secondary healthcare facilities in Africa, a nasal prong and a sterile water bottle. When optimized, this setup has the potential to mimic the therapeutic effect of an expensive and very effective therapy used in developed countries. The focus of this case report is how two adjustments of the bCPAP setup were necessary to achieve effective and safe treatment; however, we experienced that this homemade setup was very time-demanding and the quality of the treatment critically depended on the clinician to monitor and constantly optimize the equipment. So for this to be an effective and reliable treatment in secondary healthcare facilities in Tanzania, it requires sufficient staff education and nasal prongs that are suited for the purpose.