{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T13:08:51Z","timestamp":1789132131664,"version":"build-2803163510"},"reference-count":47,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Respiratory Care"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Almost 2.5 million neonatal deaths occur annually, disproportionately affecting low- and middle-income countries. Respiratory support devices remain largely inaccessible in these regions because of prohibitive costs and infrastructure requirements. The WHO-style bubble CPAP provides accessible continuous positive pressure but cannot deliver bi-level support when CPAP alone is insufficient. We hypothesized that a low-cost bubble noninvasive ventilatory (Bubble-NIV) system, meant to augment the WHO-style bubble CPAP, would perform non-inferiorly to the ventilator-driven RAM-NIV in delivering positive pressure across variable nasal interface conditions in bench testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We developed a low-cost Bubble-NIV system (\u223c$50) with a servo motor-driven lever to drive bi-level pressures via variable distal tubing water submersion depths. Performance was compared with ventilator-driven RAM-NIV in a static in\u2009vitro model across 3 nasal cannula fits (80%, 70%, 60% nostril occlusion). Primary outcome was mean airway pressure measured in the nasopharynx.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Bubble-NIV maintained bi-level pressures and delivered pressures closer to target (mean airway pressure, mean goal: 15\u2009cm H\n                      <jats:sub>2<\/jats:sub>\n                      O) than ventilator-driven RAM-NIV across all nasal interface scenarios: 15.1 versus 13.4\u2009cm H\n                      <jats:sub>2<\/jats:sub>\n                      O at 80% occlusion (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001), 12.6 versus 7.4\u2009cm H\n                      <jats:sub>2<\/jats:sub>\n                      O at 70% occlusion (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001), and 5.6 versus 1.8\u2009cm H\n                      <jats:sub>2<\/jats:sub>\n                      O at 60% occlusion (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001). The performance advantage increased with worsening leak (1.1-fold to 3.1-fold). Optimal Bubble-NIV pressures occurred with flows set within 2\u2009L\/min of minimal bubbling. Oscillatory waveforms of Bubble-NIV were greater than RAM-NIV.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>A low cost Bubble-NIV system demonstrated superior nasal leak tolerance compared with ventilator-driven RAM-NIV in bench testing. The low-cost, nonproprietary design addresses accessibility barriers to delivering bi-level noninvasive respiratory support for neonates in resource-limited settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19433654261472943","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:32:24Z","timestamp":1787067144000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["In Vitro Comparison of a Low-Cost Bubble-NIV and Ventilator-Driven NIV"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5654-0725","authenticated-orcid":false,"given":"Josephine U.","family":"Pierce Pucci","sequence":"first","affiliation":[{"name":"Drs. Pierce Pucci and Naun are affiliated with Department of Pediatrics, Tripler Army Medical Center, Honolulu, Hawaii, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley T.","family":"Pierce","sequence":"additional","affiliation":[{"name":"Dr. Pierce is affiliated with Department of Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa M.","family":"Pierce","sequence":"additional","affiliation":[{"name":"Dr. Pierce is affiliated with Department of Clinical Investigation, Tripler Army Medical Center, Honolulu, Hawaii, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5789-6878","authenticated-orcid":false,"given":"Nicholas L.","family":"Shriver","sequence":"additional","affiliation":[{"name":"Mr. Shriver and Ms. Grete are affiliated with Department of Chemistry and Life Science, United States Military Academy, West Point, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicyn F.","family":"Grete","sequence":"additional","affiliation":[{"name":"Mr. Shriver and Ms. Grete are affiliated with Department of Chemistry and Life Science, United States Military Academy, West Point, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex M.","family":"Burgess","sequence":"additional","affiliation":[{"name":"Mr. Burgess is affiliated with School of Medicine, Stanford University, Stanford, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily S.","family":"Minner","sequence":"additional","affiliation":[{"name":"Ms. Minner is affiliated with School of Engineering Medicine, Texas A&amp;M University, Houston, Texas, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dante M.","family":"DiAngelis","sequence":"additional","affiliation":[{"name":"Mr. DiAngelis is affiliated with Department of Civil and Mechanical Engineering, United States Military Academy, West Point, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret A.","family":"Nowicki","sequence":"additional","affiliation":[{"name":"Dr. Nowicki is affiliated with Department of Mechanical and Aerospace Engineering, United States Military Academy, West Point, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Ayer","sequence":"additional","affiliation":[{"name":"Dr. Ayer is affiliated with Department of Pediatrics, Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason C.","family":"Barnhill","sequence":"additional","affiliation":[{"name":"Dr. Barnhill is affiliated with Department of Cell and Molecular Biology, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher A.","family":"Naun","sequence":"additional","affiliation":[{"name":"Drs. Pierce Pucci and Naun are affiliated with Department of Pediatrics, Tripler Army Medical Center, Honolulu, Hawaii, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"key":"e_1_3_3_2_1","unstructured":"1.World Health Organization. Newborn Mortality. WHO; 2024. 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Oxygen Therapy for Children: A Manual for Health Workers. WHO; 2016. 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