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

Abstract

Objective: To evaluate how different ways of handling the neonatal self-inflating bag influence peak pressure and tidal volume.Methods: This is an experimental study involving 141 different professionals (physicians, resident physicians, physiotherapists, nurses, and nursing technicians), who ventilated an artificial lung, adjusted to simulate the lung of a term neonate, using a self-inflating bag. Each professional handled the ventilator in five different ways: a) using both hands (10 fingers); and, with only one hand, b) five fingers, c) four fingers, d) three fingers, and e) two fingers. Peak pressure and tidal volume data were recorded by the artificial lung equipment.Results: Both variables showed high variability, from 2.5 to 106.3 cmH 2 O (mean = 39.73 cmH 2 O; 95%CI 37.32-42.13) for peak pressure, and from to 4 to 88 mL (mean = 39.56 mL; 95%CI 36.86-42.25) for tidal volume. There was no significant influence of the profession on any of the variables (p > 0.05). However, bag handling significantly influenced both peak pressure and tidal volume (p < 0.0001), which were higher when the operator used both hands. Conclusion:The results indicate that most professionals delivered excessively high peak pressures and tidal volumes, which could increase the risk of barotrauma and volutrauma, especially when both hands were used to ventilate. On the other hand, a small number of professionals delivered insufficient pressure and volume for adequate lung expansion and ventilation. The delivery of inadequate ventilation was not dependent on profession. J Pediatr (Rio J). 2009;85(3):217-222:Neonatal resuscitation, manual lung ventilation, self-inflating bags, barotrauma. ResumoObjetivo: Avaliar a influência do manuseio do ventilador pulmonar manual neonatal com bolsa autoinflável sobre pico de pressão e volume corrente.Métodos: Estudo experimental com 141 profissionais de saúde (médicos, médicos residentes, fisioterapeutas, enfermeiros e técnicos de enfermagem) que ventilaram um pulmão artificial ajustado para reproduzir o pulmão de um recém-nascido a termo, utilizando ventilador pulmonar manual autoinflável com cinco diferentes modos de manuseio: com as duas mãos (10 dedos) e com uma mão, utilizando cinco, quatro, três e dois dedos. Valores de pico de pressão e volume corrente foram registrados pelo pulmão artificial.Resultados: Observou-se alta variabilidade nos valores das variáveis estudadas. A média do pico de pressão foi 39,73 cmH 2 O (IC95% 37,32-42,13), variando de 2,5 a 106,3 cmH 2 O, e do volume foi 39,56 mL (IC95% 36,86-42,25), variando de 4 a 88 mL. Não foi detectada influência significativa da profissão sobre as variáveis estudadas (p > 0,05). Observou-se que o modo de manuseio do ventilador pulmonar manual influenciou significativamente o pico de pressão e o volume corrente (p < 0,0001), que foram maiores quando o ventilador foi manuseado com as duas mãos. Conclusão:A maioria dos profissionais gerou pico de pressão e volume corrente muito elevados, principalmente quando foram empregadas as duas mã...

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

“…However, most of these studies were directed to adult patients, 4,[6][7][8][9] and only a few of them addressed this aspect in newborns. 11,24 Ganga-Zandzou et al 24 and Bassani et al 11 demonstrated that delivered peak pressures are higher when more fingers are used to compress the bag. Bassani et al 11 observed that this relationship also occurs for V T , as shown in earlier studies that compared the use of 1 or 2 hands to simulate ventilation in adults.…”

“…11,24 Ganga-Zandzou et al 24 and Bassani et al 11 demonstrated that delivered peak pressures are higher when more fingers are used to compress the bag. Bassani et al 11 observed that this relationship also occurs for V T , as shown in earlier studies that compared the use of 1 or 2 hands to simulate ventilation in adults. 4,[6][7][8][9] These observations are confirmed in the present study with a larger volunteer sample.…”

“…The trial setup was based on the method reported by Bassani et al 11 In summary, all volunteers ventilated manually the test lung with all of the 5 different handling techniques, using 10 fingers (both hands), or only the dominant hand with either 5, 4, 3, or 2 fingers to compress the bag. A 1 min interval was allowed between each test condition.…”

“…2 There is evidence that the ventilatory parameters delivered with this device may be influenced by several factors such as circuit con-figuration and brand, 4,5 the use of 1 or 2 hands to ventilate, 4,6-11 and operator's hand size, 4,7,12 profession, 6,13 and experience. 14 This may cause high variability of the absolute values of these parameters, 11,[15][16][17][18] causing delivery of either excessive or insufficient values. In the former case the risk for pulmonary injury (barotrauma and volutrauma) is increased, and in the latter there is a higher risk for hypoventilation.…”

“…In the former case the risk for pulmonary injury (barotrauma and volutrauma) is increased, and in the latter there is a higher risk for hypoventilation. 11 Both situations are potentially harmful to the newborn and might lead to a worse prognosis, longer hospital stay, and development of chronic lung disease.…”