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Feasibility and Acceptability Followed by Effectiveness of bCPAP for Treatment of Bangladeshi Children With Severe Pneumonia (Child-bCPAP)

3 februari 2022 bijgewerkt door: International Centre for Diarrhoeal Disease Research, Bangladesh

Feasibility and Acceptability Followed by Effectiveness of Bubble Continuous Positive Airway Pressure for Treatment of Bangladeshi Children With Severe Pneumonia

Background: Feasibility and acceptability of bubble continuous positive airway pressure (CPAP) were not evaluated in childhood severe pneumonia in developing countries at a larger scale.

Objective:

  1. To describe prevailing structural and functional conditions and other operational challenges in nontertiary hospitals in Bangladesh that would need to be addressed in order to introduce bubble CPAP as part of the management of children with severe pneumonia enabling a successful interventional trial.
  2. To develop and test bubble CPAP training materials of relevance to clinical staff providing care for children with severe pneumonia in district general hospitals.
  3. To determine the prevalence of hypoxaemia among hospitalised children with severe pneumonia in non-tertiary/district hospitals, current practices with regard to management and clinical outcome, to support power calculations of a future interventional trial of bubble CPAP for children with severe pneumonia.
  4. To document the early experience, particularly the feasibility and acceptability of introducing bubble CPAP in selected non-tertiary/district hospitals.

Methodology:

Feasibility/demonstration phase will be done as an internal pilot in 2 hospitals. Current treatment practice, facilities, and operational challenges will be evaluated for the introduction, clinical use and maintenance of bubble CPAP.

Outcome:

  1. To describe the structural and functional conditions and operational challenges that may influence the introduction of bubble CPAP.
  2. To have bubble CPAP training materials that can be delivered cheaply and repeatedly to a level of comprehension of staff providing care to children with pneumonia in district general hospitals in Bangladesh.
  3. A quantitative analysis of the incidence of hypoxaemia among hospitalised children with severe pneumonia, current management practices and clinical outcomes.
  4. A qualitative assessment of the feasibility of introducing bubble CPAP.

Number of children to be enrolled: 20 children in 2 hospitals as an internal pilot (i.e. 10 in each hospital)

Main inclusion criteria: Age between 2 months and 24 months with severe pneumonia and hypoxemia and guardian/parent gives written informed consent to participate in the study.

Statistical Analysis: For feasibility and acceptability study, a descriptive analysis will be performed.

Study duration: 44 months

Studie Overzicht

Toestand

Voltooid

Conditie

Interventie / Behandeling

Studietype

Observationeel

Inschrijving (Werkelijk)

20

Contacten en locaties

In dit gedeelte vindt u de contactgegevens van degenen die het onderzoek uitvoeren en informatie over waar dit onderzoek wordt uitgevoerd.

Studie Locaties

  • Bangladesh
      • Dhaka, Bangladesh, 1212
        • Institute of Child and Mother Health
      • Kustia, Bangladesh
        • 250 Bedded General Hospital

Deelname Criteria

Onderzoekers zoeken naar mensen die aan een bepaalde beschrijving voldoen, de zogenaamde geschiktheidscriteria. Enkele voorbeelden van deze criteria zijn iemands algemene gezondheidstoestand of eerdere behandelingen.

Geschiktheidscriteria

Leeftijden die in aanmerking komen voor studie

2 maanden tot 2 jaar (Kind)

Accepteert gezonde vrijwilligers

Nee

Geslachten die in aanmerking komen voor studie

Allemaal

Bemonsteringsmethode

Niet-waarschijnlijkheidssteekproef

Studie Bevolking

Children aged 2-24 months having hypoxaemia in pneumonia (Pneumonia defined by WHO criteria)

Beschrijving

INCLUSION CRITERIA

  • Staff:

    • Staff (medical and nursing) employed at the two selected hospitals with duties that include care of children with pneumonia
    • Staff who agree to participate and give written informed consent

  • Children for assessment of hypoxaemia in pneumonia and outcomes:

    • Age between 2 - 24 months
    • Attend one of the two study hospitals for the assessment of pneumonia by hospital clinician.
    • Pneumonia defined by WHO criteria

  • Children receiving bubble CPAP:

    • Age between 2 - 24 months.
    • Diagnosis of pneumonia by a hospital clinician together with hypoxaemia (SpO2<90%).
    • Parent/guardian gives informed consent to participate in the study

EXCLUSION CRITERIA

  • Hospital staff:

    o There will be no exclusion criteria

  • Children for assessment of hypoxaemia in pneumonia and outcomes, and children receiving bubble CPAP:

    • Known congenital heart disease, asthma, pulmonary TB and other chronic respiratory disorders

Studie plan

Dit gedeelte bevat details van het studieplan, inclusief hoe de studie is opgezet en wat de studie meet.

Hoe is de studie opgezet?

