Low-Cost Bubble Continuous Positive Airway Pressure (CPAP) In Indian Tertiary PICU -A Mixed Method Feasibility Study.

Pneumonia is a leading infectious cause of death globally among children younger than five years. Accounting for one third of all under five deaths from infection. More than 99% of pneumonia deaths are in low and middle income countries and closely linked to poverty. It is one of the most important causes of under five deaths in India . More than 1.1 million, under five years of age children die from pneumonia every year accounting for almost 17% under five deaths worldwide . In India during the year 2013 about 31.7 million cases of acute respiratory infections were reported during 2013 about 3278 people died of ARI and 2597 died of pneumonia  Pneumonia was responsible for about 18% of all under five year deaths in India interventions that affect mortality due to pneumonia are thus of greater importance. In any effort to improve childhood survival.

The annual global incidence of pneumonia is 9 to 0000 new cases per year out of which 282000 occurring in South Asia , though, there is evidence of decreased mortality and decreased need for invasive ventilation after use of CPAP in managing units with respiratory distress, secondary to RDS , MAS and apnoea of prematurity in NICU. There is only limited evidence for use of CPAP in infants and children with respiratory conditions like pneumonia, ARDS, pulmonary edema and status asthmaticus with very few observational and randomised control studies, indicating that CPAP exhibits promising potential in enhancing ventilation and oxygenation among infants, with pneumonia with respiratory distress and use of CPAP, may mitigate the need for endotracheal, intubation and potentially need to shorter duration of PICU stays for the young patients . Among different CPAP devices, bubble CPAP demonstrate the specific advantage of cost effectiveness, ease of assembling and its operability with any available oxygen source gives it an upper hand in low and middle income countries. Nevertheless, there is minimal evidence of CPAP efficacy in pneumonia. This study aims to investigate low-cost bubble CPAP, safety and effectiveness in paediatric respiratory distress. As a result of pneumonia, filling a critical knowledge gap in paediatric respiratory care to minimise mortality and morbidity .