Continuous positive airway pressure (CPAP) has been a key treatment modality for Coronavirus Disease 2019 (COVID-19) worldwide. Globally, the demand for CPAP outstripped the supply during the pandemic. The LeVe CPAP System was developed to provide respiratory support for treatment of COVID-19 and tailored for use in low- and middle-income country (LMIC) settings. Prior to formal trial approval, received in November 2021, these devices were used in extremis to support critically unwell adult patients requiring non-invasive ventilatory support. This is a retrospective descriptive review of adult patients with COVID-19 pneumonitis, who were treated with advanced respiratory support (CPAP and/or high-flow nasal oxygen, HFNO) at Mengo Hospital, Uganda. Patients were treated with the LeVe CPAP System, Elisa CPAP and/or AIRVO™ HFNO. Treatment was escalated per standard local protocols for respiratory failure, and CPAP was the maximum respiratory support available. Data were collected on patient characteristics, length of time of treatment, clinical outcome, and any adverse events. Overall 333 patients were identified as COVID-19 positive, 44 received CPAP ± HFNO of which 43 were included in the study. The median age was 58 years (range 28–91 years) and 58

Objectives Pneumonia remains a leading cause of mortality in children under five years. Continuous positive airway pressure (CPAP) is a key tool for managing paediatric respiratory failure worldwide but there are large barriers to its provision in low resource settings. The LeVe CPAP device has been designed with frugal engineering techniques at the University of Leeds and adapted by the biomedical engineering team at Mengo Hospital, Uganda. Having been successfully used in adult patients with COVID 19 after local approval, here we report its first use in extremis in the paediatric population at Mengo prior to a formal feasibility trial approved in September 2022. Patients offered LeVe CPAP had reached the ceiling of care available but were continuing to deteriorate. Therefore, LeVe CPAP was used in a small number of cases by the local team on a compassionate use basis when no further treatment options were available. It was expected that without further treatment options the child would inevitably die. Methods This is a retrospective case note review of patients admitted to the paediatric ward at Mengo Hospital who were treated with LeVe CPAP between May to August 2022. Case books from all paediatric admissions were reviewed to identify those receiving CPAP, and pertinent patient demographics, working diagnosis, oxygen saturations prior to initiation of CPAP, duration on CPAP and clinical outcome were collected. Results Overall, 10 patients were identified. This was 4% of the 251 patients admitted with respiratory illness during this time period (pneumonia (n=172), bronchiolitis (n=50), asthma (n=29)). Mean patient age was 15 months (range 4 months to 7 years). The most common indication was respiratory failure secondary to pneumonia (n=8). The mean CPAP duration was 2 days (range 1 – 6 days). The overall mortality was 40%; it was greatest in infants under 1 year old (67%) and those who spend a longer duration on the device. Conclusions This audit demonstrates the compassionate use of a novel frugal CPAP system to deliver respiratory support to critically unwell patients, deteriorating despite maximal usual care. The high mortality rate should be viewed in this context. Following this first compassionate use we have reported here, a formal feasibility study has been undertaken, in the same setting. Forty patients were recruited to this and we look forward to publishing the quantitative and qualitative results soon.

The COVID-19 pandemic has placed a dramatic increase in demand on healthcare providers to provide respiratory support for patients with moderate to severe symptoms. In conjunction, the pandemic has challenged existing supply-chains to meet demands for medical equipment and resources. In response to these challenges, we report our work to repurpose two existing non-invasive ventilation (NIV) systems to provide solutions for the delivery of oxygen-enriched CPAP ventilation which are inherently resource and oxygen-efficient. We consider adaptation of CPAP systems typically used for sleep apnoea, together with a new Venturi-valve design which can be readily produced through 3D printing. Our aim in both cases was to support Positive end-expiratory pressure (PEEP) of ≥10cmH2O while achieving ≥40% FiO2. This supports a crucial part in the patient pathway for COVID-19 treatment, helping to provide early respiratory support prior to invasive ventilation options in the ICU.