Manual ventilation devices in neonatal resuscitation: Tidal volume and positive pressure-provision

ObjectiveA respiratory function monitor (RFM) may improve positive pressure ventilation (PPV) technique, but many providers do not use RFM data appropriately during delivery room resuscitation. We sought to use eye-tracking technology to identify RFM parameters that neonatal providers view most commonly during simulated PPV.DesignMixed methods study. Neonatal providers performed RFM-guided PPV on a neonatal manikin while wearing eye-tracking glasses to quantify visual attention on displayed RFM parameters (ie, exhaled tidal volume, flow, leak). Participants subsequently provided qualitative feedback on the eye-tracking glasses.SettingLevel 3 academic neonatal intensive care unit.ParticipantsTwenty neonatal resuscitation providers.Main outcome measuresVisual attention: overall gaze sample percentage; total gaze duration, visit count and average visit duration for each displayed RFM parameter. Qualitative feedback: willingness to wear eye-tracking glasses during clinical resuscitation.ResultsTwenty providers participated in this study. The mean gaze sample captured wa s 93% (SD 4%). Exhaled tidal volume waveform was the RFM parameter with the highest total gaze duration (median 23%, IQR 13–51%), highest visit count (median 5.17 per 10 s, IQR 2.82–6.16) and longest visit duration (median 0.48 s, IQR 0.38–0.81 s). All participants were willing to wear the glasses during clinical resuscitation.ConclusionWearable eye-tracking technology is feasible to identify gaze fixation on the RFM display and is well accepted by providers. Neonatal providers look at exhaled tidal volume more than any other RFM parameter. Future applications of eye-tracking technology include use during clinical resuscitation.

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Manual ventilation devices for neonatal resuscitation

Cochrane Database of Systematic Reviews ◽

10.1002/14651858.cd004949.pub2 ◽

2021 ◽

Author(s):

Colm PF O'Donnell ◽

Peter G Davis

Keyword(s):

Neonatal Resuscitation ◽

Manual Ventilation

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Abstract 170: Temperature Maintenance and Oxygen Use in Newborns at Birth: A Surveillance of Clinical Practice and Compliance with Neonatal Resuscitation Guidelines

Circulation ◽

10.1161/circ.130.suppl_2.170 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Georg M Schmölzer ◽

Roxanne Pinson ◽

Marion Molesky ◽

Heather Chinnery ◽

Karen Foss ◽

...

Keyword(s):

Body Temperature ◽

Knowledge Transfer ◽

Oxygen Saturation ◽

Neonatal Resuscitation ◽

Positive Pressure ◽

Respiratory Therapists ◽

Vaginal Deliveries ◽

Resuscitation Guidelines ◽

The Right ◽

Continuous Positive Pressure

Background: Guidelines of neonatal resuscitation are revised regularly. Gaps in knowledge transfer commonly occur when the guidelines are communicated to the clinical practitioners. Maintaining body temperature and supporting oxygenation are main goals that clinical practitioners aim to achieve in assisting newborns during the feto-neonatal transition at birth. Objectives: In this study, we aim to examine the compliance to guidelines in neonatal resuscitation regarding the temperature maintenance and oxygen use in newborns at birth. Methods: From October to November 2013, a prospective questionnaire surveillance was conducted in all attended deliveries at all four hospitals in Edmonton, Alberta, Canada. All clinical practitioners (registered nurses, physicians and respiratory therapists) were requested to complete the questionnaires immediately after the attended delivery regarding temperature maintenance and oxygenation monitoring. Descriptive statistics were used with mean±SD (range) and % presented. Results: During the 14-days study period, data was obtained in 518 of 712 (73%) attended deliveries of newborns with gestational age 38.6±2.0 (23-42) weeks and birth weight 3324±589 (348-6168) g. Of these deliveries, 58% were normal vaginal deliveries and 29% were cesarean sections. There were 8.8% and 8.4% newborns who required positive pressure ventilation and continuous positive pressure, respectively. Radiant warmer heat was used in 81% (419/518) with 63% (266/419) turned to full power. Room temperature was 21.6±1.6 (17-31)°C. Body temperature at 30-60 min after birth was 36.8±0.5 (32.4-38.1)°C with hypothermia (<36.5°C) in 17%. Percutaneous oxygen saturation was measured in 15% newborns and 96% had sensors placed at the right wrist. At the initiation of resuscitation, 21% oxygen was used in 76% and the oxygen concentration was adjusted according to an oxygen saturation chart in 17%. In 70% of the cases, clinical practitioners commented that this chart was not helpful. Conclusions: Gaps in knowledge transfer contribute to non-compliance in the guidelines of neonatal resuscitation for temperature maintenance and oxygen use. Caution is needed to avoid hypothermia and hyperoxia in at-risk populations such as prematurity.

