Equipment and Operator Training Denote Manual Ventilation Performance in Neonatal Resuscitation

Abstract

High peak inspiratory pressure (PIP) and tidal volume (V(T)) from manual ventilation are hazardous to the neonatal lung. We investigated the influence of operator training on the extent of applied PIP and V(T) between two manual ventilation devices. We performed a prospective, crossover study of 84 medical professionals using a neonatal mannequin. Participants were classified into four groups, according to experience in neonatal resuscitation and previous training in manual ventilation. Provision of PIP, V(T), and inspiratory time (Ti) were compared between groups and equipment used, either a self-inflating bag (SI-bag) or a T-piece resuscitator (Neopuff). Using SI-bags, operator training significantly affected provision of PIP ( P < 0.001), V(T) ( P < 0.001), and Ti ( P = 0.048). Using a T-piece device, PIP and V(T) provision was independent of operator training ( P = 0.55 and P = 0.66, respectively). Twenty-five participants (30%) had previous experience with T-piece devices; this correlated significantly with lower PIP and lower V(T) provision ( P > 0.001 for PIP and V(T)). Operator training level and device-specific experience had a significant impact on PIP and V(T) provision when using SI-bags for manual ventilation. For operators with no specific training in manual ventilation, use of T-piece devices is advised to control for excessive PIP and V(T) application.

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

“…mostraron que, tanto la capacitación del operador como la experiencia específica con el dispositivo, tenían un impacto significativo en la provisión de mayor PIM y volumen corriente si usaban la BAI; esta diferencia no se verificó cuando usaban el dispositivo con pieza en T. Los mismos autores hallaron una gran variación interoperador para todos los niveles de capacitación cuando se usaba la bolsa autoinflable. 17 En cambio, en nuestro estudio no se halló diferencia alguna entre el grupo de expertos y el de principiantes, ni entre las maniobras repetidas por el mismo operador, lo que remarca la simplicidad en la operación de estos dispositivos. Esta disparidad con estudios anteriores podría atribuirse a la familiaridad de cada operador con las BAI utilizadas en este estudio.…”

Ventilation-Induced Brain Injury in Preterm Neonates: A Review of Potential Therapies

“…Unlike for the neonatal intensive care unit (NICU), there is a lack of guidelines and protocols to inform the initiation of ventilation in the delivery room and often an absence of sophisticated devices [4,5]. As a consequence, more than 85% of preterm infants who receive assisted ventilation in the delivery room are given dangerously high tidal volumes (V T ) [6], with potential detrimental effects on the lungs [7,8] and brain [9,10].…”

Quality Improvement Project: Implementing Guidelines Supporting Noninvasive Respiratory Management for Premature Infants

“…When initial respiratory assistance is required, a pressure-limited device such as a T-piece resuscitator is preferred because it is able to provide the most consistent peak inspiratory pressure (PIP) and positive end-expiratory pressure (PEEP) and thus has the best potential to accurately deliver the desired tidal volume and prevent baro-and volume trauma. [14][15][16][17][18][19] Although initial MV may be obligatory for establishing ventilation and the oxygenation of extremely preterm lungs, it has negative consequences. 13,20 Numerous attempts for endotracheal intubation may also damage the vocal cord.…”

“…[14][15][16][17][18][19] Although initial MV may be obligatory for establishing ventilation and the oxygenation of extremely preterm lungs, it has negative consequences. 13,20 Numerous attempts for endotracheal intubation may also damage the vocal cord. 13 During the last few decades, the neonatal society has attempted to identify better techniques for the respiratory management of preterm infants.…”