Ventilación del recién nacido: comparación entre un reanimador con pieza en t y bolsas autoinflables en un simulador de neonato prematuro

Szyld, Edgardo; Aguilar, Adriana; Musante, Gabriel; Vain, Néstor E.; Guerrero, Miriam N; Serra, M. Elina; Prudent, Luis; Carlo, Waldemar A.

doi:10.5546/aap.2012.106

Cited by 7 publications

(4 citation statements)

References 18 publications

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“…Mean PIP of a SIB and AB was higher than the expected PIP. This pattern is also observed in other studies [13,14]. The PEEP was delivered reliably only using the T-piece resuscitator.…”

Section: Discussionsupporting

confidence: 87%

“…Finer et al compared different groups based on level of training for the three devices and detected a difference among groups for the various devices [8]. Other studies do not detect a difference among the groups for any of the devices [6,7,13]. In the present study, no correlation was found between qualification of the operator and pressures achieved except PEEP while providing manual positive pressure ventilation, but breath-rate per minute and effective breath-rate varied with qualification.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of efficacy of three devices of manual positive pressure ventilation: a mannequin-based study

Nimbalkar

Nesargi

et al. 2015

Ital J Pediatr

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BackgroundWe compared the efficacy of and consistency in manual ventilation by trained healthcare professionals using three devices: self-inflating bag, flow-inflating bag, and T-piece resuscitator.MethodsProspective analytical study at a level III Neonatal unit of a tertiary care hospital. Forty participants (consultants, postgraduates, interns, and neonatal nurses – 10 each) manually ventilated a mannequin with the above three devices for three minutes each. This procedure was video recorded. The pressure delivered during the three minutes and the breath rates for the first minute, second minute, and third minute were analyzed. Descriptive statistics were used to describe the study population and group statistics were used for various parameters of interest. Factorial analysis of variance was conducted to determine the main effects of device and specialty of users.ResultsThe mean (SD) peak inspiratory pressure of T-piece resuscitator was 16.5 (1.2), self-inflating bag (SIB) was 20.7 (4.4), and flow-inflating bag (AB) was 21.2 (5.0). The mean (SD) positive end expiratory pressure of T-piece resuscitator was 4.7 (0.9) cm of H2O and AB was 1.8 (1.7) cm of H2O. The maximum pressure delivered by T-piece resuscitator was 17.5, AB was 26.2, and SIB was 25.2 cm of H2O. Clinically appropriate breath rates were delivered using all of the devices. More effective breath rates were delivered using T-piece. There was no significant difference among the professional groups.ConclusionsThe T-piece resuscitator provides the most consistent pressures and is most effective. Level of training has no influence on pressures delivered during manual ventilation.

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“…Mean PIP of a SIB and AB was higher than the expected PIP. This pattern is also observed in other studies [13,14]. The PEEP was delivered reliably only using the T-piece resuscitator.…”

Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Comparison of efficacy of three devices of manual positive pressure ventilation: a mannequin-based study

Nimbalkar

Nesargi

et al. 2015

Ital J Pediatr

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“…Due to the design of the various devices and depending on the user's experience, differences in the accuracy of applied parameters (airway pressure, PEEP, tidal volume, inspiratory time) are expected [11,12,13,14]. In a previously published experiment we did not find significant effects of 3 different devices for respiratory support during CPR on the return of spontaneous circulation [7].…”

Section: Discussionmentioning

confidence: 90%

Tidal Volume Delivery and Endotracheal Tube Leak during Cardiopulmonary Resuscitation in Intubated Newborn Piglets with Hypoxic Cardiac Arrest Exposed to Different Modes of Ventilatory Support

