Evaluation of audio-voice guided application for neonatal resuscitation: a prospective, randomized, pilot study

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Gil Dinur ◽  
Liron Borenstein-Levin ◽  
Shachar Vider ◽  
Ori Hochwald ◽  
Huda Jubran ◽  
...  
Keyword(s):  
Pilot Study ◽  
Positive Pressure Ventilation ◽  
Neonatal Resuscitation ◽  
Random Order ◽  
Medical Personnel ◽  
Positive Pressure ◽  
Mouth Pressure ◽  
And Performance ◽  
Time Frames ◽  
Order Sequence

AbstractObjectivesTo examine whether audio-voice guidance application improves adherence to resuscitation sequence and recommended time frames during neonatal resuscitation.MethodsA prospective, randomized, pilot study examining the use of an audio-voice application for guiding resuscitation on newborn mannequins, based on the Neonatal Resuscitation Program (NRP) algorithm. Two different scenarios, with and without voice guidance, were presented to 20 medical personnel (2 midwives, 8 nurses, and 10 physicians) in random order, and their performance videotaped.ResultsAudio-voice guided resuscitation compared with non-guided resuscitation, resulted in significantly better compliance with NRP order sequence (p<0.01), correct use of oxygen supplementation (p<0.01) and performance of MR SOPA (Mask, reposition, suction, open mouth, pressure, airway) (p<0.01), and shortened the time to “positive pressure ventilation” (p<0.01).ConclusionsIn this pilot study, audio-voice guidance application for newborn resuscitation simulation on mannequins, based on the NRP algorithm, improved adherence and performance of NRP guidelines.

Neonatal Resuscitation

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.

Head circumference and chronic positive pressure ventilation in children: a pilot study

2005 ◽  
Vol 21 (11) ◽  
pp. 986-990 ◽  
Author(s):  
Virginia S. Kharasch ◽  
Ning Tat Hamilton Hui ◽  
Helene M. Dumas ◽  
Stephen M. Haley ◽  
Linda Specht ◽  
...  
Keyword(s):  
Pilot Study ◽  
Head Circumference ◽  
Positive Pressure Ventilation ◽  
Positive Pressure

Approach to Infants Born Through Meconium Stained Amniotic Fluid: Evolution Based on Evidence?

2018 ◽  
Vol 35 (09) ◽  
pp. 815-822 ◽  
Author(s):  
Sushma Nangia ◽  
Praveen Chandrasekharan ◽  
Satyan Lakshminrusimha ◽  
Munmun Rawat
Keyword(s):  
Amniotic Fluid ◽  
Neonatal Intensive Care ◽  
Positive Pressure Ventilation ◽  
Neonatal Resuscitation ◽  
Meconium Aspiration Syndrome ◽  
Positive Pressure ◽  
Randomized Controlled Studies ◽  
Randomized Control ◽  
Meconium Stained Amniotic Fluid ◽  
Ischemic Encephalopathy

AbstractMeconium-stained amniotic fluid (MSAF) during delivery is a marker of fetal stress. Neonates born through MSAF often need resuscitation and are at risk of meconium aspiration syndrome (MAS), air leaks, hypoxic-ischemic encephalopathy, extracorporeal membrane oxygenation (ECMO), and death. The neonatal resuscitation approach to MSAF has evolved over the last three decades. Previously, nonvigorous neonates soon after delivery were suctioned under the vocal cords with direct visualization technique using a meconium aspirator. The recent neonatal resuscitation program (NRP) recommends against suctioning but favors resuscitation with positive pressure ventilation of nonvigorous neonates with MSAF. This recommendation is aimed to prevent delay in resuscitation and minimize hypoxia-ischemia often associated with MSAF. In this review, we discuss the pathophysiology, evolution and the evidence, randomized control trials, observational studies, and translational research to support these recommendations. The frequency of ECMO use for neonatal respiratory indication of MAS has declined over the years probably secondary to improvements in neonatal intensive care and reduction of postmaturity. Changes in resuscitation practices may have contributed to reduced incidence and severity of MAS. Larger randomized controlled studies are needed among nonvigorous infants with MSAF. However, ethical dilemmas and loss of equipoise pose a challenge to conduct such studies.

scholarly journals Improvement of Immediate Performance in Neonatal Resuscitation Through Rapid Cycle Deliberate Practice Training

2018 ◽  
Vol 10 (2) ◽  
pp. 192-197 ◽  
Author(s):  
Maclain J. Magee ◽  
Christiana Farkouh-Karoleski ◽  
Tove S. Rosen
Keyword(s):  
Confidence Level ◽  
Primary Outcome ◽  
Positive Pressure Ventilation ◽  
Deliberate Practice ◽  
Neonatal Resuscitation ◽  
Secondary Outcome ◽  
Positive Pressure ◽  
Cumulative Score ◽  
Simulation Session ◽  
Academic Training Program

