NIHR Global Health Research Unit on Respiratory Health (RESPIRE)

Bubble CPAP for treatment of COVID-19

This project is based at icddr,b in Bangladesh


  • Project title:  Optimising the treatment of Bangladeshi adult patients with severe pneumonia and/or acute respiratory distress syndrome (ARDS) using adaptive version of locally made bubble continuous positive airways pressure (CPAP): Feasibility Study
  • Based at:  icddr,b
  • Start date: September 2021
  • End date: November 2021
  • Principal investigator:  Mohammod Jobayer Chisti
  • Project team:  Ahmed Ehsanur Rahman, Tahmeed Ahmed, Shams El Arifeen, John D Clemens, Abu Sadat Mohammad Sayeem Bin Shahid, Abu Sayem Mirza Md. Hasibur Rahman, Anisuddin Ahmed, Goutom Banik, Monira Sarmin, Farzana Afroze, Lubaba Shahrin, Md. Fakhar Uddin, Md. Robed Amin, Md. Khairul Islam, Taufiq Hasan, Harish Nair, Steve Cunningham


Around 19% of diagnosed COVID-19 patients develop hypoxaemia, which requires early identification and immediate oxygen therapy. It is the most common pathway towards developing severe symptoms, which may subsequently lead to death. A significant proportion of the critical cases require mechanical ventilation and intensive care unit support, which is expensive and difficult to ensure at scale in a resource-poor setting such as Bangladesh.

Supporting breathing by high-pressure mask (continuous positive airways pressure, or CPAP) is a potentially life-saving treatment for COVID-19. Low and middle income countries urgently need low-cost adaptive technologies to provide CPAP.

A locally made low-cost bubble CPAP device has been shown to reduce mortality in children with hypoxaemia related to severe pneumonia. Adapting this technology, if safe and scaled up, could potentially reduce the need for mechanical ventilation and subsequently avert deaths among adult COVID-19 patients.

Aim and impact

This project will test a locally-made bubble CPAP in adults with COVID-19, evaluating the barriers, operational challenges, usability and acceptability of this adapted version of bubble CPAP in hospitals in Bangladesh.

The results of this project will determine the feasibility of implementing this approach and support development of a randomised clinical trial. This will generate critical evidence for improving the case management of COVID-19 patients with severe pneumonia and hypoxaemia, to safely reduce the need for intensive care and the number of deaths.

If safe and effective, this intervention could be transferrable to other low and middle income countries, helping to reduce global mortality from COVID-19.

Key developments

  • Staff training has been completed
  • Recruitment is ongoing and patients have been successfully enrolled
  • Data collection is in progress