An Evaluation of Peak Inspiratory Pressure, Tidal Volume, and Ventilatory Frequency During Ventilation With a Neonatal Self-Inflating Bag Resuscitator

Bassani, Mariana Almada; Filho, Francisco Mezzacappa; Coppo, Maria Regina de Carvalho; Marba, Sérgio Tadeu Martins

doi:10.4187/respcare.01423

Cited by 6 publications

(8 citation statements)

References 22 publications

(28 reference statements)

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“…Our finding of increased variability in delivered volume using a pressure-limited SI at initiation of ventilation is consistent with recent reports of variable tidal volumes (0-30 mL) achieved with pressure-limited resuscitation of preterm infants [30-32]. Whereas these measured tidal volumes in preterm infants were confounded by the influence of facemask leak, our measurements were free of leak due to the use of tracheal tubes with inflated cuffs.…”

Section: Discussionsupporting

confidence: 90%

Pressure- versus volume-limited sustained inflations at resuscitation of premature newborn lambs

et al. 2014

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BackgroundSustained inflations (SI) are advocated for the rapid establishment of FRC after birth in preterm and term infants requiring resuscitation. However, the most appropriate way to deliver a SI is poorly understood. We investigated whether a volume-limited SI improved the establishment of FRC and ventilation homogeneity and reduced lung inflammation/injury compared to a pressure-limited SI.Methods131 d gestation lambs were resuscitated with either: i) pressure-limited SI (PressSI: 0-40 cmH2O over 5 s, maintained until 20 s); or ii) volume-limited SI (VolSI: 0-15 mL/kg over 5 s, maintained until 20 s). Following the SI, all lambs were ventilated using volume-controlled ventilation (7 mL/kg tidal volume) for 15 min. Lung mechanics, regional ventilation distribution (electrical impedance tomography), cerebral tissue oxygenation index (near infrared spectroscopy), arterial pressures and blood gas values were recorded regularly. Pressure-volume curves were performed in-situ post-mortem and early markers of lung injury were assessed.ResultsCompared to a pressure-limited SI, a volume-limited SI had increased pressure variability but reduced volume variability. Each SI strategy achieved similar end-inflation lung volumes and regional ventilation homogeneity. Volume-limited SI increased heart-rate and arterial pressure faster than pressure-limited SI lambs, but no differences were observed after 30 s. Volume-limited SI had increased arterial-alveolar oxygen difference due to higher FiO2 at 15 min (p = 0.01 and p = 0.02 respectively). No other inter-group differences in arterial or cerebral oxygenation, blood pressures or early markers of lung injury were evident.ConclusionWith the exception of inferior oxygenation, a sustained inflation targeting delivery to preterm lambs of 15 mL/kg volume by 5 s did not influence physiological variables or early markers of lung inflammation and injury at 15 min compared to a standard pressure-limited sustained inflation.

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Section: Discussionsupporting

confidence: 90%

Pressure- versus volume-limited sustained inflations at resuscitation of premature newborn lambs

et al. 2014

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“…Bassani et al 13 A study to determine whether an educational intervention would improve target tidal volume delivery under changing compliance conditions was conducted by Bowman et al 14 An ASL 5000 simulator (Ingmar Medical, Pittsburgh, Pennsylvania) was programmed to mimic a 3-kg infant with compliances randomly varying between low (0.5 mL/cm H 2 O), normal (1.1 mL/cm H 2 O), and high (1.8 mL/cm H 2 O). Twenty-seven neonatal professionals were asked to manually ventilate at a rate of 40 -60 while maintaining a V T of 12-18 mL (4 -6 mL/kg) using a flowinflating bag with a 10-L/min gas source and a 160-mL self-inflating bag.…”

Section: Manual Ventilation Is Neither Safe Nor Effectivementioning

confidence: 99%

“…32 Its use while manually ventilating during transport has also been shown to facilitate tighter control of ventilation 33 ; however, it does not protect against and, in the case of a high end-tidal CO 2 reading, may actually incite the practitioner to ventilate beyond safe thresholds. 13 As described previously, keeping one's eye glued to a monitor while in the midst of transporting a patient is simply unrealistic. Transport ventilators allow stringent control of ventilation parameters, and their advanced monitoring and alarm capabilities provide the only means of truly accomplishing the main goal of protecting the patient.…”

Section: Physiological Risks Associated With Manual Ventilationmentioning

confidence: 99%

Should a Portable Ventilator Be Used in All In-Hospital Transports?

Holets

Davies

2016

Respir Care

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Movement of the mechanically ventilated patient may be for a routine procedure or medical emergency. The risks of transport seem manageable, but the memory of a respiratory-related catastrophe still gives many practitioners pause. The risk/benefit ratio of transport must be assessed before movement. During transport of the ventilated patients, should we always use a transport ventilator? What is the risk of using manual ventilation? How are PEEP and F IO 2 altered? Is there an impact on the ability to trigger during manual ventilation? Is hyperventilation and hypoventilation a common problem? Does hyperventilation or hypoventilation result in complications? Are portable ventilators worth the cost? What about the function of portable ventilators? Can these devices faithfully reproduce ICU ventilator function? The following pro and con discussion will attempt to address many of these issues by reviewing the current evidence on transport ventilation.

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“…3 In this issue of RESPIRATORY CARE, Bassani and colleagues investigated caregiver performance and practice using a specific procedure with a self inflating device. 6 Since self inflating resuscitation bag resuscitators are the most commonly used device in many United States hospitals and globally, 7 this important study described the impact of performance variations, and differences in pressures, volumes, and frequencies, using a unique approach with this simple device. They measured the effects of applying 2-5 fingers (at each level) when squeezing the bag and delivering the breaths.…”

Section: See the Original Study On Page 525mentioning

confidence: 99%

Manual Ventilation During Resuscitation: Does Device Matter?

Deakins

2012

Respir Care

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An Evaluation of Peak Inspiratory Pressure, Tidal Volume, and Ventilatory Frequency During Ventilation With a Neonatal Self-Inflating Bag Resuscitator

Cited by 6 publications

References 22 publications

Pressure- versus volume-limited sustained inflations at resuscitation of premature newborn lambs

Pressure- versus volume-limited sustained inflations at resuscitation of premature newborn lambs

Should a Portable Ventilator Be Used in All In-Hospital Transports?

Manual Ventilation During Resuscitation: Does Device Matter?

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