ABSTRACT Background  Simulation training is an effective method to teach neonatal resuscitation (NR), yet many pediatrics residents do not feel comfortable with NR. Rapid cycle deliberate practice (RCDP) allows the facilitator to provide debriefing throughout the session. In RCDP, participants work through the scenario multiple times, eventually reaching more complex tasks once basic elements have been mastered. Objective  We determined if pediatrics residents have improved observed abilities, confidence level, and recall in NR after receiving RCDP training compared to the traditional simulation debriefing method. Methods  Thirty-eight pediatrics interns from a large academic training program were randomized to a teaching simulation session using RCDP or simulation debriefing methods. The primary outcome was the intern's cumulative score on the initial Megacode Assessment Form (MCAF). Secondary outcome measures included surveys of confidence level, recall MCAF scores at 4 months, and time to perform critical interventions. Results  Thirty-four interns were included in analysis. Interns in the RCDP group had higher initial MCAF scores (89% versus 84%, P &lt; .026), initiated positive pressure ventilation within 1 minute (100% versus 71%, P &lt; .05), and administered epinephrine earlier (152 s versus 180 s, P &lt; .039). Recall MCAF scores were not different between the 2 groups. Conclusions  Immediately following RCDP interns had improved observed abilities and decreased time to perform critical interventions in NR simulation as compared to those trained with the simulation debriefing. RCDP was not superior in improving confidence level or retention.

Corrective steps to enhance ventilation in the delivery room

2020 ◽  
Vol 105 (6) ◽  
pp. 605-608 ◽  
Author(s):  
Kesi C Yang ◽  
Arjan B te Pas ◽  
Danielle D Weinberg ◽  
Elizabeth E Foglia
Keyword(s):  
Heart Rate ◽  
Tidal Volume ◽  
Preterm Infants ◽  
Prospective Observational Study ◽  
Positive Pressure Ventilation ◽  
Outcome Measure ◽  
Delivery Room ◽  
Positive Pressure ◽  
Mouth Pressure ◽  
Before And After

ObjectiveThe clinical impact of ventilation corrective steps for delivery room positive pressure ventilation (PPV) is not well studied. We aimed to characterise the performance and effect of ventilation corrective steps (MRSOPA (Mask adjustment, Reposition airway, Suction mouth and nose, Open mouth, Pressure increase and Alternative airway)) during delivery room resuscitation of preterm infants.DesignProspective observational study of delivery room PPV using video and respiratory function monitor recordings.SettingTertiary academic delivery hospital.PatientsPreterm infants <32 weeks gestation.Main outcome measureMean exhaled tidal volume (Vte) of PPV inflations before and after MRSOPA interventions, categorised as inadequate (<4 mL/kg); appropriate (4–8 mL/kg), or excessive (>8 mL/kg). Secondary outcomes were leak (>30%) and obstruction (Vte <1 mL/kg), and infant heart rate.ResultsThere were 41 corrective interventions in 30 infants, with a median duration of 15 (IQR 7–29) s. The most frequent intervention was a combination of Mask/Reposition and Suction/Open. Mean Vte was inadequate before 16/41 interventions and became adequate following 6/16. Mean Vte became excessive after 6/41 interventions. Mask leak, present before 13/41 interventions, was unchanged after 4 and resolved after 9. Obstruction was present before five interventions and was subsequently resolved only once. MRSOPA interventions introduced leak in two cases and led to obstruction in one case. The heart rate was <100 beats per minute before 31 interventions and rose to >100 beats per minute after 14/31 of these.ConclusionsVentilation correction interventions improve tidal volume delivery in some cases, but lead to ineffective or excessive tidal volumes in others. Mask leak and obstruction can be induced by MRSOPA manoeuvres.

Heart rate changes during positive pressure ventilation after asphyxia-induced bradycardia in a porcine model of neonatal resuscitation

2018 ◽  
Vol 104 (1) ◽  
pp. F98-F101 ◽  
Author(s):  
Maria Liza Espinoza ◽  
Po-Yin Cheung ◽  
Tze-Fun Lee ◽  
Megan O’Reilly ◽  
Georg M Schmölzer
Keyword(s):  
Heart Rate ◽  
Chest Compression ◽  
Positive Pressure Ventilation ◽  
Porcine Model ◽  
Neonatal Resuscitation ◽  
Positive Pressure ◽  
Term Newborn ◽  
Newborn Piglets ◽  
Severe Bradycardia ◽  
Neonatal Resuscitation Program

BackgroundThe Neonatal Resuscitation Program (NRP) states that if adequate positive pressure ventilation (PPV) was given for a low heart rate (HR), the infant’s HR should increase within the first 15 s of PPV.ObjectiveTo assess changes in HR in piglets with asphyxia-induced bradycardia.MethodsTerm newborn piglets (n=30) were anaesthetised, intubated, instrumented and exposed to 50 min normocapnic hypoxia followed by asphyxia. Asphyxia was achieved by clamping the tube until severe bradycardia (defined as HR at <25% of baseline). This was followed by 30 s adequate PPV and chest compression thereafter. Changes in HR during the 30 s of PPV were assessed and divided into four epochs (0–10 s, 5–15 s, 10–20 s and 20–30 s, respectively).ResultsIncrease in HR >100/min was observed in 6/30 (20%) after 30 s of PPV. Within the epochs 0–10 s, 5–15 s or 10–20 s no piglet had an increase in HR >100/min. Additional 10/30 (33%) had a >10% increase in HR.ConclusionIn contrast to NRP recommendation, adequate PPV does not increase HR within 15 s after ventilation in piglets with asphyxia-induced bradycardia.

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