A therapy known as Bubble CPAP (continuous positive airway pressure) is a simple and affordable way to deliver effective respiratory treatment for children who suffer from life threatening respiratory illnesses, but when the nasal interface responsible for delivering life-sustaining oxygen therapy does
not fit, the therapy is compromised. Without an effective nasal seal, children with severe pneumonia are not getting the pressurized gas delivery they need, leading to longer hospitalizations, wasted resources and increased mortality from pneumonia. AdaptAir is the missing link in delivering effective care to dying children in the developing world.

Surprising to many outside of the global public health sphere, pneumonia is the leading killer of children under 5 years old. At over 2 million deaths per year, pneumonia is responsible for greater annual childhood mortality than diarrheal diseases (1.7 million) and, furthermore, exceeds the combined mortality from malaria (800,000), measles (400,000), and AIDS (300,000). Pneumonia has the potential to be a fatal illness because, in severe forms, accumulation of fluid in the lungs compromises a child’s ability to breathe. The delivery of continuously pressurized oxygen is crucial for survival of children with severe pneumonia in order to keep their lungs open.

A therapy known as Bubble CPAP (continuous positive airway pressure) is a simple and affordable way to deliver effective respiratory treatment for children. A fundamental feature of effective Bubble CPAP is that the nasal interface that delivers pressurized oxygen to the baby fits well and does not allow oxygen to escape. Unfortunately, there are currently limited options in the developing world for an effective nasal interface as the customized options available in industrialized nations are prohibitively expensive. Physicians, nurses and respiratory therapists in the developing world say that a poor seal is often their greatest challenge when trying to administer Bubble CPAP. Without an effective nasal seal, children with severe pneumonia are not getting the pressurized gas delivery they need, leading to longer hospitalizations, wasted resources and increased mortality from pneumonia.

AdaptAir is the missing link in effective respiratory care for dying children in the developing world. Based on the simple concept of a one-size-fits-all adapter, AdaptAir is designed on one end to fit the generic nasal prongs currently used to deliver pressurized oxygen in resource-constrained hospitals. On the other end, tapered cones are designed to fit a variety of children’s nostrils and create a strong seal. Resource constrained hospitals can continue to use the current materials employed to administer Bubble CPAP therapy with this simple and inexpensive add-on to provide an effective seal. AdaptAir is furthermore made from soft, gentle, pliable silicone allowing it to fit comfortably and safely. Resource-limited settings also reuse the majority of medical devices and products so AdaptAir has been designed for easy cleaning and sterilization.

AdaptAir was conceived and developed in the Stanford University course “Entrepreneurial Design for Extreme Affordability” in the Winter and Spring quarters of 2011. In this course, the team was partnered with ICDDR,B, a research hospital in Dhaka, Bangladesh, and tasked with developing improvements to their Bubble CPAP system. Members of the team traveled to Bangladesh in March 2011 to do needfinding with patients, parents and providers, both in urban and rural settings. The team noted that the lack of a proper seal between the device and nose caused air leakage in infant patients, which meant the Bubble CPAP device wasn’t working efficiently and the children weren’t getting relief. Several infants were using Bubble CPAP devices, with varying levels of success. The tape on one patient’s face was starting to come loose, so one of the Doctors used his fingers to close the seal. Immediately, the bubbling of the device became constant, and the baby started breathing more easily.

Three months were then spent at Stanford developing solutions and prototypes. Initial testing was performed with sophisticated pediatric simulation tools and the advisement of pediatric nursing staff at Stanford/Packard Children’s Hospital Center for Advanced Pediatric and Perinatal Education (CAPE). These tests demonstrated that the AdaptAir interface improves the nasal seal to maintain continuous pressure for therapeutic Bubble CPAP.

The AdaptAir team continued product development after the course ended to develop refined prototypes and return to Bangladesh. ICDDR,B, an innovative and influential medical center in the developing world that treats many children with severe pneumonia, has continued to be a partner in this project.

AdaptAir is reducing the amount of time infants are in the Intensive Care Unit which not only reduces the cost to the hospital but also helps to recover the health of the infants faster. The cost of the product is very low as it can be mass produced with injection molded machinery. As it is made out of silicone it can be sterilized easily in an autoclave and not loose the materials properties. Being a one size fits all solution and easy to use helps reaching further hospitals.

Constantly talking to the doctors and seeing the positive results. We also talked to the parents of the babies using the masks and we have found that they don’t find any threat. The amount of time the babies have been in the Intensive Care Unit has reduced almost by half.

More prototypes will be made and the device tested with healthcare providers in Bangladesh and elsewhere in order to refine the product for manufacturability and prepare for clinical trial. In addition, a business model is being developed to ensure that if it continues to show potential, that the product can be made and distributed to the low-resource settings where it can make a significant impact on the effectiveness of treatment of children severe pneumonia.