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Review
. 2019 Feb;25(1):45-53.
doi: 10.1097/MCC.0000000000000568.

Optimizing respiratory management in resource-limited settings

Rebecca Inglis  1   2 , Emmanuel Ayebale  3   4 , Marcus J Schultz  5   6   7
Affiliations
Review

Optimizing respiratory management in resource-limited settings

Rebecca Inglis et al. Curr Opin Crit Care. 2019 Feb.

Abstract

Purpose of review: This review focuses on the emerging body of literature regarding the management of acute respiratory failure in low- and middle-income countries (LMICs). The aim is to abstract management principles that are of relevance across a variety of settings where resources are severely limited.

Recent findings: Mechanical ventilation is an expensive intervention associated with considerable mortality and a high rate of iatrogenic complications in many LMICs. Recent case series report crude mortality rates for ventilated patients of between 36 and 72%. Measures to avert the need for invasive mechanical ventilation in LMICs are showing promise: bubble continuous positive airway pressure has been demonstrated to decrease mortality in children with acute respiratory failure and trials suggest that noninvasive ventilation can be conducted safely in settings where resources are low.

Summary: The management of patients with acute respiratory failure in LMICs should focus on avoiding intubation where possible, improving the safety of mechanical ventilation and expediting weaning. Future directions should involve the development and trialing of robust and context-appropriate respiratory support technology.

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Figures

Box 1
Box 1
no caption available
FIGURE 1
FIGURE 1
Proposed interventions to improve outcomes in patients with acute respiratory failure in low-income and middle-income countries. ∗Evidence-based interventions; ^Authors’ opinions only, with further research required.
FIGURE 2
FIGURE 2
Proposed order of priority for respiratory support interventions.
See this image and copyright information in PMC

References

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