Abstract
BackgroundWe assessed whether a short training, effective in a high resource country, was able to improve the quality of face-mask ventilation (FMV) in a low resource setting.MethodsLocal healthcare providers at the Centre Médico-Social, Kouvè, Togo were asked to ventilate a neonatal leak-free manikin before (time—t1) and after (t2) a two-minute training session. Immediately after this section, a further two-minute training with participants aware of the data monitor was offered. Finally, a third 1-minute FMV round (t3) was performed by each participant. Ventilatory parameters were recorded using a computerized system. Primary outcome was the percentage of breaths with relevant mask leak (>25%). Secondary outcomes were percentages of breaths with a low peak inspiratory pressure (PIP<20 cm H2O), within the recommended PIP (20–35 cm H2O) and with a high PIP (>35 cm H2O).ResultsTwenty-six subjects participated in the study. The percentage of relevant mask leak significantly decreased (p<0.0001; β = -0.76, SE = 0.10) from 89.7% (SD 21.5%) at t1 to 45.4% (SD 27.2%) at t2 and to 18.3% (SD 20.1%) at t3. The percentage of breaths within the recommended PIP significantly increased (p<0.0001; β = +0.54, SE = 0.12). The percentage of breaths with PIP>35 cm H2O was 19.5% (SD 32.8%) at t1 and 39.2% (SD 37.7%) at t2 (padj = 0.27; β = +0.61, SE = 0.36) and significantly decreased (padj = 0.01; β = -1.61, SE = 0.55) to 6.0% (SD 15.4%) at t3.ConclusionsA 2-minute training on FMV, effective in a high resource country, had a positive effect also in a low resource setting. FMV performance further improved after an extra 2-minute verbal recall plus real time feedback. Although the training was extended, it still does not cost much time and effort. Further studies are needed to establish if these basic skills are transferred in real patients and if they are maintained over time.
Highlights
Every year around 6,6 million children worldwide under 5 year die
We assessed whether a short training, effective in a high resource country, was able to improve the quality of face-mask ventilation (FMV) in a low resource setting
Further studies are needed to establish if these basic skills are transferred in real patients and if they are maintained over time
Summary
Every year around 6,6 million children worldwide under 5 year die. Of these, 44% are in the neonatal period. Intrapartum-related events (“birth asphyxia”), account for a quarter of neonatal deaths suggesting that basic skill training of those involved in the care of neonates at delivery is a crucial investment [1,2,3]. Newton and English reviewed the evidence for neonatal resuscitation and concluded that effective resuscitation in low-resource settings was possible with basic equipment and skills [4]. Training health care providers in neonatal resuscitation may prevent 30% of deaths of full-term babies experiencing adverse intrapartum events, as well as 5%–10% of deaths among infants born preterm [5,6]. We assessed whether a short training, effective in a high resource country, was able to improve the quality of face-mask ventilation (FMV) in a low resource setting
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