BREATHE: Building Respiratory support in East Africa Through High flow versus low flow oxygen Evaluation

With this funding, we hope to achieve a decrease in mortality for the 20 million critically ill adults in sub-Saharan Africa with acute hypoxemic respiratory failure. In the setting of COVID-19, governmental and nongovernmental organizations are working toward improving oxygen availability through large PSA plants and bedside oxygen concentrators. While sources of oxygen are increasing, what remains unknown is the impact of using different delivery systems for oxygen, which include low flow nasal cannula and facemasks, HFNC, CPAP, and invasive ventilation. Low flow systems are limited in the degree of oxygen support they can provide and are therefore only appropriate for mildly hypoxemic patients; non-invasive CPAP carries a significant aspiration risk for patients with altered mental status and requires close monitoring by trained staff; mechanical ventilation requires even more significant infrastructure, consumables, and human resources to operate safely. In HICs, HFNC has been shown to reduce the need for mechanical ventilation, and in some cases reduce mortality. In LICs, where safe mechanical ventilation is largely unavailable, we predict a robust mortality reduction. This funding will yield definitive evidence for HFNC's impact on mortality, and develop the resources to widely disseminate that evidence, including comprehensive strategies for implementation and scaling.