Comparison of methods of bag and mask ventilation for neonatal resuscitation
Section snippets
Background
At the present time, the need for resuscitation is greater in the neonate than in any other age group. The Neonatal Resuscitation Program (NRP) was developed by the American Academy of Pediatrics and the American Heart Association and endorsed in 1987 and revised thereafter [1]. The course has been widely taught in the United States and has become the standard of care in newborn resuscitation. Competency in the course material is demonstrated by successful completion of a written and
Methods
We utilized a neonatal manikin (Laerdal Armonk, NY) with a functional larynx and lungs, and placed the manikin on a flat table at the height of the resuscitation radiant warmers in our delivery areas. A clear cushioned mask (Owens-BriGam, Morganton, NC) was chosen to be the correct size for this manikin. Flow dependent anesthesia bags attached to wall-mounted flow meters identical to those utilized for neonatal resuscitation in our hospital were placed next to the manikin with the
Results
We evaluated five pediatric residents, five nurses, four neonatologists, six neonatal fellows, two neonatal nurse practitioners and five neonatal respiratory therapists. There were no significant differences in the rate of ventilation between groups of operators and anesthesia bags, and these results will not be presented. The PIP was significantly different between operators using either anesthesia bag, P<0.001. Similar results were found for PEEP with a significant difference among the
Discussion
Our results have demonstrated that the bag and mask ventilation skills of a group of operators, as assessed on a neonatal manikin, vary by individuals and training. In our unit, the respiratory therapists attend all high-risk deliveries and have historically taken a principal role in providing the bag and mask ventilation in the delivery area. Their ability to produce more consistent peak pressures and PEEP reflects their continued exposure and experience, and familiarity with the devices.
Conclusion
We believe that further research needs to be performed to evaluate the use of CPAP and PEEP, and the use of prolonged inflations as part of the initial resuscitation of neonates, involving not only the use of these modalities, but evaluating the most optimal equipment to provide such support. Our experience suggests that the Neopuff, a unique neonatal resuscitator ventilator, facilitates the delivery of desired airway pressures while allowing the operators to use both hands to attempt obtain
Acknowledgements
The authors wish to thank all of our respiratory therapists, neonatologists and fellows, neonatal nurse practitioners and nurses who participated in this evaluation. We also thank Chris Hutchinson of Fischer and Paykel for providing the Neopuff for this evaluation.
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