ArticleArchives of disease in childhood. Fetal and neonatal edition2020
Basic principles of neonatal bubble CPAP: effects on CPAP delivery and imposed work of breathing when altering the original design.
Article in Archives of disease in childhood. Fetal and neonatal edition, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it, 31 citations in OpenAlex.
- The Care of Preterm and Term Newborns with Respiratory Conditions: A Systematic Synthesis of Evidence from Low- and Middle-Income Countries.Neonatology · 2025Pooled it
- Comparison of Ventilator-Derived and Modified Bubble Continuous Positive Airway Pressure for Early Stabilization of Transient Tachypnea of the Newborn: A Retrospective Cohort Study in a Transitional Care Unit.Turkish archives of pediatrics · 2025Article
- Contextual factors influencing bubble continuous positive airway pressure implementation for paediatric respiratory distress in low-income and middle-income countries: a realist review.The Lancet. Global health · 2025Review
- The practice of a modified bubble CPAP therapy in a rural Sierra Leone SCBU-A pilot study.Frontiers in pediatrics · 2025Article
- The novel LESS (low-cost entrainment syringe system) OFrontiers in pediatrics · 2024Article
- Reported Complications of Bubble Continuous Positive Airway Pressure Systems in Low-Resource Settings: An International Survey.The American journal of tropical medicine and hygiene · 2023Article
- Bubble devices versus other pressure sources for nasal continuous positive airway pressure in preterm infants.The Cochrane database of systematic reviews · 2023Review
- Feasibility and usability of a very low-cost bubble continuous positive airway pressure device including oxygen blenders in a Ugandan level two newborn unit.PLOS global public health · 2023Article
- Doing more with less: The use of non-invasive ventilatory support in a resource-limited setting.PloS one · 2023Article
- Innovations and adaptations in neonatal and pediatric respiratory care for resource constrained settings.Frontiers in pediatrics · 2022Review
- Respiratory distress syndrome management in resource limited settings-Current evidence and opportunities in 2022.Frontiers in pediatrics · 2022Review
- Nonclinical Bench Performance Testing of a Very Low-Cost Nonelectric Bubble Continuous Positive Airway Pressure (bCPAP) and Blenders Device Designed for Newborn Respiratory Support.Medical devices (Auckland, N.Z.) · 2022Article
- Testing positive pressure delivered from commercial and WHO-style pediatric bubble CPAP devices.BMC pediatrics · 2021Article
Corrections and comments
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Authors and funding
5 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe original bubble continuous positive airway pressure (bCPAP) design has wide-bore tubing and a low-resistance interface. This creates a stable airway pressure that is reflected by the submersion depth of the expiratory tubing. Several systems with alterations to the original bCPAP design are now available. Most of these are aimed for use in low-income and middle-income countries and have not been compared with the original design.
objectiveWe identified three major alterations to the original bCPAP design: (1) resistance of nasal interface, (2) volume of dead space and (3) diameter of expiratory tubing. Our aim was to study the effect of these alterations on CPAP delivery and work of breathing in a mechanical lung model. Dead space should always be avoided and was not further tested.
methodsThe effect of nasal interface resistance and expiratory tubing diameter was evaluated with simulated breathing in a mechanical lung model without interface leakage. The main outcome was delivered CPAP and imposed work of breathing.
resultsHigh-resistance interfaces and narrow expiratory tubing increased the work of breathing. Additionally, narrow expiratory tubing resulted in higher CPAP levels than indicated by the submersion depth.
conclusionOur study shows the significant effect on CPAP delivery and imposed work of breathing when using high-resistance interfaces and narrow expiratory tubing in bCPAP systems. New systems should include low-resistance interfaces and wide-bore tubing and be compared with the original bCPAP. Referring to all systems that bubble as bCPAP is misleading and potentially hazardous.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.