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Effects of nasal positive-pressure hyperventilation on the glottis in normal awake subjects

Journal of Applied Physiology ◽

10.1152/jappl.1995.79.1.176 ◽

1995 ◽

Vol 79 (1) ◽

pp. 176-185 ◽

Cited By ~ 44

Author(s):

V. Jounieaux ◽

G. Aubert ◽

M. Dury ◽

P. Delguste ◽

D. O. Rodenstein

Keyword(s):

Tidal Volume ◽

Positive Pressure Ventilation ◽

Anterior Commissure ◽

Minute Ventilation ◽

Intermittent Positive Pressure Ventilation ◽

Positive Pressure ◽

Vocal Cords ◽

Diaphragmatic Muscle ◽

Inspiratory Resistance ◽

Cyclic Changes

We have recently observed obstructive apneas during nasal intermittent positive-pressure ventilation (nIPPV) and suggested that they were due to hypocapnia-induced glottic closure. To confirm this hypothesis, we studied seven healthy subjects and submitted them to nIPPV while their glottis was continuously monitored through a fiber-optic bronchoscope. During wakefulness, we measured breath by breath the widest inspiratory angle formed by the vocal cords at the anterior commissure along with several other indexes. Mechanical ventilation was progressively increased up to 30 l/min. In the absence of diaphragmatic activity, increases in delivered minute ventilation resulted in progressive narrowing of the vocal cords, with an increase in inspiratory resistance and a progressive reduction in the percentage of the delivered tidal volume effectively reaching the lungs. Adding CO2 to the inspired gas led to partial widening of the glottis in two of three subjects. Moreover, activation of the diaphragmatic muscle was always associated with a significant inspiratory abduction of the vocal cords. Sporadically, complete adduction of the vocal cords was directly responsible for obstructive laryngeal apneas and cyclic changes in the glottic aperture resulted in waxing and waning of tidal volume. We conclude that in awake humans passive ventilation with nIPPV results in vocal cord adduction that depends partly on hypocapnia, but our results suggest that other factors may also influence glottic width.

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Novel Neonatal Simulator Provides High-Fidelity Ventilation Training Comparable to Real-Life Newborn Ventilation

Children ◽

10.3390/children8100940 ◽

2021 ◽

Vol 8 (10) ◽

pp. 940

Author(s):

Joanna Haynes ◽

Peder Bjorland ◽

Øystein Gomo ◽

Anastasia Ushakova ◽

Siren Rettedal ◽

...

Keyword(s):

Skill Acquisition ◽

Low Cost ◽

Negative Relationship ◽

Real Life ◽

Neonatal Resuscitation ◽

Healthcare Personnel ◽

Positive Pressure ◽

High Fidelity ◽

High Resource ◽

Clinical Conditions

Face mask ventilation of apnoeic neonates is an essential skill. However, many non-paediatric healthcare personnel (HCP) in high-resource childbirth facilities receive little hands-on real-life practice. Simulation training aims to bridge this gap by enabling skill acquisition and maintenance. Success may rely on how closely a simulator mimics the clinical conditions faced by HCPs during neonatal resuscitation. Using a novel, low-cost, high-fidelity simulator designed to train newborn ventilation skills, we compared objective measures of ventilation derived from the new manikin and from real newborns, both ventilated by the same group of experienced paediatricians. Simulated and clinical ventilation sequences were paired according to similar duration of ventilation required to achieve success. We found consistencies between manikin and neonatal positive pressure ventilation (PPV) in generated peak inflating pressure (PIP), mask leak and comparable expired tidal volume (eVT), but positive end-expiratory pressure (PEEP) was lower in manikin ventilation. Correlations between PIP, eVT and leak followed a consistent pattern for manikin and neonatal PPV, with a negative relationship between eVT and leak being the only significant correlation. Airway obstruction occurred with the same frequency in the manikin and newborns. These findings support the fidelity of the manikin in simulating clinical conditions encountered during real newborn ventilation. Two limitations of the simulator provide focus for further improvements.

