Table 4

Outcomes for non-randomised control trials

Author, yearTotal sample sizeMortalityAdditional findingsAdverse eventsReported limitationsReported conclusions
1062 (2%)N/A0 (0%)Possibility of missing dataNIPPV can be a simple and cost-effective way to treat patients with acute respiratory failure
838 (10%)Patients with severe illness based on Tal score:
0 hours: 64/83 (77%)
2 hours: 12/83 (15%)
Severe: 0
Mild: 5 (6%)
Mild AE included nasal tissue irritation and abdominal distension
Evaluations for complications based only on clinical exam, not powered to evaluate effectiveness, differences in pretrial and trial patientsSEAL-bCPAP is safe for treatment of respiratory distress in non-neonatal children in LMIC with a trend towards decreased mortality
154Avoided intubation: 3.8%
Required intubation: 38.8%
No need for intubation: 80/154 (52%)
Duration of NIV (days, median (IQR)):
Avoided intubation: 4 (2.25–6)
Required intubation: 2 (1–4)
Duration of hospital stay (days, median (IQR)):
Avoided intubation: 6 (5–9)
Required intubation: 13 (9–24)
Skin breakdown noted but number of adverse events not reportedRetrospective study design with no control group, no rigid protocol to determine when therapies should be escalated or discontinuedNIV avoided mechanical ventilation in a high proportion of children
10 (0%)Duration of bCPAP: 4 days
Duration of hospital stay: 6 days
0 (0%)Limitations not reportedA low-cost bCPAP could reduce child mortality in Africa
120Not reportedSuccess of bCPAP: 72%
Duration of bCPAP (hours, mean (CI)): 75 (65–85)
Duration of ICU stay (days, mean (CI)): 10 (9–11)
4 (3%)
Complications included abdominal bloating and pneumothorax
Limitations not reportedA reduction in respiratory rate, heart rate and TAL scores at 2 hours after starting intervention were predictors of success
422 (5%)Duration of nasopharyngeal CPAP (days, mean (SD)): 4.12 (3.71)
Need for mechanical ventilation: 13/42 (31%)
8 (19%)
Complications included tube obstructions and apnoea due to excessive sedation
Small sample sizeNasopharyngeal CPAP was useful to avoid mechanical ventilation
360 (0%)Duration of ICU stay (days, median (range)): 2 (2–5)
Duration of hospital stay (days, median (range)): 7 (6–11)
Decrease in mean RR after 6 hours:
H1N1 positive: 20
H1N1 negative: 17
0 (0%)Limitations not reportedIndigenous NB-CPAP improves hypoxemia and signs and symptoms in hemodynamically stable children with acute respiratory failure due to influenza-like injury
12919 (15%)Duration of NIV (days, median (IQR)): 4 (2–8)
Duration of PICU stay (days, median (IQR)): 4.5 (2–9)
Avoided mechanical ventilation for ≥5 days: 98 (76%)
29 (22%)
Complications included pneumonia while on NIV, pressure from mask and problems with mask fitting
Not an RCT, no routine use of blood gas sampling, shortage of NIV machinesNIV represents a viable strategy that provided effective respiratory support and prevented intubation in majority of patients
7923 (29%)Duration of CPAP (days, mean): 3.12
Duration of hospitalisation (days, mean): 8.41
Had lower RISC score after 24 hours: 63 (80%)
Not reportedClinical diagnoses could have led to misclassificationbCPAP was most beneficial to patients with bronchiolitis
10 (0%)Duration of bCPAP (days): 70 (0%)Limitations not reportedbCPAP was successful in treating an infant with PJP pneumonia secondary to HIV infection
11738 (33%)Required intubation: 15/115 (13%)
Duration of treatment (hours, median (IQR)): 24 (24–60)
13 (11%)
Complications included blocked nostrils or nasal prongs, interruption of oxygen supply, nasal septum lesions and aspiration
Observational study design, small sample size, limited human resources and some missing data pointsIt is feasible to use bCPAP in the hospital management of critically ill children in resource-limited settings
6435 (55%)RDS (mean (IQR)):
Pre-CPAP: 11 (10–12)
1 hour: 9 (8–11)
84 hours: 6.5 (6–8)
Not reportedObservational study design, bCPAP only used when oxygen failedbCPAP improves oxygenation and reduces respiratory distress in some children but children with comorbidities continue to do poorly
7736 (47%)Duration of treatment (days, median (IQR)): 3 (3–5)13 (17%)Non-randomised and uncontrolled, small sample size, understaffing, missing vital sign databCPAP can be feasibly implemented into a tertiary African hospital with high-risk patients
  • AEs, adverse events; bCPAP, bubble continuous positive airway pressure; CPAP, continuous positive airway pressure; RR, respiratory rate in breaths per minute.