Ontwerpdetails

Cohorten en interventies

Groep / Cohort
Interventie / Behandeling
bubble CPAP arm

Oxygen will be delivered by Bubble CPAP device, which will have three components:

  1. Continuous gas flow into the circuit: The gas flow rate required to generate CPAP is usually 5-10 L/min.
  2. A nasal interface connecting the child's airway with the circuit: short nasal prongs are generally used to deliver nasal CPAP. They must be carefully fitted to minimize leakage of air (otherwise, CPAP will not be achieved) .
  3. An expiratory arm with the distal end submerged in water to generate end-expiratory pressure: in bubble CPAP, the positive pressure is maintained by placing the far end of the expiratory tubing in water. The pressure is adjusted by altering the depth of the tube under the surface of the water.
Apparaat: Bubble CPAP oxygen delivery device

In Bubble CPAP, pressurized oxygen from an oxygen cylinder is delivered to the nasopharynx of the baby. An underwater tube (expiratory arm) that acts as a blow off valve is interposed between the oxygen source and the baby. Adjusting the height of the water column above the exit of the tube can regulate the pressure in the system and the amount of CPAP delivered to the baby. The constant bubbling of gas through the blow off mechanism delivers the bubbling CPAP effect. Oxygen may be delivered by nasal prongs inserted into the nostril of child.

The system has three components:

  1. Continuous gas flow into the circuit: The gas flow rate required to generate CPAP is usually 5-10 L/min.
  2. A nasal interface connecting the child's airway with the circuit:
  3. An expiratory arm with the distal end submerged in water to generate end-expiratory pressure.

The source of oxygen will be either an oxygen concentrator or cylinder, central distribution through pipelines.

Wat meet het onderzoek?

Primaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
The structural, functional and operational challenges will be described
Tijdsspanne: 44 month
Human resources, Supply chain, logistics equipment maintenance, power failure, disconnection of oxygen with local complications will be identified.
44 month
To have bubble CPAP training materials that can be delivered cheaply and repeatedly to a level of comprehension of staff providing care to children with pneumonia in district general hospitals in Bangladesh
Tijdsspanne: 44 month
The training module, Standard Operating Procedure, treatment algorithm will be provided to the hospital staff. Hands-on training will be done.
44 month
A quantitative analysis of the incidence of hypoxaemia among hospitalised children with severe pneumonia, current management practices and clinical outcomes
Tijdsspanne: 44 month
Prevalence, management, mortality, referral, discharge, hospital stay, oxygen therapy duration of severe pneumonia cases will be identified.
44 month
Feasibility and acceptability of introducing bubble CPAP
Tijdsspanne: 44 month
Challenges related to the introduction of bCPAP, enrollment, patient management with follow-up recording, human resources, respiratory support will be identified.
44 month

Medewerkers en onderzoekers

Hier vindt u mensen en organisaties die betrokken zijn bij dit onderzoek.

Sponsor

International Centre for Diarrhoeal Disease Research, Bangladesh

Medewerkers

University of Edinburgh
NIHR Global Health Research Unit on Respiratory Health (RESPIRE)
Director General of Health Services, Bangladesh

Onderzoekers

  • Hoofdonderzoeker: Md. Mohammod J Chisti, PhD, Senior Scientist

Studie record data

Deze datums volgen de voortgang van het onderzoeksdossier en de samenvatting van de ingediende resultaten bij ClinicalTrials.gov. Studieverslagen en gerapporteerde resultaten worden beoordeeld door de National Library of Medicine (NLM) om er zeker van te zijn dat ze voldoen aan specifieke kwaliteitscontrolenormen voordat ze op de openbare website worden geplaatst.

Bestudeer belangrijke data

Studie start (Werkelijk)

1 december 2018

Primaire voltooiing (Werkelijk)

31 december 2021

Studie voltooiing (Werkelijk)

31 december 2021

Studieregistratiedata

Eerst ingediend

16 oktober 2018

Eerst ingediend dat voldeed aan de QC-criteria

3 februari 2022

Eerst geplaatst (Werkelijk)

15 februari 2022

Updates van studierecords

Laatste update geplaatst (Werkelijk)

15 februari 2022

Laatste update ingediend die voldeed aan QC-criteria

3 februari 2022

Laatst geverifieerd

1 december 2021

Meer informatie

Termen gerelateerd aan deze studie

Trefwoorden

Aanvullende relevante MeSH-voorwaarden

Andere studie-ID-nummers

  • PR-18049

Plan Individuele Deelnemersgegevens (IPD)

Bent u van plan om gegevens van individuele deelnemers (IPD) te delen?

NEE

Beschrijving IPD-plan

After the end of the study, data will be analyzed as ter the defined data analysis plan on the protocol. Study results will be shared with other researchers by journal publications, conferences proceedings and dissemination programs

Informatie over medicijnen en apparaten, studiedocumenten

Bestudeert een door de Amerikaanse FDA gereguleerd geneesmiddel

Nee

Bestudeert een door de Amerikaanse FDA gereguleerd apparaatproduct

Nee

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