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Impact of delivered tidal volume on the occurrence of intraventricular haemorrhage in preterm infants during positive pressure ventilation in the delivery room

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2017-313864 ◽

2018 ◽

Vol 104 (1) ◽

pp. F57-F62 ◽

Cited By ~ 19

Author(s):

Qaasim Mian ◽

Po-Yin Cheung ◽

Megan O’Reilly ◽

Samantha K Barton ◽

Graeme R Polglase ◽

...

Keyword(s):

Brain Injury ◽

Tidal Volume ◽

Preterm Infants ◽

Positive Pressure Ventilation ◽

Intraventricular Haemorrhage ◽

Delivery Room ◽

Positive Pressure ◽

Reference Ranges ◽

The Mean ◽

Spontaneously Breathing

Background and objectivesDelivery of inadvertent high tidal volume (VT) during positive pressure ventilation (PPV) in the delivery room is common. High VT delivery during PPV has been associated with haemodynamic brain injury in animal models. We examined if VT delivery during PPV at birth is associated with brain injury in preterm infants <29 weeks’ gestation.MethodsA flow-sensor was placed between the mask and the ventilation device. VT values were compared with recently described reference ranges for VT in spontaneously breathing preterm infants at birth. Infants were divided into two groups: VT<6 mL/kg or VT>6 mL/kg (normal and high VT, respectively). Brain injury (eg, intraventricular haemorrhage (IVH)) was assessed using routine ultrasound imaging within the first days after birth.ResultsA total of 165 preterm infants were included, 124 (75%) had high VT and 41 (25%) normal VT. The mean (SD) gestational age and birth weight in high and normal VT group was similar, 26 (2) and 26 (1) weeks, 858 (251) g and 915 (250) g, respectively. IVH in the high VT group was diagnosed in 63 (51%) infants compared with 5 (13%) infants in the normal VT group (P=0.008).Severe IVH (grade III or IV) developed in 33/124 (27%) infants in the high VT group and 2/41 (6%) in the normal VT group (P=0.01).ConclusionsHigh VT delivery during mask PPV at birth was associated with brain injury. Strategies to limit VT delivery during mask PPV should be used to prevent high VT delivery.

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Neonatal Resuscitation

Pediatric Emergencies ◽

10.1093/med/9780190073879.003.0007 ◽

2020 ◽

pp. 64-66

Author(s):

Anneka Hooft ◽

Seema Shah

Keyword(s):

United States ◽

Emergency Department ◽

Heart Rate ◽

Neonatal Resuscitation ◽

The United States ◽

Pediatric Emergency ◽

Positive Pressure ◽

Respiratory Effort ◽

Neonatal Resuscitation Program ◽

Hospital Births

The majority of neonates born in the United States breathe spontaneously and do not require special assistance, but approximately 10% require some intervention, and less than 1% require extensive resuscitation measures. Although the number of infants delivered in the emergency department is unknown, out-of-hospital births have been increasing; thus, pediatric emergency physicians should be prepared for the possibility of a neonatal resuscitation in the emergency department. The acute resuscitation of the neonate should follow the Neonatal Resuscitation Program algorithm and includes assessment of heart rate, color, tone, and respiratory effort within the first minute of life. Initial treatment requires warming and gentle stimulation. Positive pressure ventilation should be initiated if the heart rate is <100 beats per minute, and chest compressions should be initiated if the heart rate is <60 beats per minute.

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Neonatal Resuscitation

Pediatric Anesthesia Procedures ◽

10.1093/med/9780190685188.003.0013 ◽

2021 ◽

pp. 177-182

Author(s):

Sarah Nizamuddin

Keyword(s):

Heart Rate ◽

Respiratory Distress ◽

Positive Pressure Ventilation ◽

Neonatal Resuscitation ◽

Positive Pressure ◽

Respiratory Effort ◽

Chest Compressions ◽

Adequate Ventilation

After birth, the neonate must be immediately examined to evaluate the need for further resuscitation. Presence of an adequate respiratory effort and heart rate is vital, in addition to adequate tone and temperature. Warm, dry, and closely monitor the infant immediately after birth. Give positive pressure ventilation if there are any signs of respiratory distress or bradycardia. Low heart rate in a neonate is almost always due to hypoxia, so establish adequate ventilation as soon as possible in these cases. In cases of continued bradycardia, chest compressions and medication (epinephrine) may be necessary. Following resuscitation, transfer the neonate to an appropriate unit for continued monitoring.

