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Bubble CPAP splitting: innovative strategy in resource-limited settings
  1. Akanksha Verma,
  2. Rahul Jaiswal,
  3. Kirti M Naranje,
  4. Girish Gupta,
  5. Anita Singh
  1. Neonatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
  1. Correspondence to Dr Kirti M Naranje, Neonatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, India; drkirtinaranje{at}


Background Non-invasive respiratory support for neonates using bubble continuous positive airway pressure (bCPAP) delivery systems is now widespread owing to its safety, cost effectiveness and easy applicability. Many innovative solutions have been suggested to deal with the possible shortage in desperate situations like disasters, pandemics and resource-limited settings. Although splitting of invasive ventilation has been reported previously, no attempts to split non-invasive respiratory support have been reported.

Objective The primary objective was to test the feasibility of splitting the bCPAP assembly using a T-piece splitter in a simulation model.

Methods A pilot simulation-based study was done to split a single bCPAP assembly using a T-piece. Other materials consisted of a heated humidification system, an air oxygen blender, corrugated inspiratory and expiratory tubing, nasal interfaces and two intercostal chest tube drainage bags. Two pressure manometers were used simultaneously to measure delivered pressures at different levels of set bCPAPs at the expiratory limb of nasal interfaces.

Results Pressures measured at the expiratory end of two nasal interfaces were 5.1 and 5.2 cm H2O, respectively, at a flow of 6 L/min and a water level of 5 cm H2O in both chest bags. When tested across different levels of set continuous positive airway pressure (3–8 cmH2O) and fractional inspired oxygen concentration (0.30–1.0), measured parameters corresponded to set parameters.

Conclusion bCPAP splitting using a T-piece splitter is a technically simple, feasible and reliable strategy tested in a simulation model. Further testing is needed in a simulated lung model.

  • neonatology
  • nursing
  • technology

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  • Contributors GG conceptualised the idea. KMN, AV and RJ performed the practical assembly and testing of the methodology. AV and KMN wrote the manuscript. AS and GG performed the critical appraisal.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.