First use of a new frugal CPAP device: the LeVe CPAP System, in adult patients with COVID-19 pneumonitis at Mengo Hospital, Kampala, Uganda

Abstract Background: Continuous positive airway pressure (CPAP) has been a key treatment modality for COVID-19 worldwide. Globally, the demand for CPAP outstripped the supply during the pandemic. The LeVe CPAP device was developed to provide respiratory support for treatment of COVID-19 and tailored for use in low- and middle-income country (LMIC) settings. It was designed using principles of frugal innovation to be oxygen efficient, compatible with a range of oxygen sources, simple to use and sustainable to maintain. 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. Methods: This is a retrospective 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, Kampala, Uganda. Treatment was escalated as per standard local protocols for respiratory failure, and CPAP was the ceiling of care. Data were collected on patient demographics, length of time of treatment, clinical outcome, and any adverse events. Results: Overall 43 COVID-19 positive patients were included in the study. The majority (83.7%) received CPAP only, 4.7% received HFNO only, and 11.6% received a combination of HFNO/CPAP. In terms of demographics, 58% were female and the median age was 58 years (range 28-91 years). The median duration of advanced respiratory support was 7 days (range 1-18 days). Of all patients escalated to HFNO/CPAP, 65.1% were initially commended on the LeVe device. Overall (all device) mortality was 49% and this was similar between those started on LeVe and non-LeVe devices (50% vs 47%). Conclusions: The LeVe device was the most used CPAP device during the pandemic, bringing the hospital’s number of available HFNO/CPAP devices from two to 14. They were a critical resource for providing respiratory support to the sickest group of patients when no alternative devices were available. The devices appear to be safe and well tolerated with no serious adverse events recorded. This study is unable to assess the efficacy of the LeVe CPAP device, therefore formal comparative studies are required to inform further use.