How doctors learn and perform sustained inflations with a self-inflating bag: a manikin study with a newborn lung simulator.

Abstract

Sustained inflations during initial resuscitation may help a depressed infant make a more efficient transition to air-filled lungs. This study examined whether doctors could perform sustained inflations with a self-inflating bag in high and low compliance settings and with an open or blocked pressure-relief valve. We asked 43 doctors to carry out sustained inflations for more than 5-sec in a manikin connected to a newborn lung simulator with randomised compliance settings. Tidal volume, inflation time, peak and mean inflating pressure were measured, and 34 were retested 3 months later. The majority of the doctors - 72% in the initial study and 62% in the retest - managed sustained inflations within three ventilation attempts, irrespective of lung compliance setting and years of work experience. Using a blocked pressure-relief valve produced higher tidal volume (27.8 versus 22.6 mL, p < 0.001), inflation time (8.9 versus 8.1 sec, p = 0.025), peak inflating pressure (34.0 versus 28.0 cmH2O; p = 0.012) and mean inflating pressure (28.1 versus 22.8 cmH2O; p < 0.001). The majority of doctors could deliver sustained inflation with a self-inflating bag in a newborn lung simulator for more than 5-sec. Using a blocked pressure-relief valve resulted in higher inflation time, tidal volume and inflation pressure.