Table 2

Characteristics of included studies

Author, YearCountry and settingStudy designSample size and populationIntervention and equipmentComparisonOutcomes of interest
Randomised control trials
Cam,
20029
Vietnam
Referral hospital Intensive care unit
Randomised control trialN=37
Age 0–15 years, dengue shock syndrome with respiratory failure despite nasal canula oxygen
CPAP
(n=18)
Via Beneveniste valve
Oxygen mask
(n=19)
Mortality
Adverse events
Success of treatment at 30 min* and 24 hours
Chisti,
201510
Bangladesh
Center for Diarrhoeal Disease Research Intensive care unit
Randomised control trialN=225
Age 0–5 years, severe pneumonia and hypoxemia
Locally constructed bCPAP
(n=79)
Low flow oxygen
(n=67)
High flow oxygen
(n=79)
Mortality
treatment failure* (clinical failure, mechanical ventilation or death)
Duration of hospital stay
Duration of symptoms
Lal,
201811
India
Referral hospital
Randomised control trialN=72
Age 1–12 months, acute bronchiolitis with wheezing
bCPAP via Gregory circuit
(n=36)
Standard of care with oxygen mask
(n=36)
Mortality
Adverse events
Need for mechanical ventilation
Change in vital signs* and MPSNZ-SS+ and SA score+
McCollum,
201912
Malawi
District Hospital General ward
Randomised control trialN=644
Age 1–59 months, severe pneumonia and one or more high risk conditions (HIV infection or exposure, Hypoxemia, severe malnutrition)
bCPAP via Fisher and Paykel healthcare CPAP system
(n=321)
Low-flow oxygen
(n=323)
Mortality*
Adverse events
Duration of respiratory support
Morales,
200415
Mexico
National Institute of Respiratory Disease
Intensive care unit
Prospective comparative study‡N=26
Age 0–14 years, acute respiratory failure, Glasgow Coma Score >8
NIV via quantum ventilator
(n=14)
Orotracheal intubation
(n=12)
Mortality
Adverse events
Treatment success* (vital sign stabilisation after 2 hours)
Vital sign changes
Duration of hospital stay
Wilson,
201313
Ghana
Four district hospitals
General wards
Crossover randomised control trialN=69
Age 3 months to 5 years, tachypnoea and retractions or nasal flaring
Hudson RCI CPAP nasal cannula and DeVilviss IntelliPAP CPAP machineImmediate CPAP use
(n=31) delayed CPAP use
(n=38)
Mortality
Change in vital signs*
Wilson,
201714
Ghana
District hospital and Municipal hospital
General wards
Crossover cluster Randomised control trialN=2200
Age 1 month-5 years, tachypnoea and retractions or nasal flaring
Hudson RCI CPAP nasal cannula and DeVilviss IntelliPAP CPAP machine
(n=1025)
Oxygen via non-rebreather face mask
(n=1175)
Mortality*
Adverse events
Duration of CPAP
Non-comparative studies
Balfour-Lynn,
201416
Ghana
District hospital General ward
Observational implementation study20 N=106
Age 0–5 years, respiratory distress based on respiratory rate, SpO2, intercostal retractions and grunting
NIV via Nippy Junior paediatric pressure controlled portable ventilatorN/AMortality*
Adverse events
Bjorkland,
201917
Uganda
Referral hospital
Acute care unit
Prospective, non-blinded, non-randomised interventional studyN=83
Age 30 days - 5 years, moderate or severe respiratory distress based on a calculated respiratory score (Tal score >3) or hypoxia despite low-flow oxygen
SEAL-bCPAP with nasal prong adaptation from ear plug materialN/AMortality*
Adverse events*
Change in respiratory rate, oxygen saturation and Tal score†
Bonora,
201118
Argentina
Referral hospital
Intensive care unit
Retrospective observational studyN=154
Age 1–18 years, patients needing NIV for >30 min to attempt to avoid intubation
Neumovent graph, neumovent graph net or harmony devices for NIVN/AMortality
Need for intubation*
Duration of NIV
Duration of hospital stay
Brown,
201327
Malawi
Referral hospital
Case reportN=1
Age 6 months, respiratory distress
Low cost bCPAP device developed by authorsN/AMortality
Adverse events
Vital sign changes after 1 hour
Length of hospital stay
Figuera,
201719
Argentina
Provincial hospital
Intermediate care unit
Retrospective descriptive studyN=120
Age 1–24 months, weight <12 kg, Tal score >5
Hudson RCI-CPAPN/AMortality
Adverse events
Success of CPAP (15% decrease in RR)
Changes in vital signs and Tal score†
Duration of NIV
Duration of ICU stay
Ghiggi,
200020
Argentina
Referral hospital
Intensive care unit
Prospective observational studyN=42
Age 1 month- 5 years,
Acute respiratory failure from pulmonary cause with indication for mechanical ventilation
Nasopharyngeal CPAP via Sechrist IV100 B respiratorsN/AMortality
Adverse events
Need for mechanical ventilation*
Change in vital signs
Duration of NIV
Kinikar,
201121
India
Referral hospital
Intensive care unit
Case-control studyN=36
Age 0–12 years, influenza like illness, moderate to severe respiratory distress or respiratory failure
Locally constructed nasal bubble CPAPN/AMortality
Adverse events
Changes in vital signs in first 6 hours*
Lum,
201122
Malaysia
Referral hospital
Intensive care unit
Prospective observational studyN=129
Age 0–16 years, patients deemed likely to require intubation based on vital signs and work of breathing
NIV via Mapleson F breathing systemN/AMortality
Adverse events
Length of NIV
Length of PICU stay
Treatment success* (intubation avoided)
Vital Sign changes
Machen,
201523
Malawi
Referral hospital
Acute care unit
Prospective observational studyN=79
Weight<10 kg, respiratory distress, bCPAP deemed appropriate by physician
bCPAPN/AMortality*
Duration of bCPAP
Duration of hospital stay
Change in RISC score†
McCollum,
201128
Malawi
Referral hospital
Case reportN=1
3 month old, respiratory distress
Hudson RCI -bCPAPN/AMortality
Adverse events
Duration of bCPAP
Change in vital signs
Myers,
201924
Malawi
Referral hospital
Critical care zone, emergency zone
Prospective observational studyN=117
Age 0–59 months, severe respiratory distress
Diamedica “Baby CPAP”N/AMortality*
Adverse events
Pulsan,
201925
Papua New Guinea
Referral hospital
Intensive care unit, Special care nursery
Prospective observational studyN=64
Children with severe acute lower respiratory infection, with hypoxaemia or severe respiratory distress despite standard oxygen therapy
Diamedica-modified Airsep intensity bCPAPN/AMortality
Change in respiratory distress score*†
Walk,
201626
Malawi
Referral hospital
High dependency unit, emergency ward
Prospective observational studyN=77
Age 1 week to 14 years, progressive acute respiratory failure despite oxygen and antimicrobial therapy
Locally constructed CPAPN/AMortality*
Adverse events
Treatment failure (death or intubation)
Duration of CPAP
Changes in vital signs
  • *Primary outcome.

  • †Scoring tool to evaluate illness severity

  • ‡Non-randomised comparative study.

  • bCPAP, bubble continuous positive airway pressure; CPAP, continuous positive airway pressure; HIV, immunodeficiency virus; ICU, intensive care unit; MPSNZ-SS, Modified paediatric society of New Zealand severity score; NIV, non-invasive ventilation; PICU, paediatric intensive care unit; RICS score, respiratory index of severity in children.