Mendler

Weber²,

Hassan³

et al. 2016

Neonatology

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Background: There are few data available on the interaction of inflations, chest compressions (CC), and delivery of tidal volumes in newborn infants undergoing resuscitation in the presence of endotracheal tube (ET) leaks. Objectives: To determine the effects of different respiratory support strategies along with CC on changes in tidal volume and ET leaks in hypoxic newborn piglets with cardiac arrest. Methods: Asphyxiated newborn piglets, intubated with weight-adapted uncuffed ET, were randomized into three groups and resuscitated according to ILCOR 2010 guidelines: (1) T-piece resuscitator (TPR) group = peak inspiratory pressure (PIP)/positive end-expiratory pressure (PEEP) 25/5 cm H₂O, rate 30/min, inflations interposed between CC (3:1 ratio); (2) self- inflating bag (SIB) group = PIP 25 cm H₂O without PEEP, rate 30/min, inflations interposed between CC (3:1 ratio), and (3) ventilator group = PIP/PEEP of 25/5 cm H₂O, rate 30/min. CC were applied with a rate of 120/min without synchrony to inflations. Results: We observed a significant increase of leak (average increase 11.4%) when CC was added to respiratory support (p = 0.0001). Expired tidal volume was larger in the SIB group than in the two other modes which both applied PEEP. However, tidal volumes caused by CC only were larger in the two groups with PEEP than in the SIB group (without PEEP). Conclusions: There is interaction between lung inflations and CC affecting leak and delivery of tidal volume, which may be influenced by the mode/device used for respiratory support. Leak is larger in the presence of PEEP. However, CC cause additional tidal volume which is larger in the presence of PEEP.

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“…However, due to the design of the devices, differences in the accuracy of applied airway pressure, tidal volume, inspiratory time and PEEP are likely. The achieved ventilation depends on the user's experience [10], but it seems to be more consistent when pressure-controlled devices such as a T-piece device rather than an SIB are used, although the clinical implications are not clear [11]. Maneuvers such as sustained inflations, which may facilitate lung aeration, are also easier to perform with a mechanical ventilator or T-piece than with an SIB [12].…”

Section: Discussionmentioning

confidence: 99%

Different Techniques of Respiratory Support Do Not Significantly Affect Gas Exchange during Cardiopulmonary Resuscitation in a Newborn Piglet Model

Mendler¹,

Maurer²,

Hassan

et al. 2015

Neonatology

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Background: There are no evidence-based recommendations on the use of different techniques of respiratory support and chest compressions (CC) during neonatal cardiopulmonary resuscitation (CPR). Objectives: We studied the short-term effects of different ventilatory support strategies along with CC representing clinical practice on gas exchange [arterial oxygen saturation (SaO₂), arterial partial pressure of oxygen (PaO₂) and arterial partial pressure of carbon dioxide (PaCO₂)], hemodynamics and cerebral oxygenation. We hypothesized that in newborn piglets with cardiac arrest, use of a T-piece resuscitator (TPR) providing positive end-expiratory pressure (PEEP) improves gas exchange as measured by SaO₂ during CPR as compared to using a self-inflating bag (SIB) without PEEP. Furthermore, we explored the effects of a mechanical ventilator without synchrony to CC. Methods: Thirty newborn piglets with asystole were randomized into three groups and resuscitated for 20 min [fraction of inspired oxygen (FiO₂) = 0.21 for 10 min and 1.0 thereafter]. Group 1 received ventilation using a TPR [peak inspiratory pressure (PIP)/PEEP of 20/5 cm H₂O, rate 30/min] with inflations interposed between CC (3:1 ratio). Group 2 received ventilation using a SIB (PIP of 20 cm H₂O without PEEP, rate 30/min) with inflations interposed between CC (3:1 ratio). Group 3 received ventilation using a mechanical ventilator (PIP/PEEP of 20/5 cm H₂O, rate 30/min). CC were applied with a rate of 120/min without synchrony to inflations. Results: We found no significant differences in SaO₂ between the three groups. However, there was a trend toward a higher SaO₂ [TPR: 28.0% (22.3-40.0); SIB: 23.7% (13.4-52.3); ventilator: 44.1% (39.2-54.3); median (interquartile range)] and a lower PaCO₂ [TPR: 95.6 mm Hg (82.1-113.6); SIB: 100.8 mm Hg (83.0-108.0); ventilator: 74.1 mm Hg (68.5-83.1); median (interquartile range)] in the mechanical ventilator group. Conclusions: We found no significant effect on gas exchange using different respiratory support strategies during CPR.

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Ventilación del recién nacido: comparación entre un reanimador con pieza en t y bolsas autoinflables en un simulador de neonato prematuro

Cited by 7 publications

References 18 publications

Comparison of efficacy of three devices of manual positive pressure ventilation: a mannequin-based study

Comparison of efficacy of three devices of manual positive pressure ventilation: a mannequin-based study

Tidal Volume Delivery and Endotracheal Tube Leak during Cardiopulmonary Resuscitation in Intubated Newborn Piglets with Hypoxic Cardiac Arrest Exposed to Different Modes of Ventilatory Support

Different Techniques of Respiratory Support Do Not Significantly Affect Gas Exchange during Cardiopulmonary Resuscitation in a Newborn Piglet Model

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