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Effects of altering ventilation on steady-state diffusing capacity for carbon monoxide

Journal of Applied Physiology ◽

10.1152/jappl.1963.18.1.89 ◽

1963 ◽

Vol 18 (1) ◽

pp. 89-96 ◽

Cited By ~ 10

Author(s):

Kaye H. Kilburn ◽

Harry A. Miller ◽

John E. Burton ◽

Ronald Rhodes

Keyword(s):

Carbon Monoxide ◽

Steady State ◽

Tidal Volume ◽

Lung Volume ◽

Dead Space ◽

Control Level ◽

Alveolar Ventilation ◽

Positive Pressure ◽

Diffusing Capacity ◽

Fixed Rate

Alterations in the steady-state diffusing capacity for carbon monoxide (Dco) by the method of Filley, MacIntosh, and Wright, produced by sequential changes in the pattern of breathing were studied in anesthetized, paralyzed, artificially ventilated dogs. The Dco of paralyzed, artificially ventilated control dogs did not differ significantly during 3 hr from values found in conscious and anesthetized controls. A fivefold increase in tidal volume without changing frequency of breathing raised alveolar ventilation and CO uptake 500% and Dco 186%. A high correlation between tidal volume and Dco was noted during reciprocal alterations of tidal volume and rate which maintained minute volume. The Dco appeared to fall when alveolar ventilation was tripled by increments of rate with a fixed-tidal volume, despite a 63% increase in CO uptake. Doubling end-expiratory lung volume by positive pressure breathing without altering tidal volume or rate did not affect Dco. The addition of 100 ml of external dead space with rate and tidal volume constant decreased Dco to 42% of control level, however, stepwise reduction of dead space from 100 ml to 0 in two dogs failed to change Dco. Added dead space equal to frac12 tidal volume (170 ml) reduced Dco to 25% of control in two dogs with a return to control with removal of dead space. Thus, in paralyzed artificially ventilated dogs, tidal volume appears to be the principal ventilatory determinant of steady-state Dco. Dco is minimally affected by increases in alveolar ventilation with a constant tidal volume effected by increasing the frequency of breathing. Prolonged ventilation, at fixed rate and volume, and increased dead space either did not effect, or they reduced Dco, perhaps by rendering less uniform the distribution of gas, and blood in the lungs. Although lung volume was doubled by positive-pressure breathing, pulmonary capillary blood volume was probably reduced to produce opposing effects on diffusing capacity and no net change. Submitted on March 14, 1962

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Pediatrics Residents' Preparedness for Neonatal Resuscitation Assessed Using High-Fidelity Simulation

Journal of Graduate Medical Education ◽

10.4300/jgme-d-12-00192.1 ◽

2013 ◽

Vol 5 (3) ◽

pp. 399-404 ◽

Cited By ~ 8

Author(s):

Leandro Cordero ◽

Brandon J. Hart ◽

Rene Hardin ◽

John D. Mahan ◽

Peter J. Giannone ◽

...

Keyword(s):

Intensive Care ◽

Neonatal Intensive Care ◽

Neonatal Resuscitation ◽

Delivery Room ◽

Positive Pressure ◽

High Fidelity ◽

Procedural Skill ◽

Actual Performance ◽

Self Confidence ◽

Skill Performance

Abstract Background Pediatrics residents are expected to demonstrate preparedness for neonatal resuscitation, yet research has shown gaps in residents' readiness to perform this skill. Objective To evaluate procedural skills and team performance of pediatrics residents during neonatal resuscitation (NR) using a high-fidelity mannequin, and to assess residents' confidence in their NR skills before and after training. Methods Two teams of residents (all had completed NR program training) participated in 2 separate, 90-minute sessions (2 to 3 weeks apart) in an off-site delivery room during their neonatal intensive care rotation. Residents' confidence in assisting and leading NR was surveyed before each session. Teams participated in a scenario (adapted from the NR program), which required 5 skills (positive pressure ventilation, chest compressions, endotracheal intubation, umbilical vein catheterization, and epinephrine administration). Video recording was used for debriefing and scoring. Skills were scored for technique and timeliness, and team behaviors were scored for communication, management, and leadership. Results Twenty-six residents (11 teams) completed 2 paired sessions. Self-confidence scores increased between the 2 sessions but were not correlated with performance. Gaps in procedural skill performance were observed, and timeliness for most skills did not meet expectations. Significant improvement in team communication was noted. Conclusions Important gaps in procedural skill performance, particularly timeliness, were detected by NR simulation training; residents' improvements in self-confidence did not reflect gains in actual performance. Their relative unpreparedness for NR (despite prior certification) highlights the need for deliberate practice and specific team training before and during neonatal intensive care delivery room rotations.

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