In an attempt to make breathing devices available to low-income and isolated areas, scientists have developed the LeVe CPAP System for respiratory support to treat COVID patients with tests showing promising results.
LeVe CAP System. Image Credit: University of Leeds
Making respiratory support more available to support COVID patients
The surge of COVID-19 infections in low- and middle-income countries requires alternative strategies to those implemented in wealthier nations.
In response, the World Health Organisation is encouraging the development of low-cost breathing aids easily deployable in poorer-resourced healthcare systems. For that to be possible, the devices must operate with low-pressure oxygen systems.
Contrasting to richer nations, clinical facilities in poorer settings may not have a centralized oxygen supply, which provides a steady supply of oxygen cylinders, and is a critical tool in the treatment of COVID infection.
In a new study published in the journal Frontiers in Medical Technology, a team of researchers has designed the continuous positive airway pressure, or CPAP, device, to provide respiratory support for mild and severe cases of COVID.
The device was developed by a team of scientists, engineers, and doctors based at the University of Leeds, Leeds Teaching Hospitals NHS Trust, Bradford Teaching Hospitals NHS Foundation Trust, Medical Aid International, and the Mengo Hospital in Uganda.
The device was tested ten healthy volunteers and has shown that it “can be used safely without inducing hypoxia (low levels of oxygen in tissues) or hypercapnia (build-up of carbon dioxide in the bloodstream) and that its use was well tolerated by users, with no adverse events reported”.
To ensure the device remains simple as well as effective, the team used principles of frugal innovation in the design of this breathing aid. Meeting clinical demands in a health setting with limited access to resources was a focal point in the development of this CPAP system.
A particular innovation to generate the required airflow is the use of an electric fan, akin to the fans used to cool electronic devices, to overcome the lack of access to high-pressure air and oxygen supplies. This provides a constant air supply for patients under mild or severe cases of infection.
Offering greater access to critical clinical care technology
The supervising academic on the project, Nikil Kapur, Professor of Applied Fluid Dynamics at the University of Leeds describes: “By adopting the approach of frugal innovation, we have been able to redesign an important piece of medical equipment so it can function effectively in poorer resourced healthcare settings.
We have stripped away unnecessary complexity and ensured the device will work in settings where oxygen supplies are scarce and need to be conserved. The prototype is an important step in developing a device that will create greater access to critical care technology and help save lives.”
Despite conventional CPAP machines costing around GBP 600 and ventilators costing over GBP 30,000, the current prototype device costs in total around GBP 150 (equivalent to USD 207).
Dr. Tom Lawton, Consultant in Critical Care and Anaesthesia at Bradford Teaching Hospitals NHS Foundation Trust and a member of the research team, states: “In the UK, CPAP has been effective as the mainstay of respiratory treatment for severe COVID-19 and helps to keep patients from needing advanced ICU care such as ventilators.
“In many countries, resource limitations mean that even CPAP is difficult to come by and more severe disease frequently leads to death. Simple CPAP devices, designed to operate in a resource-limited setting, can help reduce global healthcare inequality and save lives both now with covid-19 and potentially with other diseases in the future.”
Dr. Pete Culmer, Associate Professor in the School of Mechanical Engineering at Leeds and the study’s lead author, said: “The Leeds prototype has been specifically made to work with oxygen concentrators, which have a low ow of oxygen and at low pressure.
“The fan or CPAP blower is connected to what is known as a breathing circuit. That circuit is made up of alter to catch viruses and bacteria in the air ow, tubing, face mask, a valve which controls the ow of oxygen from the oxygen concentrator, and an expiration outlet.”
The device can generate four different levels of air pressure dependent on the patient’s need. The findings also describe that desirable oxygen saturation levels in the blood – between 96 percent and 100 percent – were maintained in the healthy volunteers taking part in the trial.
Upcoming patient trials and future developments
Further trials are planned to be conducted begin at the Mengo Hospital in Kampala, Uganda, in September, with patients infected by COVID.
It is only the regional referral and the national referral hospitals that have access to CPAP. Yet patients first present to the lower-level facilities when they have breathing difficulties and by the time they arrive at the regional referral centers, in some cases, it is too late. The ability to hook a patient onto ventilation when they need it potentially saves many lives and reduces the hospital stay."
Dr. Edith Namulema
She then adds, “Also, as a country, we have about 500 ICU beds for 42 million Ugandans which is very few.”
The prototype developed in the current study will provide a widely deployable device that aims to address the challenge of limited access to breathing support. By using cost-effective components that are adaptable to a range of settings, respiratory devices may be more accessible to low-income and isolated areas.
Professor David Brettle, Chief Scientific Officer at the Leeds Teaching Hospitals NHS Trust and a member of the team that developed the device, describes: “The innovation at the heart of this device is the simplicity of its design, the low production cost and how it efficiently makes use of scarce oxygen supplies.
In the UK access to the necessary health technology can be taken for granted, but even relatively simple technology is sometimes not available in low-and middle-income countries. This innovative device aims to level the playing field.”