Review of supplemental oxygen and respiratory support for paediatric emergency care in sub-Saharan Africa Andreas Hansmann, Brenda May Morrow, Hans-Joerg.

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Review of supplemental oxygen and respiratory support for paediatric emergency care in sub-Saharan Africa Andreas Hansmann, Brenda May Morrow, Hans-Joerg Lang African Journal of Emergency Medicine Volume 7, Pages S10-S19 (January 2017) DOI: 10.1016/j.afjem.2017.10.001 Copyright © 2017 African Federation for Emergency Medicine Terms and Conditions

Fig. 1 Different oxygen delivery systems. Note: Modified from B Frey, F Shann [28]. *Face mask and head box are no longer recommended as they require a high flow of oxygen, carry the risk of rebreathing and obstruct access to the face for oral feeding and suctioning, reducing oxygen delivery during these interventions. African Journal of Emergency Medicine 2017 7, S10-S19DOI: (10.1016/j.afjem.2017.10.001) Copyright © 2017 African Federation for Emergency Medicine Terms and Conditions

Fig. 2 Bubble continuous positive airway pressure. Note: Example of a bubble continuous positive airway pressure set-up as outlined in the WHO document: “Oxygen therapy for children” [13]. There are also bCPAP set-ups available which use modified oxygen concentrators with an air and oxygen outlet. bCPAP, Bubble continuous positive airway pressure. African Journal of Emergency Medicine 2017 7, S10-S19DOI: (10.1016/j.afjem.2017.10.001) Copyright © 2017 African Federation for Emergency Medicine Terms and Conditions

Fig. 3 Treatment algorithm for respiratory support in the emergency centre where options for NIV and mechanical ventilation exist. NIV, non-invasive ventilation; bCPAP, bubble continuous positive airway pressure; HFNC, high-flow nasal cannula. African Journal of Emergency Medicine 2017 7, S10-S19DOI: (10.1016/j.afjem.2017.10.001) Copyright © 2017 African Federation for Emergency Medicine Terms and Conditions

Fig. 4 Severity of respiratory dysfunction and modes of respiratory support. Note: Reproduced with thanks to Dr. Ramnarajan, PICU, St. Mary’s Hospital, London, UK. Suggestion for the use of supplemental oxygen, different forms of NIV and mechanical ventilation, depending on the severity of respiratory severity/general clinical condition and response to management. The possibility to “escalate” levels of critical care depends on available resources and work-load. If facilities for mechanical ventilation are available, it is important not to delay intubation if the child is in a very critical state and/or NIV is clearly not successful. Further research is required in order to evaluate the role of different NIV-modalities in the management of different causes of respiratory failure and other aspects of NIV-use. NIV, non-invasive ventilation; BIPAP, bi-level positive airway pressure; CPAP, continuous positive airway pressure; HFNC, high-flow nasal cannula. African Journal of Emergency Medicine 2017 7, S10-S19DOI: (10.1016/j.afjem.2017.10.001) Copyright © 2017 African Federation for Emergency Medicine Terms and Conditions