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Nowadly CD, Portillo DJ, Davis ML, Hood RL, De Lorenzo RA. The Use of Portable Oxygen Concentrators in Low-Resource Settings: A Systematic Review. Prehosp Disaster Med 2022; 37:1-8. [PMID: 35232523 DOI: 10.1017/s1049023x22000310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Portable oxygen concentrators (POCs) are medical devices that use physical means to separate oxygen from the atmosphere to produce concentrated, medical-grade gas. Providing oxygen to low-resources environments, such as austere locations, military combat zones, rural Emergency Medical Services (EMS), and during disasters, becomes expensive and logistically intensive. Recent advances in separation technology have promoted the development of POC systems ruggedized for austere use. This review provides a comprehensive summary of the available data regarding POCs in these challenge environments. METHODS PubMed, Google Scholar, and the Defense Technical Information Center were searched from inception to November 2021. Articles addressing the use of POCs in low-resource settings were selected. Three authors were independently involved in the search, review, and synthesis of the articles. Evidence was graded using Oxford Centre for Evidence-Based Medicine guidelines. RESULTS The initial search identified 349 articles, of which 40 articles were included in the review. A total of 724 study subjects were associated with the included articles. There were no Level I systematic reviews or randomized controlled trials. DISCUSSION Generally, POCs are a low-cost, light-weight tool that may fill gaps in austere, military, veterinary, EMS, and disaster medicine. They are cost-effective in low-resource areas, such as rural and high-altitude hospitals in developing nations, despite relatively high capital costs associated with initial equipment purchase. Implementation of POC in low-resource locations is limited primarily on access to electricity but can otherwise operate for thousands of hours without maintenance. They provide a unique advantage in combat operations as there is no risk of explosive if oxygen tanks are struck by high-velocity projectiles. Despite their deployment throughout the battlespace, there were no manuscripts identified during the review involving the efficacy of POCs for combat casualties or clinical outcomes in combat. Veterinary medicine and animal studies have provided the most robust data on the physiological effectiveness of POCs. The success of POCs during the coronavirus disease 2019 (COVID-19) pandemic highlights the potential for POCs during future mass-casualty events. There is emerging technology available that combines a larger oxygen concentrator with a compressor system capable of refilling small oxygen cylinders, which could transform the delivery of oxygen in austere environments if ruggedized and miniaturized. Future clinical research is needed to quantify the clinical efficacy of POCs in low-resource settings.
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Affiliation(s)
- Craig D Nowadly
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TexasUSA
| | - Daniel J Portillo
- Department of Mechanical Engineering, The University of Texas at San Antonio, San Antonio, TexasUSA
| | - Maxwell L Davis
- Department of Respiratory Therapy, Keesler Air Force Base, Biloxi, Mississippi, USA
| | - R Lyle Hood
- Department of Mechanical Engineering, The University of Texas at San Antonio, San Antonio, TexasUSA
- Department of Emergency Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TexasUSA
| | - Robert A De Lorenzo
- Department of Emergency Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TexasUSA
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Bakare AA, Graham H, Ayede AI, Peel D, Olatinwo O, Oyewole OB, Fowobaje KR, Qazi S, Izadnegahdar R, Duke T, Falade AG. Providing oxygen to children and newborns: a multi-faceted technical and clinical assessment of oxygen access and oxygen use in secondary-level hospitals in southwest Nigeria. Int Health 2020; 12:60-68. [PMID: 30916340 PMCID: PMC6964224 DOI: 10.1093/inthealth/ihz009] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 01/13/2019] [Accepted: 02/22/2019] [Indexed: 11/14/2022] Open
Abstract
Background Oxygen is an essential medical therapy that is poorly available globally. We evaluated the quality of oxygen therapy in 12 secondary-level Nigerian hospitals, including access to oxygen equipment, equipment functionality, healthcare worker knowledge and appropriateness of use. Methods We conducted a three-part evaluation of oxygen access and use involving: (1) facility assessment (including technical evaluation of oxygen equipment), (2) clinical audit (children and neonates admitted January 2014–December 2015) and (3) survey of healthcare worker training and experience on the clinical use of oxygen (November 2015). Results Oxygen access for children and newborns is compromised by faulty equipment, lack of pulse oximetry and inadequate care practices. One hospital used pulse oximetry for paediatric care. Eleven hospitals had some access to oxygen supplies. Testing of 57 oxygen concentrators revealed two (3.5%) that were ‘fit for use’. Overall, 14.4% (3708/25 677) of children and neonates received oxygen some time during their admission; 19.4% (1944/10 000) of hypoxaemic children received oxygen; 38.5% (1217/3161) of children who received oxygen therapy were not hypoxaemic. Conclusions Oxygen access for children in Nigerian hospitals is poor, and likely results in substantial excess mortality. To improve oxygen access for children globally we must focus on actual provision of oxygen to patients—not simply the presence of oxygen equipment at the facility level. This requires a systematic approach to improve both oxygen (access [including equipment, maintenance and affordability]) and oxygen use (including pulse oximetry, guidelines and continuing education).
