ORIGINAL RESEARCH article
Front. Pediatr.
Sec. Pediatric Critical Care
Feasibility of Use and Integration of a Novel Bubble CPAP System in a Public Referral PICU in Mysuru, India
Provisionally accepted
Molly K Rudman1*
Sarah Badin1,2
Savitha M Ramaraj3Shalini S Rangaswamy3
Paula K Rauschendorf1
Raj Prakash4Alix Boisson-Walsh5
Thomas F Burke1,2,6,7- 1Vayu Global Health Foundation, Medford, United States
- 2Massachusetts General Hospital Department of Emergency Medicine, Boston, United States
- 3Mysore Medical College and Research Institute, Mysuru, India
- 4King's College Hospital NHS Foundation Trust, London, United Kingdom
- 5Rutgers New Jersey Medical School, Newark, United States
- 6Harvard Medical School, Boston, United States
- 7Harvard T H Chan School of Public Health, Boston, United States
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Objective: The objective of this study was to evaluate the feasibility of use and integration of a novel bubble CPAP (bCPAP) system into the PICU of the Mysore Medical College and Research Institute, India. S Study Design: We conducted an explanatory sequential prospective mixed-methods study using questionnaire-based surveys, focus group discussions (FGDs), and patient records. Survey and FGD participants included nurses, pediatric postgraduates, and pediatricians who worked in the PICU and used the bCPAP system. The FGDs were transcribed, coded, and systematically analyzed for emergent themes using the COM-B framework. Results: From July 31, 2023, to July 24, 2024, 81 children were treated with the bCPAP system. The median age was 6.5 months (IQR: 3-11), the median weight was 6.5 kg (IQR: 4.9-7.8), and the median treatment duration was 24 hours (IQR: 18-38). Most (n=72, 89%) patients treated with the bCPAP system were discharged home. Forty-eight healthcare workers completed the survey, and 29 participated in the FGDs. Survey respondents rated the bCPAP system as more effective (67%) or much more effective (17%) than previous treatments for respiratory distress. They found the integration of the bCPAP system into the PICU feasible (63%) or very feasible (35%). FGD participants reported that the bCPAP system was easy to use, portable, and required minimal training. They also noted rapid patient improvement and a reduction in the number of patients requiring mechanical ventilation. Conclusion: The bCPAP system was integrated and adopted into the PICU of this public referral facility in Mysuru, India. Further research is needed in additional settings.
Keywords: Bubble CPAP, global health, non-invasive ventilation, pediatric intensive care unit, Respiratory distress
Received: 14 Aug 2025; Accepted: 11 Dec 2025.
Copyright: © 2025 Rudman, Badin, Ramaraj, Rangaswamy, Rauschendorf, Prakash, Boisson-Walsh and Burke. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Molly K Rudman
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