"The number of COVID-19 patients hospitalised with severe breathing difficulty is increasing. Unfortunately, there is acute scarcity in the availability of mechanical ventilators to meet the increasing demand of hospitalised COVID-19 patients requiring assisted breathing. The situation is particularly alarming in countries with limited resources like Bangladesh. Low- and middle-income countries urgently need low-cost adaptive technologies to provide CPAP. A trial by the lead investigator demonstrated that a locally made low-cost bubble CPAP was effective in significantly reducing the mortality in children with severe pneumonia. Bubble CPAP device comprises (a) an interface; nasal seal, (b) oxygen delivery piping, connectors and nasal cannula, (c) appropriately sized transparent plastic bottles (containing sterilized water). The safety of the pediatric device and its use in children with acute respiratory disease has already been approved by the Directorate General of Drug Administration (DGDA), Government of Bangladesh. Adapting this technology, if safe and scaled up, could potentially reduce the need for mechanical ventilation and subsequently averting deaths among adult COVID-19 patients.

Our adaptations have included ensuring adequate seal for the interface (mask for nose) when delivering oxygen at high pressure to meet the demand of hypoxaemia in adult lungs. To prevent nasal air leak around the mask, we developed and successfully tested a prototype in healthy individuals which is silicon-based and ergonomically designed considering the variations in size and direction of adult nasal cavities as well as the comfort of patients. This adaptive version of nasal canula was made with the help of Bangladesh University of Engineering and Technology (BUET).

The design phase has demonstrated that (a) using a collaborative approach we can consistently produce adult silicone nasal seals, (b) we can deliver effective PEEP with a mean pressure that is overall within +/-12% of target pressure, with most loss only at the highest pressure setting (15cmH2O), (c) the device is well tolerated by participants with no in-study adverse events of note and no skin injury or undue discomfort in relation to the cannula or flow.

The safety phase initiated on 1st November 2020 and ended on 30th April 2021. We have enrolled twelve patients (ten RT-PCR negatives for COVID-19 and rest of the two RT-PCR positives for COVID-19) in this trial. One participant withdrew from the study by voluntary approach. The rest of the patients were successfully discharged. None of them developed any adverse event(s).

This study aims to evaluate the barriers and operational challenges related to the introduction of adult bubble CPAP oxygen therapy along with the acceptability and usability of introduction of adult bubble CPAP in tertiary level hospitals of Bangladesh " "CNN : The plastic bottle saving babies from pneumonia

https://www.youtube.com/watch?v=IU-QzOVPEj4 "