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Affiliation(s)
- Ayobami A Bakare
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Hamish Graham
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria.,Centre for International Child Health, University of Melbourne, MCRI, Royal Children's Hospital, Parkville, Australia
| | - Adejumoke I Ayede
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria.,Department of Paediatrics, University of Ibadan, Ibadan, Nigeria
| | | | - Olatayo Olatinwo
- Biomedical Services, University College Hospital, Ibadan, Nigeria
| | - Oladapo B Oyewole
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Kayode R Fowobaje
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Shamim Qazi
- Department of Maternal, Newborn, Child and Adolescent Health, WHO, Nigeria
| | | | - Trevor Duke
- Centre for International Child Health, University of Melbourne, MCRI, Royal Children's Hospital, Parkville, Australia
| | - Adegoke G Falade
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria.,Department of Paediatrics, University of Ibadan, Ibadan, Nigeria
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Duke T, Hwaihwanje I, Kaupa M, Karubi J, Panauwe D, Sa'avu M, Pulsan F, Prasad P, Maru F, Tenambo H, Kwaramb A, Neal E, Graham H, Izadnegahdar R. Solar powered oxygen systems in remote health centers in Papua New Guinea: a large scale implementation effectiveness trial. J Glob Health 2018; 7:010411. [PMID: 28567280 PMCID: PMC5441450 DOI: 10.7189/jogh.07.010411] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Pneumonia is the largest cause of child deaths in Papua New Guinea (PNG), and hypoxaemia is the major complication causing death in childhood pneumonia, and hypoxaemia is a major factor in deaths from many other common conditions, including bronchiolitis, asthma, sepsis, malaria, trauma, perinatal problems, and obstetric emergencies. A reliable source of oxygen therapy can reduce mortality from pneumonia by up to 35%. However, in low and middle income countries throughout the world, improved oxygen systems have not been implemented at large scale in remote, difficult to access health care settings, and oxygen is often unavailable at smaller rural hospitals or district health centers which serve as the first point of referral for childhood illnesses. These hospitals are hampered by lack of reliable power, staff training and other basic services. METHODS We report the methodology of a large implementation effectiveness trial involving sustainable and renewable oxygen and power systems in 36 health facilities in remote rural areas of PNG. The methodology is a before-and after evaluation involving continuous quality improvement, and a health systems approach. We describe this model of implementation as the considerations and steps involved have wider implications in health systems in other countries. RESULTS The implementation steps include: defining the criteria for where such an intervention is appropriate, assessment of power supplies and power requirements, the optimal design of a solar power system, specifications for oxygen concentrators and other oxygen equipment that will function in remote environments, installation logistics in remote settings, the role of oxygen analyzers in monitoring oxygen concentrator performance, the engineering capacity required to sustain a program at scale, clinical guidelines and training on oxygen equipment and the treatment of children with severe respiratory infection and other critical illnesses, program costs, and measurement of processes and outcomes to support continuous quality improvement. CONCLUSIONS This study will evaluate the feasibility and sustainability issues in improving oxygen systems and providing reliable power on a large scale in remote rural settings in PNG, and the impact of this on child mortality from pneumonia over 3 years post-intervention. Taking a continuous quality improvement approach can be transformational for remote health services.
