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In resource-poor countries, severe pneumonia in children has a high mortality rate. Provision of adequate oxygenation is a major challenge. A low-cost way to deliver continuous positive airway pressure (CPAP) without a ventilator involves connecting the expiratory limb of the breathing circuit to a tube, the end of which is submerged in water. When a good seal is made with the upper airway, bubbles appear in the water bottle — hence the name bubble CPAP. Another alternative to standard low-flow oxygen involves humidified high-flow air and oxygen delivered via nasal cannula. Neither of these approaches had been studied in children in developing countries.
In an open, randomized trial conducted at a hospital in Dhaka, Bangladesh, investigators…