Evaluation of peak inspiratory pressure and respiratory rate during ventilation of an infant lung model with a self-inflating bag

Abstract

Objective: To evaluate the peak inspiratory pressure and ventilation rate achieved by physicians when using a neonatal self-inflating bag on a lung model. Methods: Fifteen physicians ventilated full term and preterm infant lung simulators while the outcomes were captured by a ventilation monitor.Results: Median peak pressures in cmH 2 O for full term and preterm lungs were 23 (interquartile range: 15-47) and 26 (interquartile range: 14-51), being less than 20 in 41.2 and 35.8% of the pressure curves analyzed, more than 40 in 29.7 and 33.6%, and between 27 and 33 cmH 2 O in 8.2 and 6.5% of the curves, respectively. Median ventilation rates were 45 (interquartile range: 36-57) and 48 (interquartile range: 39-55.5) cycles per minute, being more than 30 in 9.3 and 6.7% of pressure curves and more than 60 in 12 and 13.3% of pressure curves, for the full term and preterm lungs, respectively. The differences between these medians were not statistically significant.Conclusions: Ventilation rates achieved with the self-inflating bag were adequate in approximately 80% of pressure curves analyzed, but the physicians were unable to provide ventilation with minimal pressure variation, producing pressures that diverged from those defined by the neonatal resuscitation training course in 70% of the curves. This was irrespective of whether they were ventilating the lung model analogous to preterm or full term infant lungs.

Inflammation and lung maturation from stretch injury in preterm fetal sheep

“…The newborn infant is more susceptible to lung injury from mechanical ventilation at birth because the lung is transitioning from fluid to air filled (24). Although clinicians attempt to provide low tidal volumes in the delivery room, the tidal volumes delivered are not measured and are likely high (40,42). Clinicians using a T-piece respirator to ventilate preterm infants (Ͻ32 wk) provided tidal volume breaths between 0 and 31 ml/kg (42).…”

A metronome for pacing manual ventilation in a neonatal resuscitation simulation: Table 1

“…Several studies have demonstrated that colour assessment is not a reliable proxy for O 2 saturation12 and that experienced NRP providers are unable to accurately determine heart rate whether using auscultation or palpation techniques 13 14. There are no studies evaluating the potential effects of delivering an inadequate RR, but the evidence shows high operator-dependent variability and a propensity to deliver higher RR than recommended 9 15 16. Delivering a RR below 40 inflations/min was, during the STD, more frequent than reported.…”

Peak pressure and tidal volume are affected by how the neonatal self-inflating bag is handled

“…Achados semelhantes foram obtidos em dois estudos realizados por Rezende et al 25,26 , nos quais foi avaliado o desempenho de médicos neonatologistas experientes durante a ventilação pulmonar. Foram avaliados pico de pressão, frequência ventilatória 25,26 e volume corrente 26 gerados. Em ambos os estudos, os autores observaram alta variabilidade nos valores obtidos para pico de pressão 25,26 e volume corrente 26 .…”

“…Foram avaliados pico de pressão, frequência ventilatória 25,26 e volume corrente 26 gerados. Em ambos os estudos, os autores observaram alta variabilidade nos valores obtidos para pico de pressão 25,26 e volume corrente 26 . Observaram que, além de alta variabilidade, os valores gerados foram frequentemente superiores àqueles recomendados para a reanimação neonatal, com mediana (IQ25-75%) de 39,8 cmH 2 O (30,2-47,2) e 17,8 mL/kg (14,1-22,4) para pico de pressão e volume corrente, respectivamente.…”