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Affiliation(s)
- Trevor Duke
- Center for International Child Health, University of Melbourne and MCRI, Melbourne, Australia.,School of Medicine and Health Sciences, University of PNG, Taurama Campus, NCD, Papua New Guinea
| | - Ilomo Hwaihwanje
- Goroka General Hospital, Eastern Highlands Province, Goroka, Papua New Guinea
| | - Magdalynn Kaupa
- Mt Hagen General Hospital, Western Highlands, Mount Hagen, Papua New Guinea
| | - Jonah Karubi
- Mt Hagen General Hospital, Western Highlands, Mount Hagen, Papua New Guinea
| | | | - Martin Sa'avu
- Mendi Hospital, Southern Highlands Province, Mendi, Papua New Guinea
| | - Francis Pulsan
- School of Medicine and Health Sciences, University of PNG, Taurama Campus, NCD, Papua New Guinea
| | | | - Freddy Maru
- AusTrade Pacific, Port Moresby, Papua New Guinea
| | - Henry Tenambo
- Health Facilities Branch, National Department of Health, Papua New Guinea
| | - Ambrose Kwaramb
- Health Facilities Branch, National Department of Health, Papua New Guinea
| | - Eleanor Neal
- Center for International Child Health, University of Melbourne and MCRI, Melbourne, Australia
| | - Hamish Graham
- Center for International Child Health, University of Melbourne and MCRI, Melbourne, Australia
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Walk J, Dinga P, Banda C, Msiska T, Chitsamba E, Chiwayula N, Lufesi N, Mlotha-Mitole R, Costello A, Phiri A, Colbourn T, McCollum ED, Lang HJ. Non-invasive ventilation with bubble CPAP is feasible and improves respiratory physiology in hospitalised Malawian children with acute respiratory failure. Paediatr Int Child Health 2016; 36:28-33. [PMID: 25434361 PMCID: PMC4449832 DOI: 10.1179/2046905514y.0000000166] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND In low-income countries and those with a high prevalence of HIV, respiratory failure is a common cause of death in children. However, the role of non-invasive ventilation with bubble continuous positive airway pressure (bCPAP) in these patients is not well established. METHODS A prospective observational study of bCPAP was undertaken between July and September 2012 in 77 Malawian children aged 1 week to 14 years with progressive acute respiratory failure despite oxygen and antimicrobial therapy. RESULTS Forty-one (53%) patients survived following bCPAP treatment, and an HIV-uninfected single-organ disease subgroup demonstrated bCPAP success in 14 of 17 (82%). Compared with children aged ≧60 months, infants of 0-2 months had a 93% lower odds of bCPAP failure (odds ratio 0·07, 95% confidence interval 0·004-1·02, P = 0·05). Following commencement of bCPAP, respiratory physiology improved, the average respiratory rate decreased from 61 to 49 breaths/minute (P = 0·0006), and mean oxygen saturation increased from 92·1% to 96·1% (P = 0·02). CONCLUSIONS bCPAP was well accepted by caregivers and patients and can be feasibly implemented into a tertiary African hospital with high-risk patients and limited resources.
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Affiliation(s)
- J. Walk
- University Medical Centre Utrecht, Utrecht, The Netherlands,Department of Paediatrics, Kamuzu Central Hospital, Malawi
| | - P. Dinga
- Department of Paediatrics, Kamuzu Central Hospital, Malawi
| | - C. Banda
- Department of Paediatrics, Kamuzu Central Hospital, Malawi
| | - T. Msiska
- Department of Paediatrics, Kamuzu Central Hospital, Malawi
| | - E. Chitsamba
- Department of Paediatrics, Kamuzu Central Hospital, Malawi
| | - N. Chiwayula
- Department of Paediatrics, Kamuzu Central Hospital, Malawi
| | - N. Lufesi
- Ministry of Health, Community Health Sciences Unit, Lilongwe, Malawi
| | | | - A. Costello
- University College London Institute for Global Health, London, UK
| | - A. Phiri
- Department of Paediatrics, Kamuzu Central Hospital, Malawi
| | - T. Colbourn
- University College London Institute for Global Health, London, UK
| | - E. D. McCollum
- Department of Paediatrics, Kamuzu Central Hospital, Malawi,University College London Institute for Global Health, London, UK,Department of Pediatrics, Division of Pulmonology, Johns Hopkins School of Medicine, Baltimore, USA
| | - H. J. Lang
- Department of Paediatrics, Kamuzu Central Hospital, Malawi
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Bradley BD, Chow S, Nyassi E, Cheng YL, Peel D, Howie SRC. A retrospective analysis of oxygen concentrator maintenance needs and costs in a low-resource setting: experience from The Gambia. HEALTH AND TECHNOLOGY 2015. [DOI: 10.1007/s12553-015-0094-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Peel D, Neighbour R, Eltringham RJ. Evaluation of oxygen concentrators for use in countries with limited resources. Anaesthesia 2013; 68:706-12. [PMID: 23654218 DOI: 10.1111/anae.12260] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2013] [Indexed: 11/28/2022]
Abstract
Seven different models of oxygen concentrators were purchased. The manufacturer's data were evaluated by a ranking method for operation at high temperature and high relative humidity, power consumption, warranty and cost. Measurements were then made of the oxygen concentration produced at maximum operating temperature. All the concentrators were CE marked and claimed compliance with the relevant Standard ISO 8359:1996. Only two models complied with their specification. On examination of the concentrators and the accompanying documents we found that compliance with 61 points listed in ISO 8359 ranged from 85% to 98%. Oxygen concentration was measured with the machines running simultaneously under both high temperature and high humidity. All models delivered low oxygen concentrations at 40 °C and 95% relative humidity. Only two models delivered >82% at 35 °C and 50% relative humidity. Concentrators intended for use in countries with limited resources should be evaluated before they are purchased, by independent experts, using the methods described herein.
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Affiliation(s)
- D Peel
- Ashdown Consultants, Hartfield, UK
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